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Talent transfer has enabled elite athletes to be successful in another sport, with great potential in para-sport. Previous research suggests that similarities between donor and recipient sports may facilitate talent transfer; however, this remains unclear in para-sport. This study investigated patterns between donor and recipient sports' characteristics, identifying the impact on talent transfer in para-sport. An Australian case study utilizing secondary data of 38 Australian Paralympians who competed at the Paralympic Games from 2000 through 2020 was analyzed. Results demonstrated that similarities between sports were not significantly associated with successful talent transfers between Paralympic sports. Understanding patterns associated with successful Paralympic talent transfers offers a foundation of knowledge for designing and developing future talent-transfer pathways and research. Based on this study, it is recommended that sport administrators and practitioners explore greater opportunity for talent transfer in para-sport, rather than limiting talent-transfer opportunities based on athletes' donor sports. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether genetic variations in cytokine genes involved in the pathogenesis of peri-implantitis are associated with the occurrence of peri-implantitis, an issue that remains controversial and may vary according to the population evaluated. Materials and Methods: A cross-sectional analytical study was carried out on 102 Caucasian Portuguese individuals who were divided into two groups: (1) 43 individuals with peri-implantitis and (2) 59 individuals with good peri-implant health. Samples from the buccal mucosa were obtained, and genetic analysis was performed using the real-time polymerase chain reaction (PCR) technique for IL-1A and IL-1B and PCR for IL-1RN. Results: The IL-1A-889 C/T polymorphism presented with a higher prevalence of the less common allele (T allele) in patients with peri-implantitis (27.9%) than in healthy patients (16.9%), but without statistical significance (P = .060). For the IL-1B+3954 C/T and IL-1RN (variable number of tandem repeats [VNTR]) polymorphisms, analysis revealed that the allele and genotype frequencies did not differ significantly between groups. There was a significant association between a history of periodontitis and peri-implantitis (P = .020). Conclusions: The evaluated genetic polymorphisms had no influence on the occurrence of peri-implantitis in the study population. Further research into genetic variations in different populations is needed to elucidate the role of genetic factors in the onset and progression of peri-implant disease. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Children and adolescents with cerebral palsy (CP) show a reduced physical activity (PA) level compared with their typically developed peers. This study aimed to identify potential predictors of objectively evaluated habitual PA using data from a national clinical registry—the Cerebral Palsy Follow-Up Program (CPFP)—and proxy-reported questionnaires. Data from the CPFP database showed that female sex was associated with a lower PA level. Additional questionnaire data revealed age, popliteal angle limitation, Pediatric Outcomes Data Collection Instrument–Sports and Physical Functioning Scale score, screen time, Functional Mobility Scale score at 50 m, and fatigue as predictors. The proposed models can be used for the prediction and early detection of the PA level and consequently for the potential improvement among ambulant/semiambulant individuals with CP. Further research should investigate the predictive impact of personal, social, and environmental factors on the PA level and the gap in PA levels between girls and boys. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to determine whether a health service system is an independent influencing factor of having pressure injury problems in individuals with chronic spinal cord injury living in three countries Design: This is a cross-sectional study. Methods: Data from the International Spinal Cord Injury Community Survey were analyzed. The pressure injury problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to “having problem” and “not having problem”). Health service systems were categorized as an inpatient-oriented spinal cord injury–specialized system and a primary care–oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of pressure injury problems. Results: Of 790 included participants, 277 (35%) had pressure injury problems. Being recruited from countries with inpatient-oriented spinal cord injury–specialized systems (model 1) and visiting rehabilitation medicine/spinal cord injury physicians at least once a year (model 2) is an independent negative correlating factor of pressure injury problems (odds ratio = 0.569 [95% confidence interval = 0.374–0.866] and 0.591 [95% confidence interval = 0.405–0.864], respectively). Conclusions: Spinal cord injury–specialized health service systems might be a protective factor of pressure injury problems in middle-income country contexts. This result suggests the importance of having spinal cord injury–specialized services in middle-income countries to reduce the prevalence of pressure injury problems. [ABSTRACT FROM AUTHOR]

Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans. Methods This retrospective study comprised consecutive patients with ANP who underwent a baseline CECT within first 2 weeks and follow-up CECT in the third to fifth weeks of illness. Presence, extent, and encapsulation thickness (defined as enhancing wall around the collection) on baseline CECT were compared with follow-up CT (done in the third–fifth weeks of illness). Results Thirty patients (19 males and 11 females; mean age 41.5 ± 13.5 years) were included in the study. The mean time to first CECT was 10 ± 3.6 days. There were 58 collections. The most common site was the lesser sac (n = 29), followed by the left pararenal space (n = 15). At baseline CT, 52 (89.7%) collections had varying degree of encapsulation (15.3%, complete encapsulation). Complete encapsulation was seen in 52 and 82.6% collections in third and fourth week, respectively. All collections in fifth week and beyond were encapsulated. The wall was thicker on follow-up CECT scans (p < 0.01). The mean wall thickness was not significantly associated with the degree of encapsulation (p = 0.417). There was no significant association between the site and degree of encapsulation (p = 0.546). Conclusion Encapsulation is dynamic and collections may get "walled off" before 4 weeks. Walled-off collections should be defined based on imaging rather than a fixed 4-week revised Atlanta classification threshold. [ABSTRACT FROM AUTHOR]

Background: Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. Methods: A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. Results: 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. Conclusion: Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice. [ABSTRACT FROM AUTHOR]

Background: Cefazolin is guideline recommended for perioperative prophylaxis in orthopedic surgery. Despite its unique R1 side chain, cefazolin is often avoided in patients with beta-lactam allergy with concern for cross reactivity. Objectives: The primary outcome was the percentage of patients who received cefazolin perioperatively. Secondary outcomes included the percentage of patients with a beta-lactam allergy clarified following the telephone interview and clinical outcomes including acute kidney injury, surgical site infection, Clostridioides difficile infection, and re-admission at 30 and 90 days. Methods: This single-center, quasi-experimental study evaluated a pilot program in which a pharmacist phoned patients > 18 years of age with a scheduled orthopedic surgery and a documented beta-lactam allergy to assess their allergy preoperatively. Recommendations to use cefazolin were based on an algorithm. Patients were divided into pre- and post-intervention cohorts. Results: A total of 832 patients were screened for inclusion with 135 and 66 patients included in the pre- and post-intervention cohorts. No significant difference was identified in the primary outcome. In the post-intervention cohort, 62% had a beta-lactam reaction updated in the electronic medical record. Those with a beta-lactam allergy delabeled or made less severe were numerically more likely to receive cefazolin than those with an unchanged reaction or a reaction made more severe (95.2% vs 68% vs 65%). There were no differences in clinical outcomes between groups. Conclusion: A pharmacist-conducted preoperative beta-lactam allergy interview in adult patients undergoing elective orthopedic surgery improved beta-lactam allergy documentation but, did not result in increased utilization of cefazolin. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have investigated the role of gender in clinical symptoms, social functioning, and neuropsychological performance in people with first-episode psychosis (FEP). However, the evidence of gender differences for metacognition in subjects with FEP is still limited and controversial. The aim of the present study was to explore gender differences in cognitive insight and cognitive biases in this population. Methods: Cross-sectional study was carried out in a sample of 104 patients with FEP (35 females and 69 males) recruited from mental health services. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive insight with the Beck Cognitive Insight Scale, and cognitive bias by the Cognitive Biases Questionnaire for Psychosis. The assessment also included clinical and sociodemographic characteristics. Results: After controlling for potential confounders (level of education, marital status, and duration of psychotic illness) analysis of covariance revealed that males presented greater self-reflectiveness (p = 0.004) when compared to females. However, no significant differences were found in self-certainty and composite index of the cognitive insight scale, as in the cognitive biases assessed. Conclusions: Gender was an independent influence factor for self-reflectiveness, being better for males. Self-reflectiveness, if shown to be relatively lacking in women, could contribute to the design of more gender-sensitive and effective psychotherapeutic treatments, as being able to self-reflect predicts to better treatment response in psychosis. [ABSTRACT FROM AUTHOR]

