Search

The COVID-19 pandemic has posed unprecedented challenges with its impact on patient safety culture and staff well-being. This study was to identify potential changes in safety culture among health care workers from before to during the COVID-19 pandemic, and to determine the differences across occupational groups. The Safety Attitudes Questionnaire (SAQ) was administered electronically in both English and Malay languages using the Google Forms platform in 2018 and was repeated in 2021, during the COVID-19 pandemic. Comparisons were made between 2018 and 2021 to determine changes in patient safety culture for the overall staff population and by occupational groups. A total of 3175 health care workers completed the questionnaire in 2021. Overall, a comparable percentage agreement was found for all SAQ domains in 2018 and 2021 with visible improvements for doctors and support staff. Safety Attitudes Questionnaire domain scores differed in teamwork, safety climate, perception of hospital management, and working condition domains across occupational groups. Self-isolation and COVID-19 were associated with poorer SAQ domain scores, while redeployment was associated with improvements in SAQ domain scores. Interventions targeting areas of weakness as well as utilizing positive experiences such as redeployment should be explored to enhance patient safety in hospitals settings postpandemic. [ABSTRACT FROM AUTHOR]

Following late-life spousal bereavement, sensory and quasi-sensory experiences of the deceased (SED) are commonly reported. This longitudinal study examined SED among 310 older widowed adults 6–10 (T1) and 18–20 (T2) months post loss. Reports of SED in the first 6–10 months after loss were associated with higher symptom levels of prolonged grief, post-traumatic stress, and loneliness at T1. Experiencers of SED were more likely to experience symptoms of prolonged grief and post-traumatic stress above cut-off scores at T1. Importantly, only a minority of the experiencers of SED displayed these elevated levels of bereavement-related distress. In addition, employing multi-level-modeling, a similar trajectory of decreasing bereavement-related distress over time was found for both experiencers and non-experiencers of SED. We argue that SED may be one of several potential reactions to bereavement, which should not be seen as an indicator of grief complications per se. [ABSTRACT FROM AUTHOR]

Cyber dating abuse (CDA) concerns the use of digital technology to control, monitor, and hurt one's intimate partner. CDA can have profound detrimental outcomes, such as mental health problems. As such, it is important to identify intrapersonal factors that may explain these behaviors. Previous research suggests that one such factor is the personality cluster of Dark Triad traits (DTT), comprising Machiavellianism, narcissism, and psychopathy. Additionally, DTT and CDA perpetration have both been linked to poor self-control ability, but these relationships have not yet been tested together in one model. As such, the present study examines if individuals' poor self-control ability mediates the relationship between the DTT and CDA perpetration. To test these associations, we conducted a survey study among a representative sample of Belgian adults (n = 1,144; M age = 47.66 years; 51.3% female). Findings from correlation analyses revealed that all three DTT were individually associated with CDA perpetration, such that higher scores on these traits corresponded with more CDA perpetration. Additionally, pathway analyses from structural equation modeling revealed that individuals' poor self-control ability fully explained the relationship between Machiavellianism and narcissism and CDA perpetration, and partially explained the relationship between psychopathy and CDA perpetration. As our findings suggest that self-control plays an instrumental role in explaining why individuals control and monitor their partner via digital technology, prevention and intervention efforts should seek ways to improve individuals' self-control ability in situations that may trigger such harmful interpersonal behaviors, particularly among individuals who exhibit Dark Triad personality traits. [ABSTRACT FROM AUTHOR]