Alcohol use disorders (AUD) are pressing social problems. News media play a key role in setting the agenda for the public discourse and framing these problems. They provide people affected and unaffected with health-related information on different facets of the disease and present the topic in various contexts. In doing so, they shape the public opinion and influence behaviors. On the basis of an explorative quantitative content analysis of N = 402 articles published in 2019 in nine German newspapers and magazines, this study provides information on the topic-specific framing with regard to AUD. The results show only scant contextualization of the topic in the German media. This deficiency has particular regard to causal relationships and treatment opportunities, leaving room for interpretation from the audience. The topic-specific framing analysis showed that articles on AUD mostly appear either in the context of celebrities, endorsing favorable presentations of recovered people, or in the context of crime and violence, which goes hand in hand with portraying acutely affected people as perpetrators. Increased news coverage that includes the portrayal of non-famous people who have successfully engaged in alcohol treatment and recovery is necessary. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the current knowledge and experiences of consumers in Australia on adverse drug reaction (ADR) reporting and their reasons for reporting or not reporting ADRs, with a focus on the use of digital tools for ADR reporting. Methods: A cross-sectional online survey was conducted among adults who had taken medicine in Australia. A structured questionnaire with multiple choice or Likert scale responses with an option for participants to provide free-text responses and pretested for face validity was used. Consumer characteristics, knowledge, and ADR reporting practices were analyzed using descriptive statistics and the chi-square test or Fisher's exact test. Results: A total of 544 survey responses were included in the analysis. The majority of respondents were women (68%), and 22% were aged between 65 and 74 years. Fifty-eight percent (n = 317) of respondents knew that they could report ADRs to either the Therapeutic Goods Administration (TGA), state or territory government health department, or healthcare professionals. Three-quarters (n = 405) of respondents stated that they had experienced an ADR; of these, 36% reported an ADR to either the TGA, state or territory government health department, or healthcare professionals. Among those who reported ADRs, 58% were unaware that they could use digital tools to report ADRs. The main reason for not reporting was that they did not think the ADR was serious enough to report (39%). Conclusion: Over half of consumers knew that they could report ADR; however, improved consumer awareness about using digital tools for ADR reporting and increased ADR reporting is needed. [ABSTRACT FROM AUTHOR]

Objective While there are known racial disparities in cesarean delivery (CD) rates, the exact etiologies for these disparities are multifaceted. We aimed to determine if differences in induction of labor (IOL) management contribute to these disparities. Study Design This retrospective cohort study evaluated all nulliparous patients with an unfavorable cervix and intact membranes who underwent IOL of a term, singleton gestation at a single institution from October 1, 2018, to September 30, 2020. IOL management was at clinician discretion. Patients were classified as Black, Indigenous, and People of Color (BIPOC) or White based on self-report. Overall rates of CD were compared for BIPOC versus White race. Chart review then evaluated various IOL management strategies as possible contributors to differences in CD by race. Results Of 1,261 eligible patients, 915 (72.6%) identified as BIPOC and 346 (27.4%) as White. BIPOC patients were more likely to be younger (26 years interquartile range (IQR): [22–30] vs. 32 years IQR: [30–35], p < 0.001) and publicly insured (59.1 vs. 9.9%, p < 0.001). Indication for IOL and modified Bishop score also differed by race (p < 0.001; p = 0.006). There was 40% increased risk of CD for BIPOC patients, even when controlling for confounders (30.7 vs. 21.7%, p = 0.001; adjusted relative risk (aRR) = 1.41, 95% confidence interval (CI): [1.06–1.86]). Despite this difference in CD, there were no identifiable differences in IOL management prior to decision for CD by race. Specifically, there were no differences in choice of cervical ripening agent, cervical dilation at or time to amniotomy, use and maximum dose of oxytocin, or dilation at CD. However, BIPOC patients were more likely to undergo CD for fetal indications and failed IOL. Conclusion BIPOC nulliparas are 40% more likely to undergo CD during IOL than White patients within our institution. These data suggest that the disparity is not explained by differences in IOL management prior to cesarean, indicating that biases outside of induction management may be important to target to reduce CD disparities. Key Points The etiologies for racial disparities in cesarean are likely multifaceted. In this work, there were no differences by race in measures of labor induction management. Biases outside of induction management during labor may be targeted to reduce CD disparities. [ABSTRACT FROM AUTHOR]

Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021–February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. 2024;114(10):1097–1109. https://doi.org/10.2105/AJPH.2024.307754) [ABSTRACT FROM AUTHOR]

We aimed to explore attitudes and training experiences of medical students toward gender medicine (GM). A cross-sectional study with convenience sampling was conducted (sample size = 430). To assess predictors of high GM consideration in patient management, a multivariable logistic regression was performed. A total of 82% considered sex and gender important; 61% stated that they would use GM skills in their careers. A total of 76% had never discussed GM with their tutors, with differences between male and female students (p =.002). Predictors of high GM consideration were: age (adjOR = 1.4, 95%CI = 1.1–1.8) and the impression that tutors considered patients' sex and gender during practice (adjOR = 3.9, 95%CI = 2.0–7.6). Thus, participants considered GM important, but some students were unsure whether it could be useful in practice. The strongest predictor of high GM consideration was the tutors' good example during training. It would be advisable to implement the teaching of this topic during both courses and traineeships. [ABSTRACT FROM AUTHOR]

Caring for patients in the intensive care unit (ICU) creates competing priorities of interventions for nurses and other health care providers. Oral care might be prioritized lower; however, its neglect may lead to sequelae such as extended time in the ICU, nosocomial diseases most notably ventilator-associated pneumonia (VAP), or oral problems. Safe patient care depends on effective and efficient oral care. The aim of this study was to lower the incidence of VAP and maintain oral health through implementing an “oral care bundle” for mechanically ventilated (MV) patients. Using a quasi-experimental design, we divided 82 adult MV patients in the ICUs of a university-based hospital in Egypt into a control group (n = 41) that received the standard of care and a bundle group (n = 41) that received an “oral care bundle.” The results of the study reported a significantly lower incidence of VAP in the intervention group (P = .015). It can be concluded that there is a significant relationship between receiving an oral care bundle and improved oral health and a reduction in the VAP rate among MV patients. This highlights the need to incorporate the oral care bundle in the daily nursing care for MV patients. [ABSTRACT FROM AUTHOR]

Background: The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance. Objective: The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke. Design and setting: A randomized controlled trial was conducted at a university hospital. Methods: The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale. Results: The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was 17.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores. Conclusions: Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance. [ABSTRACT FROM AUTHOR]

Background: In the United States, less than 5% of all adult cancer patients enroll in clinical trials. Few studies explore participation in cancer clinical trials at safety net hospitals, which disproportionately care for minoritized, low-income, uninsured, and underinsured populations. Our study aims to investigate disparities in clinical trial discussions and enrollment among lung cancer patients at Boston Medical Center, the largest safety net hospital in New England. Methods: We included 1121 patients diagnosed with lung cancer between January 2015 and December 2020. Electronic Medical Records (EMR) were queried, and patients were categorized into three groups: (1) clinical trial discussed and the patient enrolled, (2) clinical trial discussed but the patient not enrolled, and (3) clinical trial not discussed. Sociodemographic variables such as age, gender, race, ethnicity, city, primary language, median household income, medical insurance type, and education level were also collected. Chi-squared, t test, and multivariate regression analysis was done using SPSS version 26.0. Results: Of the 1121 patients, clinical trials were discussed in 141 patients (12.6%), of which 22 (15.6%) were enrolled. Clinical trial discussions were conducted more with younger patients (68.19 vs 71.37, p =.001), but on multivariate analysis there was no significant difference (OR = 1.023; 95% CI 0.998-1.048; p =.068). There was no significant difference in clinical trial discussion or enrollment between the other sociodemographic factors. Conclusion: Additional study of barriers to cancer clinical trial discussion and enrollment at safety net institutions can serve as a prerequisite to ameliorating racial disparities observed on a national scale. [ABSTRACT FROM AUTHOR]

Objective: To assess efficacy of Chinese medicine (CM) on insomnia considering characteristics of treatment based on syndrome differentiation. Methods: A total of 116 participants aged 18 to 65 years with moderate and severe primary insomnia were randomized to the placebo (n=20) or the CM group (n=96) for a 4-week treatment and a 4-week follow-up. Three CM clinicians independently prescribed treatments for each patient based on syndromes differentiation. The primary outcome was change in total sleep time (TST) from baseline. Secondary endpoints included sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency, Pittsburgh Sleep Quality Index (PSQI) and CM symptoms. Results: The CM group had an average 0.6 h more (95% confidence interval (CI): 0.3–0.9, P<0.001) TST and 34.1% (10.3%–58.0%, P=0.005) more patients beyond 0.5 h TST increment than that of the placebo group. PSQI was changed −3.3 (−3.8 to −2.7) in the CM group, a −2.0 (−3.2 to −0.8, P<0.001) difference from the placebo group. The CM symptom score in the CM group decreased −2.0 (−3.3 to −0.7, P=0.003) more than the placebo group. SOL and WASO changes were not significantly different between groups. The analysis of prescriptions by these clinicians revealed blood deficiency and Liver stagnation as the most common syndromes. Prescriptions for these clinicians displayed relative stability, while the herbs varied. All adverse events were mild and were not related to study treatment. Conclusion: CM treatment based on syndrome differentiation can increase TST and improve sleep quality of primary insomnia. It is effective and safe for primary insomnia. In future studies, the long-term efficacy validation and the exploratory of eutherapeutic clinicians' fixed herb formulas should be addressed (Registration No. NCT01613183). [ABSTRACT FROM AUTHOR]

The recent pandemic has shown that protecting the general population from hazardous substances or pathogens can be a challenging and urgent task. The key element to adequate protection is appropriately sized, well-fitted and sufficiently distributed personal protective equipment (PPE). While these conditions are followed for adult PPE wearers, they are less considered when it comes to protecting subadults. In this study, the assessment of the fit and design improvements of a 3D-printed facial half mask for subadult wearers (4–18 years) is designed. The target population was represented by 1137 subadults, aged 4.06–18.94 years, for whom 3D face models were acquired. The half mask tested, which was originally provided in one subadult size, did not fit appropriately the target population. This finding prompted the creation of four size categories using the age-dependent distribution of the centroid size calculated from 7 facial landmarks. For each size category, a modified half-mask virtual design was created, including resizing and reshaping, and fit was evaluated visually and numerically using averaged and random 3D face representatives. Practitioner summary: The reason for this study was to describe procedures which led to design improvement of an existing half-mask and provide respiratory protection for subadults. To address this, fit was assessed using an innovative metric approach. Four sizes were then created based on centroid size, resulting in improved fit and design. Abbreviations: CH: cheilion landmark; CS: centroid size; EX: exocanthion landmark; GN: gnathion landmark; N: nasion landmark; PPE: personal protective equipment; PR: pronasale landmark; RPE: respiratory protective equipment HIGHLIGHTS: 3D human face dataset was used for modifying and validating protective equipment for subadults To ensure optimal protection for subadults, four size categories were proposed based on 3D face landmarks and centroid size Modified half-mask design fit was validated virtually using a visual and numerical approach [ABSTRACT FROM AUTHOR]

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities. [ABSTRACT FROM AUTHOR]

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P <.001) and more likely to serve both elementary and secondary school settings (P =.002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P <.001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P <.001, for each), and suicide risk assessment and screening (P =.012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity. [ABSTRACT FROM AUTHOR]

Background: Among individuals who use substances, the perceived stigma of substance use harms their quality of life and may be an obstacle to quitting. We explored the effect of the stigma perceived due to substance use on executive functioning. Methods: This cross-sectional study involved 80 individuals who used substances and sought to quit while admitted to a public neuropsychiatric hospital in south Iran in March 2022. Data were collected using the Barkley Executive Function Questionnaire and the Stigma Scale. Statistical analyses were done using SPSS v. 25. Results: The participants' mean age was 36.56 ± 9.37 years, and most (85.0%) were males. Among them, 28 (35%) used narcotics, 7 (8.8%) used stimulants, and 45 (56.3%) used multiple substances. Increased total sigma scores correlated with deficits in self-management to time, self-organization/problem-solving, self-regulation of emotion, self-motivation, self-restraint, and total executive function. Moreover, each stigma dimension had some correlations with executive dysfunction or its subscales. Conclusions: Self-perceived stigma is directly linked with executive dysfunction in individuals who use substances and seek to quit. Since stigma and executive function both play essential roles in addiction treatment success, interventions should be adjusted to reduce self-perceived stigma and executive function deficits among individuals who use substances. [ABSTRACT FROM AUTHOR]

Objective: The term psychotic experiences (PEs) encompass subclinical hallucinatory and delusional experiences. There are limited number of studies on PEs clinical and socio-demographic characteristics. We aimed to investigate the association between PEs and patterns of cannabis use, cognitive functions, schizotypy and childhood traumas. Methods: Participants were recruited from specialized units using the snowball method. All of the participants were regular cannabis users. Participants with PEs and without PEs were compared by looking into socio-demographic and clinical correlates. Significant variables at univariate comparisons were included in binary multivariate logistic regression analysis with PEs as the dependent variable. Results: Forty participants were recruited (20 with PEs, 20 without PEs). Adolescence onset of cannabis use (χ2 = 8.120; p < 0.05), positive schizotypy (t = 3.762; p < 0.01), Trail Making Test A (TMT A) Scores (u = 98.5; p < 0.01) and emotional neglect (u = 128; p = 0.05) were significantly associated with PEs. The binary regression model included a significant contribution of positive schizotypy (OR = 1.16, CI 1.025–1.330) and TMT A Score (OR = 1.22, CI 1.03–1.44). Conclusions: Results showed a novel positive association of PEs with adolescent-onset cannabis use, TMT A Scores, positive schizotypy and emotional neglect. PEs were predicted independently by positive schizotypy and TMT A Scores. [ABSTRACT FROM AUTHOR]

This study explores the complex nature of female genital mutilation/cutting (FGM/C) by juxtaposing the mental and sexual health of women who had undergone FGM/C as part of initiation/membership into a traditional women's society (TWS) with those who were also cut but not initiated into a TWS. While considerable differences emerged between TWS members and nonmembers, there was no evidence that TWS membership was protective against the physical and psychological trauma typically ascribed to FGM/C. In fact, the pattern of results would tend to suggest the opposite. Possible explanations for and implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded. Results: All pigs presented airway closure (AOP > 0.5cmH2O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13–19] to 9%[IQR:4–12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16–30] to 23%[IQR:14–27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases. Conclusions: In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease (IBD). It is characterized by diffuse inflammatory process of the bowel mucosa with a relapsing course. The precise evaluation of UC severity is pivotal in the therapeutic decision-making. Modified Mayo score is consistently used for the evaluation of the disease activity which depends on the patient's symptoms as well as the colonoscopic findings. The aim of this study is to assess the role of the CT enterography (CTE) scoring system in the evaluation of the disease severity in ulcerative colitis. From October 2022 to July 2023, 66 patients with known ulcerative colitis patients at time of disease activity were referred from the inflammatory bowel disease unit for radiological assessment by CTE. CT images were analyzed to determine the anatomical location of the affected bowel segments, mucosal thickening and hyperenhancement as well as the extra-enteric involvement. Correlation with the modified Mayo score was established. Results: Our results showed a statistical significant correlation between modified Mayo score and CTE with a P value of 0.000. The correlation coefficient is r = 0.964. The cut-off value of the optimal CTE score to predict mild and moderate UC was 7.5 with 0.996 area under the ROC curve, 92%sensitivity and 100% specificity. The cut-off value of the optimal CTE score to predict moderate and severe UC was 10.5 with 0.983 area under the ROC curve, 90.6% sensitivity and 100% specificity. Conclusions: CTE is a reliable diagnostic method in the systematic assessment of the disease severity of active ulcerative colitis. CTE score shows a strong proportionate correlation with modified Mayo score. The aggravation of the course of the disease increased the CTE score. CTE scoring system can help plan the therapeutic strategy and predict prognosis. [ABSTRACT FROM AUTHOR]

Background: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is typically resistant to pharmacological interventions; however, achieving seizure freedom is possible through surgery. Our objective was to focus on the pregnancy and seizure outcomes during pregnancy of women with TLE-HS, and aim to identify predictors of seizure control. Methods: The West China Registry of Pregnancy of Women with Epilepsy (WCPR_EPi) was a monocentric prospective cohort study of women with epilepsy (WWE). We screened women with TLE-HS in this database. Their clinical profile, anti-seizure medication (ASM) use, and pregnancy outcomes were extracted from the records of the registry (2010–2023). Results: Out of 2320 WWE followed up, 47 pregnancies in women with TLE-HS were identified and analyzed. Seizure exacerbation occurred in 40.4% of pregnancies, and seizure freedom was present in 34.0% of these during pregnancy. Factors associated with seizure exacerbation during pregnancy was ASM non-adherence (odds ratio [OR] =7.00, 95% confidence interval [CI] 1.43–34.07, P=0.016). The surgery group showed a significantly higher seizure freedom rate (OR = 6.87, 95% CI 1.02–46.23, P=0.016) and lower rate of induced labor (0.0% vs 26.5%, P=0.047) compared to the medically-treated group alone. Caesarean section was chosen in 77.1% of cases due to seizure concerns, with comparable in epilepsy-related (n=20) and obstetric causes (n=24). No major congenital malformations were reported. Conclusions: Surgical treatment before pregnancy appears to offer a higher chance of seizure freedom compared to medication alone. Most of women with TLE-HS can deliver healthy offspring regardless of suboptimal seizure control and unwarranted concerns. [ABSTRACT FROM AUTHOR]

Background: The Individual Care Plan (ICP) for pediatric palliative care translates the general guideline recommendations into a personalized plan for the child. Various documents exist in pediatrics globally, aimed at facilitating anticipatory care or coordinating end-of-life care. The ICP aims both, but user experiences have not been studied post-development. Objective: The overall aim is to enhance knowledge and understanding of the content of the ICP from the perspectives of parents and healthcare professionals (HCPs). Design and method: We conducted a mixed-method study using a convergent parallel design consisting of questionnaires and individual and focus group interviews among parents and HCPs having user experience with the ICP. The questionnaire and interview data were analyzed separately. Quantitative data were descriptively analyzed using mean, ±SD, and median. Qualitative data were thematically analyzed. A narrative approach and joint display were used to describe the results. Results: In total, 27 parents and 161 HCPs participated. Overall, the content of the ICP was seen as important and complete, but changes and additions were called for on language, structure, and content. The chapter on the needs and wishes of child and parents was considered most important. HCPs would like to see this chapter expanded to incorporate more advance care planning outcomes, and parents wished for this chapter to reflect better who their child is. HCPs mentioned missing a chapter for palliative sedation, mainly to guide other HCPs. The ICP was appraised as not user-friendly and might possibly improve by making the ICP available in a secure digital environment. Conclusion: To meet the needs of parents and HCPs considering importance and completeness of the content of the ICP and its user-friendliness, changes are necessary in the content of the ICP, and preferably the ICP should be made digitally available. Although various documents exist globally to facilitate anticipatory care or coordinating end-of-life care, it appears that the combination of describing the values and preferences of the child and parents, along with medical decisions and life-sustaining treatments, makes the ICP a unique and comprehensive care plan. [ABSTRACT FROM AUTHOR]

Background: In Nigeria, the attitudes of community pharmacists toward providing pharmaceutical care (PC) for people with mental illnesses remain unclear. This study aimed to assess the community pharmacists' attitudes and barriers toward providing PC services for clients with mental disorders in Enugu, Nigeria. Methods: A cross-sectional survey was conducted among all eligible community pharmacists in Enugu, Nigeria. The data were obtained using validated self-administered questionnaire adapted from the literature and a sociodemographic form. The data collected were analyzed using descriptive statistics and Chi-square/Fisher's Exact test. P values less than 0.05 were considered significant. Results: A total of 155 community pharmacists took part in the survey, giving a response rate of 95.6%. The findings showed that more than half of the community pharmacists (n = 80, 51.6%) had positive attitudes toward providing PC services for patients with mental illness. Positive attitudes were associated with having a family member with mental illness (p = 0.038) and a good self-rated knowledge of mental illness (p < 0.001). The most frequently reported barriers to PC were patient factors associated with their symptoms (59.4%) and a lack of patient information (52.9%). Conclusion: The attitudes of community pharmacists toward providing PC for patients with mental illness is largely positive but suboptimal. Patient factors related to their symptoms were cited as the major obstacle to providing PC. Therefore, continued education and training and supportive environment are encouraged to improve the situation. [ABSTRACT FROM AUTHOR]

Background: Healthy lifestyle behavior includes appropriate behaviors such as eating habits, physical activity and weight control in order to stay healthy and prevent diseases. The aim of this cross-sectional study is to evaluate healthy lifestyle behaviors, physical activity levels and social media use of dental students. Methods: An online questionnaire including demographic characteristics, International Physical Activity Questionnaire Short Version (IPAQ-S) and Health Promoting Lifestyle Profile (HPLP) was filed by 420 dental students. The data were evaluated statistically. Results: The mean age was 21.6 ± 1.96 years and the majority of the students (71.7%) were living with their families. Obesity and overweight in males and underweight in females were statistically higher. There was no difference between the genders in terms of social media use. The most preferred applications were Instagram (92.7%), YouTube (85%) and Twitter (59.7%). In terms of IPAQ durations and HPLP scores, there was no gender difference. According to the IPAQ classification, while the majority of students (64.3%) were physically low active, 23.1% were physically inactive. As the total HPLP score increased, the total IPAQ score increased. Conclusion: It is concluded that as the university students make up the majority of the young adults, encouraging their health-promoting behaviors is crucial for improving public health. [ABSTRACT FROM AUTHOR]

Introduction: Angiography is associated with anxiety, stress, and changes in patients' vital signs. The role of the liaison nurse is to bridge gaps and solve problems between departments, thereby preventing the occurrence of undesired complications during patient transfers. Proper preparation of patients by the liaison nurse may lead to an improvement in the hemodynamic status of patients. The present study was conducted to investigate the effect of liaison nurse on hemodynamic status during transfer process to angiography. Method: This randomized controlled trial was conducted from December 2019 to March 2020 on 62 patients who were candidates for elective angiography at Imam Reza Hospital in Mashhad. Participants were selected using a convenience sampling method and then randomly assigned to either the control or intervention group using a lottery system. In the intervention group, patients benefited from the presence of a liaison nurse from the moment the transfer order was issued by the doctor. Tools used included a demographic information questionnaire and a hemodynamic signs checklist. Data were analyzed using SPSS 25 with independent T-tests, paired T-tests, Wilcoxon, Mann-Whitney test, chi-squared, and Fisher's exact test. Result: Following the intervention, the mean systolic blood pressure, heart rate, and respiratory rate in the intervention group were found to be significantly lower than those in the control group (p < 0.05). In contrast, the mean body temperature, diastolic blood pressure and the percentage of arterial blood oxygen saturation did not exhibit a statistically significant difference between the two groups (p > 0.05). Conclusion: The liaison nurse role emerges as a valuable strategy for enhancing patients' hemodynamic stability, and its implementation can have a positive impact on patient outcomes in hospital settings. [ABSTRACT FROM AUTHOR]

Background: New daily persistent headache (NDPH) is a continuous, unremitting headache from onset that yields suboptimal results with traditional medicines. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive treatment for other headache disorders, such as migraine, and neuromodulation has not been well-studied in NDPH. The objective of the study was to evaluate the efficacy of rTMS in reducing the frequency and severity of headaches, and associated anxiety and depressive symptoms in NDPH patients. Methods: This was an open label prospective, single arm, interventional pilot study conducted between October 2022 and September 2023. All eligible participants received 10 Hz rTMS (600 pulses, 10 trains), delivered to the left prefrontal cortex for three consecutive days. The post-rTMS headache severity was recorded weekly for four weeks and headache free days/functional disability, PHQ-9, and GAD-7 scores at the end of four weeks and compared with pre-rTMS parameters. The primary outcome was defined by ≥ 50% reduction in headache severity on Visual Analogue Scale (VAS) score, decrease in headache days from the baseline and secondary outcome was ≥ 6 point reduction in HIT-6 score at 4 weeks. Results: Fifty NDPH patients (mean [SD] age, 35.06 [13.91] years; 31 females [62%]) participated in this study. Thirty-five patients (70%) reported ≥ 50% improvement in pain severity (p-value < 0.001), with a mean reduction of 10.84 (4.88) headache days per 28 days from a baseline of 28 headache days (p-value < 0.001). Thirty-eight patients (76%) reported a ≥ 6 point's reduction in HIT score at 4 weeks. Maximum improvement in the above parameters was observed in NDPH patients with chronic migraine. Two patients reported intolerance to the sound of the rTMS. The median (IQR) PHQ-9 and GAD-7 scores reduced from 11.5(3.75,20) to 7(2,15) (p-value < 0.001) and 10(3,14) to 5.5(0,9) (p-value < 0.001) respectively. Conclusion: rTMS was well tolerated and effective in reducing pain severity, headache days and headache related disability, depressive and anxiety symptoms. Trial registration: CTRI/2023/05/053247. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder is an incapacitating disease that causes pain and limitation in the shoulder joint functional capacity. This work aimed to assess the efficacy of ultrasound-guided combined intra-articular corticosteroids (CS) injection and suprascapular nerve block (SSNB) in pain control in patients with frozen shoulders. Results: Our prospective study included 40 patients, equally divided into two groups: group A; managed with combined ultrasound (US) guided intra-articular corticosteroids injection (IACSI) and SSNB, and group B patients managed with US-guided SSNB. The visual analog scale score statistically significantly improved after both injections. This success was maintained and showed mild improvement at 8-week intervals (with increased patient capability to do physiotherapy after pain control). Similarly, improvement in the functional capacity of the shoulder joint was identified and assessed by the Oxford shoulder score (OSS) in both groups. Mean OSS was statistically significantly higher at 4-week intervals than before the nerve block for groups A and B. At 8 weeks interval, this favorable result was sustained (p <.001). Conclusions: US-guided SSNB is an effective, radiation-free method to alleviate frozen shoulder-related pains. However, US-guided combined SSNB and IACSI was more effective than SSNB alone in both pain alleviation and improved shoulder joint function. [ABSTRACT FROM AUTHOR]

Background: Organizational readiness for change, defined as the collective preparedness of organization members to enact changes, remains understudied in implementing sepsis survivor transition-in-care protocols. Effective implementation relies on collaboration between hospital and post-acute care informants, including those who are leaders and staff. Therefore, our cross-sectional study compared organizational readiness for change among hospital and post-acute care informants. Methods: We invited informants from 16 hospitals and five affiliated HHC agencies involved in implementing a sepsis survivor transition-in-care protocol to complete a pre-implementation survey, where organizational readiness for change was measured via the Organizational Readiness to Implement Change (ORIC) scale (range 12-60). We also collected their demographic and job area information. Mann-Whitney U-tests and linear regressions, adjusting for leadership status, were used to compare organizational readiness of change between hospital and post-acute care informants. Results: Eighty-four informants, 51 from hospitals and 33 from post-acute care, completed the survey. Hospital and post-acute care informants had a median ORIC score of 52 and 57 respectively. Post-acute care informants had a mean 4.39-unit higher ORIC score compared to hospital informants (p = 0.03). Conclusions: Post-acute care informants had higher organizational readiness of change than hospital informants, potentially attributed to differences in health policies, expertise, organizational structure, and priorities. These findings and potential inferences may inform sepsis survivor transition-in-care protocol implementation. Future research should confirm, expand, and examine underlying factors related to these findings with a larger and more diverse sample. Additional studiesmay assess the predictive validity of ORIC towards implementation success. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study conducted in Senegal on the recognition and treatment of abdominal pain in horses. The study found that early detection is crucial for positive outcomes in both foals and adult horses, and there is a need for improved education and awareness among horse owners to ensure timely detection and treatment. The study also highlights the importance of effective communication and awareness-raising. However, the study acknowledges limitations in terms of data collection and assessing owner experience. Overall, the research emphasizes the need for prompt recognition and appropriate interventions for abdominal pain management in horses. [Extracted from the article]

Background: Malay herbal medicine (MHM) is a popular medication and supplementation among Malaysian mothers during pregnancy and postpartum. It is expected to improve the baby's health, increase breastmilk production, promote slimming and uterine involution, and improve the mother's general health. Recent increases in reports of heavy metal contamination have raised safety concerns. Objective: This pilot exploratory study employed a comparative cross-sectional design to investigate the types of MHM ingested during pregnancy and postpartum, their possible heavy metal contamination and associated health risks. Method: This study involved 167 healthy postpartum Malay women. Findings: MHM consumption was significantly associated with the mother's number of pregnancies and children (p < 0.05) as well as her pre-pregnancy weight (p < 0.05). Mothers who consume MHM were twice as likely (95% CI 1.077–3.963) to experience threatened abortion. Heavy metals were detected in the three most widely consumed MHM samples. The mean concentration of heavy metals in these samples were 47.44 ± 67.74 μg/kg for As, 25.34 ± 2.48 μg/kg for Cd, 3685.87 ± 5683.36 μg/kg for Cr and 194.33 ± 195.19 μg/kg for Pb. The calculated non-carcinogenic hazard health risks (HQ) and health index (HI) were less than one, suggesting no adverse health impacts under the exposure conditions studied. Conclusion: While the HQ and HI values indicate no immediate health risks, the potential transfer from mother to foetus during pregnancy and from mother to infant during breastfeeding warrants further investigation. Additional studies are essential to confirm our findings and monitor the health of mothers and infants. [ABSTRACT FROM AUTHOR]

Background: There is a lack of literature which assesses both patient and health care provider (HCP) perceptions of barriers and facilitators to diabetes health care in immigrant and refugee populations within the United States. This study uniquely incorporates both cohorts' perceptions on the same topic to assess for congruency and discrepancies in perspectives. Methods: Surveys were deployed to patients with diabetes and HCPs to solicit perceptions of barriers and facilitators to diabetes care, with the intention to determine similarities and differences between cohorts. A literature review was conducted to explore barriers and facilitators to diabetes care in immigrant/refugee populations in the US to aid in development of the survey used in this study, as no validated survey existed. Broad recruitment strategies were used, including snowball sampling. Descriptive statistics were calculated and reported p-values were derived from a chi-squared or Fisher's exact test and used for categorical data and a Wilcoxon rank sum or Kruskal–Wallis rank sum test was used for continuous data. Qualitive analysis was completed using the inductive analysis method. Results: Among 19 immigrant and refugee patients and 35 HCPs, almost all facilitators to diabetes care were endorsed by patients and HCPs as helpful. The highest ranked facilitator among patients and HCPs was having access to health insurance. Patients rated stress, while HCPs rated lack of health insurance as the biggest barriers to diabetes care for immigrants and refugees. Patients and HCPs differed in perspective on who held primary responsibility for diabetes management. Patients wanted more diabetes education and nutrition support, while HCPs thought understanding patients' cultural context/sensitivity, providing more education, and having language/translation services were the most important things HCPs can do to care for patients' diabetes. Conclusions: Immigrant/refugee patients and HCPs largely agree about what factors are most helpful in managing diabetes, with access to health insurance as the greatest facilitator. However, while HCPs identified lack of health insurance as the greatest barrier to care, immigrant and refugee patients cited the role of stress as the greatest challenge in managing their diabetes. There was a striking difference in perception of responsibility for diabetes management, with 89% of patient participants responding that the patient is responsible, while only 17% of HCPs responded that the patient was responsible. Future work should include surveys translated into languages other than English to further elicit the perspective of diabetes care in immigrant/refugee populations. Clinical recommendations based on this study include assessing and supporting patient stressors, assuring patients understand that diabetes management is a partnership, providing culturally tailored diabetes education, and increasing access to health insurance. [ABSTRACT FROM AUTHOR]

Purpose: After stroke, upper limb somatosensation can be impaired which affects motor control. Vision is often used to compensate for this. A clinical assessment which assesses the combined sensorimotor function in the absence of vision would be beneficial in studies targeting sensorimotor improvement. Methods and materials: We adapted the Action Research Arm Test (ARAT) to be performed without vision and called this modified version the sensorimotor ARAT (sARAT). Sixty healthy participants and 22 participants with chronic stroke performed the ARAT, sARAT, Fugl-Meyer upper extremity assessment (FM-UE) and Erasmus modified Nottingham sensory assessment (EmNSA). Discriminative validity of sARAT was evaluated by comparing performance between healthy participants and participants with chronic stroke. Convergent validity was evaluated by correlating sARAT with FM-UE and EmNSA. Results: Participants with stroke performed worse on the sARAT compared to healthy participants (p < 0.001), with median scores of 52 (IQR 32-57) and 57 (IQR 57-57), respectively. The sARAT showed high correlations with FM-UE and EmNSA (r = 0.80-0.90). Conclusions: The sARAT shows good discriminative and convergent validity in people with chronic stroke. It allows a quick assessment of the combined upper limb sensorimotor function, by performing the well-known ARAT with the eyes closed. IMPLICATIONS FOR REHABILITATION: The sensorimotor adaptation of the Action Research Arm Test (sARAT) is a clinical assessment of upper limb activity which is performed with the eyes closed. Combining the gold standard ARAT with the sensorimotor adaptation sARAT can inform about the influence of somatosensory impairments on upper limb activity in stroke survivors when vision is blocked. The sARAT shows good discriminative and convergent validity in persons with chronic stroke. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions. Methods: In the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth. Results: In almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part. Conclusions: The unprecedented visiting restrictions in hospitals during the pandemic were like an "experiment" born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital. Trial registration: German Clinical Trials Register (DRKS) (DRKS00027975). [ABSTRACT FROM AUTHOR]

Background: Determining risk indicators behind dental caries is important for identifying children in need of enhanced dental care. The aim of this register-based study was to investigate the association of family-related risk indicators and dental attendance in the development of dental caries in preschool children. Methods: The data for this study were collected from the medical records of 206 randomly chosen preschool children who lived in the city of Oulu, Finland, during 2014–2020. Data on challenges in family life, missing appointments and utilization of oral health care were collected. Sum functions were formed of risk indicators. Analyses were carried out for three age groups (1- to 2-, 3- to 4- and 5- to 6-year-olds) born between 2014 and 2018. Results: There was a significant association between the number of family-related risk indicators and the prevalence of manifested caries lesions in the age group of 5- to 6-year-olds. All family-related risk indicators and information about health care utilization were associated with dental caries risk. Challenges in a child's family life were present among 20.3% of the 5- to 6-year-olds. In all age groups, the most common challenges in family life were parental exhaustion and problems in the parents' relationship or divorce. Conclusion: Family-related risk indicators and dental attendance should be considered when determining caries risk. The caries risk indicators investigated here are associated with each other. [ABSTRACT FROM AUTHOR]

Background: Good wound healing is critical to infection prophylaxis and satisfactory rehabilitation in Total Knee Arthroplasty (TKA). Currently, two techniques, i.e., barbed continuous subcuticular suture without skin adhesive or combined use skin adhesive (n-butyl-2) are being used for superficial wound closure of TKA. While a new skin adhesive (2-octyl) with self-adhesive mesh has been employed as an alternative to conventional surgical skin closure in TKA, its superiority, especially in reducing wound complications and improving wound cosmetic outcomes has not been investigated. This study aimed to compare 2-octyl, n-butyl-2, and no skin adhesive in terms of safety and efficacy in TKA superficial wound closure. Methods: We conducted a multicenter, prospective, randomized controlled study in 105 patients undergoing primary TKA between May 2022 and October 2023. Each patient's knee was randomized to receive 2-octyl, n-butyl-2, or no skin adhesive skin closure with all using barbed continuous sutures in deep tissue. Wounds were followed 1, 3, 5 days, 2, 6 weeks, and 3 months after surgery. Wound discharge, complications, cosmetic outcomes, patient satisfaction, and wound-related costs were compared among these three methods. Results: Wound discharge was less in 2-octyl group and n-butyl-2 group than in non-adhesive group at 1 day, with the discharge only being less in 2-octyl group than in the non-adhesive group at day 3 and day 5 days (P < 0.05). There was no statistical difference in the incidence of other wound complications among the groups (P > 0.05). The 2-octyl group achieved better cosmetic effects than the other two groups in 6 weeks and 3 months (P < 0.05). Compared to the non-adhesive group, 2-octyl group scored higher in overall patient satisfaction score in 2 weeks and incurred lower costs (P < 0.05). Conclusions: Skin closure in TKA using 2-octyl adhesive material showed superiority when compared to no skin adhesive or n-butyl-2, in reducing wound discharge, improving the cosmetic outcomes, without increasing wound complications. In addition, the use of 2-octyl yielded better patient satisfaction and also was less costly compared to no skin adhesive. Our study exhibited that 2-octyl was a safe and effective wound closure technique for patients undergoing TKA. Trial registration: This study has been registered at Clinical Trials. Gov (No. ChiCTR210046442). [ABSTRACT FROM AUTHOR]

Background: COPD patients show higher mortality and worse prognosis in the acute phase of COVID-19, and survivors may suffer persistent symptoms that could make them more vulnerable to exacerbations. Objectives: We aimed to evaluate the impact of COVID-19 on the exacerbations, symptoms, quality of life, and mental health of a cohort of COPD patients. Methods: Retrospective case-control single-centre study including all COPD patients from the pulmonary consultation of University Hospital Santa Maria (Lleida, Spain) surviving COVID-19 between March 2020 and September 2021, and similar propensity-score-matched (1:2) COPD patients. Differences in COPD exacerbations, COPD clinical evolution (lung function, dyspnoea, CAT and symptoms), long COVID-19 symptoms, quality of life, and mental health, were assessed at the end of 2021. Results: We included 39 COVID-19 COPD patients and 78 similar non-COVID-19. No differences were found on exacerbations (46(59%) vs. 27(69.2%), p = 0.380), dyspnoea (2 [1; 3] vs. 2 [1; 3], p = 0.921) CAT (14.5 [10.0; 18.8] vs. 13.0 [10.0; 16.0], p = 0.432). Only the prevalence of smell or taste disorders, hair loss and tingling was higher in COVID-19 patients. No differences were found in quality of life or mental health. Conclusions: COPD patients surviving COVID-19 were not at a higher risk of COPD exacerbations nor showed significant changes in COPD clinical evolution, and only showed differences in a few very specific COVID-19 symptoms. These unexpected results suggest that the conditions triggered by the pandemic and its management could have affected COPD patients as much as actually having had COVID-19. [ABSTRACT FROM AUTHOR]

Background: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates. Methods: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors. Results: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73). Conclusions: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities. [ABSTRACT FROM AUTHOR]

The application of artificial intelligence (AI) algorithms to 12-lead electrocardiogram (ECG) provides promising age prediction models. We explored whether the gap between the pre-procedural AI-ECG age and chronological age can predict atrial fibrillation (AF) recurrence after catheter ablation. We validated a pre-trained residual network-based model for age prediction on four multinational datasets. Then we estimated AI-ECG age using a pre-procedural sinus rhythm ECG among individuals on anti-arrhythmic drugs who underwent de-novo AF catheter ablation from two independent AF ablation cohorts. We categorized the AI-ECG age gap based on the mean absolute error of the AI-ECG age gap obtained from four model validation datasets; aged-ECG (≥10 years) and normal ECG age (<10 years) groups. In the two AF ablation cohorts, aged-ECG was associated with a significantly increased risk of AF recurrence compared to the normal ECG age group. These associations were independent of chronological age or left atrial diameter. In summary, a pre-procedural AI-ECG age has a prognostic value for AF recurrence after catheter ablation. [ABSTRACT FROM AUTHOR]

Background: Lacunes, a characteristic feature of cerebral small vessel disease (CSVD), are critical public health concerns, especially in the aging population. Traditional neuroimaging techniques often fall short in early lacune detection, prompting the need for more precise predictive models. Methods: In this retrospective study, 587 patients from the Neurology Department of the Affiliated Hospital of Hebei University who underwent cranial MRI were assessed. A nomogram for predicting lacune incidence was developed using LASSO regression and binary logistic regression analysis for variable selection. The nomogram's performance was quantitatively assessed using AUC-ROC, calibration plots, and decision curve analysis (DCA) in both training (n = 412) and testing (n = 175) cohorts. Results: Independent predictors identified included age, gender, history of stroke, carotid atherosclerosis, hypertension, creatinine, and homocysteine levels. The nomogram showed an AUC-ROC of 0.814 (95% CI: 0.791-0.870) for the training set and 0.805 (95% CI: 0.782-0.843) for the testing set. Calibration and DCA corroborated the model's clinical value. Conclusion: This study introduces a clinically useful nomogram, derived from binary logistic regression, that significantly enhances the prediction of lacunes in patients undergoing brain MRI for various indications, potentially advancing early diagnosis and intervention. While promising, its retrospective design and single-center context are limitations that warrant further research, including multi-center validation. [ABSTRACT FROM AUTHOR]

Background: For patients with sepsis receiving non-invasive ventilation (NIV), early rehabilitation is crucial. The Sitting Baduanjin (SBE) is an efficient early rehabilitation exercise suitable for bed patients. There is no consensus about the effect of SBE on the early rehabilitation of septic patients with NIV. This study focused on how the SBE affected the early rehabilitation of sepsis patients with NIV. Methods: 96 sepsis patients with NIV were randomly assigned to either an Baduanjin group that received the SBE based on the routine rehabilitation exercise (n = 48) or a control group (n = 48) that received routine rehabilitation exercise. The primary outcome was the Medical Research Council(MRC)score, and the Barthel Index score, the duration of NIV, length of ICU stay, length of total stay, hospitalization expense as secondary outcomes. Results: A total of 245 sepsis patients were screened, with 96 randomly assigned. The study was completed by 90 patients out of the 96 participants.Results revealed that the MRC score increased in both groups, but the improvement of muscle strength in Baduanjin group was more obvious, with statistical significance (p < 0.001).There was statistically significantly difference between the two groups in Barthel Index at the day of transfer out of ICU(P = 0.028).The patients in the Baduanjin group had an average reduction of 24.09 h in the duration of NIV and 3.35 days in total length of hospital stay compared with the control group (p < 0.05).Of note, the Baduanjin group had significantly reduction the total hospitalization expense. No serious adverse events occurred during the intervention period. Conclusions: In patients with sepsis, the SBE appears to improve muscle strength and activities of daily living (ADL), and lowed the duration of NIV, the length of the total stay, and the hospitalization expense. Trial registration: The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR1800015011 (28/02/2018). [ABSTRACT FROM AUTHOR]

Objectives: Temporomandibular disorders (TMDs) have a relatively high prevalence among university students. This study aimed to identify independent risk factors for TMD in university students and develop an effective risk prediction model. Methods: This study included 1,122 university students from four universities in Changchun City, Jilin Province, as subjects. Predictive factors were screened by using the least absolute shrinkage and selection operator (LASSO) regression and the machine learning Boruta algorithm in the training cohort. A multifactorial logistic regression analysis was used to construct a TMD risk prediction model. Internal validation of the model was conducted via bootstrap resampling, and an external validation cohort comprised 205 university students undergoing oral examinations at the Stomatological Hospital of Jilin University. Results: The prevalence of TMD among university students was 44.30%. Ten predictive factors were included in the model, comprising gender, facial cold stimulation, unilateral chewing, biting hard or resilient foods, clenching teeth, grinding teeth, excessive mouth opening, malocclusion, stress, and anxiety. The model demonstrated good predictive ability with area under the receiver operating characteristic curve (AUC) values of 0.853, 0.838, and 0.821 in the training cohort, internal validation cohort, and external validation cohort, respectively. The calibration curves demonstrated that the predicted results were consistent with the actual results, and the decision curve analysis (DCA) indicated the model's high clinical utility. Conclusions: An online nomogram of TMD in university students with good predictive performance was constructed, which can effectively predict the risk of TMD in university students. The model provides a useful tool for the early identification and treatment of TMDs in university students, helping clinicians to predict the probability of TMDs in each patient, thus providing more personalized and accurate treatment decisions for patients. [ABSTRACT FROM AUTHOR]

Background: Severe trauma is the leading cause of disability and mortality in the patients under 35 years of age. Surgical site infections (SSI) represent a significant complication in this patient population. However, they are often inadequately investigated, potentially impacting the quality of patient outcomes. The aim of this study was to investigate the epidemiology of SSI and risk factors in severe trauma patients. Methods: We conducted a multicenter retrospective cohort study screening the severe trauma patients (STP) admitted to two intensive care units of an academic institution in Marseille between years2018 and 2019. Those who underwent orthopedic or spinal surgery within 5 days after admission were included and classified into two groups according to the occurrence of SSI (defined by the Centers for Disease Control (CDC) international diagnostic criteria) or not. Our secondary goal was to evaluate STP survival at 48 months, risk factors for SSI and microbiological features of SSI. Results: Forty-seven (23%) out of 207 STP developed an SSI. Mortality at 48-months did not differ between SSI and non-SSI patients (12.7% vs. 10.0%; p = 0.59). The fractures of 22 (47%) severe trauma patients with SSI were classified as Cauchoix 3 grade and 18 (38%) SSI were associated with the need for external fixators. Thirty (64%) severe trauma patients with SSI had polymicrobial infection, including 34 (72%) due to Gram-positive cocci. Empirical antibiotic therapy was effective in 31 (66%) cases. Multivariate analysis revealed that risk factors such as low hemoglobin, arterial oxygenation levels, hyperlactatemia, high serum creatinine and glycemia, and Cauchoix 3 grade on the day of surgery were associated with SSI in severe trauma patients. The generated predictive model showed a good prognosis performance with an AUC of 0.80 [0.73–0.88] and a high NPV of 95.9 [88.6–98.5] %. Conclusions: Our study found a high rate of SSI in severe trauma patients, although SSI was not associated with 48-month mortality. Several modifiable risk factors for SSI may be effectively managed through enhanced perioperative monitoring and the implementation of a patient blood management strategy. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor globally and a leading cause of mortality in cirrhotic patients. Our study aimed to estimate the diagnostic performance of triphasic CT and inter-observer reliability in the preoperative detection of microvascular invasion (MVI) in HCC. Two independent radiologists accomplished a retrospective analysis for 99 patients with HCC to assess the CT features for MVI in each lesion. Postoperative histopathology was considered the gold standard. Results: Multivariate regression analysis revealed that incomplete or absent tumor capsules, presence of TTPV, and absence of hypodense halo were statistically significant independent predictors of MVI. There was excellent agreement among observers in evaluating peritumoral enhancement, identifying intratumoral arteries, hypodense halo, TTPV, and macrovascular invasion. Also, our results revealed moderate agreement in assessing the tumor margin and tumor capsule. Conclusion: Triphasic CT features of MVI are reliable imaging predictors that may be helpful for standard preoperative interpretation of HCC. [ABSTRACT FROM AUTHOR]

Introduction: Oral lesions are a common clinical symptom arising from various etiologies and disrupt the patient's quality of life. However, no definite treatment is not yet possible, due to the constantly changing environment of the mouth. In recent years, herbal treatments have gained popularity among patients and physicians due to their availability, safety, affordability, and antimicrobial properties. This research aims to investigate the therapeutic effects of a nano-emulsion of Plantago major standardized extract (PMSE) on oral ulcers in a Wistar rat model using histomorphometry and stereological parameters. Materials and Methods: The study involved 72 Wistar rats divided randomly into 24 groups of 3 each: groups A1 to A4 received one dose to 4 doses of 5% PMSE nano emulsion, groups B1 to B4 received one dose to 4 doses of 10% PMSE nano emulsion, and groups C1 to C4 received one dose to 4 doses of 20% PMSE nano emulsion, groups D1 to D4 received one dose to 4 doses of nano-emulsion without PMSE, groups E1 to E4 received one dose to 4 doses of PMSE, and group F served as the control group. An incision measuring 2 mm in diameter was made in the animals' hard palate using a biopsy punch. A swab containing the necessary material was used to administer the medication orally to the wound. Histological samples were collected on days 2, 4, 6, and 8 and sent to the pathology laboratory for examination. Data analysis was performed using SPSS 26 and setting statistical significance at p < 0.05. Results: Group A showed a high rate of complete and normal re-epithelialization of the wound at 66.7%, compared to the other groups. Group D had a re-epithelialization rate of 50%, while groups C, E, and F had rates of 7.41% and group B had 7.16%. In terms of inflammation reduction, 23.88% of group A had no inflammation, a higher percentage compared to the other groups. Group B and D had no inflammation in 3.33% of cases, lower than the other groups. The study evaluated frequency of re-epithelialization and inflammation levels in different groups on days 2, 4, 6, and 8 after four doses of the drug with no significant differences found among the groups. Conclusion: None of the nano emulsions or PMSE enhanced the healing rate of oral ulcers. However, a 5% PMSE nano emulsion displayed an increase in lesion re-epithelialization. Key message: • Design of PMSE nano emulsion on oral wound healing. • Select a superior formulation for PMSE nano-emulsion on oral wound healing. • The composition of 5% PMSE nano emulsion is suggested for healing oral wounds. [ABSTRACT FROM AUTHOR]