This pilot randomized controlled trial tested the potential efficacy of a brief internet-based, passive psychoeducation intervention, Free From Abuse, in promoting healthy relationships among young adults. Participants aged 18 to 24 years were randomly assigned to an intervention treatment (n = 71) or a placebo control condition (n = 77). Participants in the treatment arm had a larger increase in recognition of abusive behavior and reduction in domestic violence myth acceptance scores than participants in the control arm postintervention and after one week. This study provides preliminary evidence that brief internet-based passive psychoeducation is potentially useful in promoting healthy relationships among young adults. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus (DM) is one of the world's major public health problems. There are few published data on 25-hydroxyvitamin D (25[OH]D) concentrations and DM, and these studies showed different results. Objectives: The current study aimed to compare 25[OH]D concentrations between patients with type 2 DM (T2DM) and healthy controls in eastern Sudan. Methods: A case–control study of two groups matched for age and gender (88 in each group) was conducted in eastern Sudan from March to May 2022. The cases were patients with T2DM, and the controls were healthy participants. Sociodemographic data were collected, and serum 25(OH)D levels were assessed. A univariate analysis was performed. Results: Of the total 176, 82 (47%) were males, and 94 (53%) were females; the median (interquartile range [IQR]) of age, body mass index (BMI), and 25(OH)D concentration were 55 (50–61) years, 27 (23–31) kg/m2, and 13 (10–19) ng/mL, respectively. Of the 176, 137 (78%) were vitamin D deficiency cases. Compared with the controls, age, gender, educational level, marital status, or BMI were not different in the circumstances. Moreover, the median (IQR) for serum 25(OH)D concentrations showed no difference between patients with T2DM and the healthy controls (12 [10–18] ng/mL vs. 13 [10–20] ng/mL). The prevalence of vitamin D deficiency (25(OH)D level < 20 ng/mL) was not different between patients with T2DM and the healthy controls (66/88 [75%] vs. 71/88 [81%]). There was no association in the serum 25(OH)D levels between diabetic and nondiabetic participants (OR = 1.01, 95% CI 0.97–1.06) or in vitamin D deficiency between diabetic and nondiabetic participants (OR = 0.72, 95% CI 0.35–1.47). Conclusion: There was no significant difference in 25(OH)D levels between diabetic and nondiabetic participants in this study. Further studies investigating the mechanisms of association between 25(OH)D levels and DM are needed. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) aims to realign the varus knee to alleviate stress in the medial compartment. However, detailed information on the impact of HTO on stress distribution across the tibiofemoral joint surface still needs to be completely elucidated. Purpose/Hypothesis: The present study aimed to analyze the subchondral bone density distribution to validate the alignment threshold causing paradoxical changes. We hypothesized that there would be a paradoxical stress change in the medial compartment beyond a specific threshold for lower limb realignment after HTO. Study Design: Case series; Level of evidence, 4. Methods: A retrospective clinical study of 32 knees from 30 patients who underwent medial opening-wedge HTO between 2015 and 2019 was conducted at Hokkaido University Hospital. The subchondral bone density across the tibiofemoral joint was analyzed using computed tomography–osteoabsorptiometry before and after HTO. The high-density area (HDA) within the medial and lateral compartments and their subregions, which were quartered in the coronal plane, was specifically examined. Results: The hip-knee-ankle angle, medial proximal tibial angle (MPTA), joint line obliquity (JLO), and joint line convergence angle significantly changed after HTO (P <.01). The HDA of the medial compartment to the total HDA ratio decreased from 83% to 77%. Paradoxically, the HDA in the most central subregion of the medial compartment increased from 24% to 30%. There were significant differences between MPTA and JLO in patients with and without paradoxical changes in the HDA. MPTA and JLO cutoff values causing paradoxical changes in the HDA were 94° and 4°, respectively. Conclusion: There was a paradoxical stress increase in the M4 region at the medial compartment associated with the MPTA and JLO beyond specific thresholds. Therefore, surgical planning should be cautiously performed to prevent overcorrection, which can lead to adverse stress distribution changes. [ABSTRACT FROM AUTHOR]

Background: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. Purpose: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. Results: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P ≥.999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P =.301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. Conclusion: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment—including exercise therapy for ≥3 months—does not relieve patient's symptoms. Registration: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. Study Design: Cohort study; Level of evidence, 2. Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P <.001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P <.001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P =.592). Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery. [ABSTRACT FROM AUTHOR]

Approximately 85% of children with autism spectrum disorder from the SPARK study receiving standard interventions such as speech-language and occupational therapies. In contrast, only 32%–13% of children with autism spectrum disorder received movement therapies such as physical and recreational therapies, respectively. Little is known about how service receipt changes as a function of children's motor difficulties. Parents of children with autism spectrum disorder completed online surveys to provide a report of their child's motor difficulties using the Developmental Coordination Disorder–Questionnaire as well as the various therapies their child received (speech-language therapy, occupational therapy, physical therapy, applied behavioral analysis, social skill interventions, recreational therapy) by location (at school, privately/in community, or both). While movement therapies (occupational therapy, physical therapy, recreational therapy) increased with increasing motor risk and severity, there continued to be large disparities in physical therapy (37%–55%) and recreational therapy (15%–19%) compared to occupational therapy (85%–92%) across various settings indicating clear unmet needs for specific motor services given that 88.3% of this sample of children with autism spectrum disorder is at risk for motor difficulties/Developmental Coordination Disorder. Developmental Coordination Disorder–Questionnaire fine- and gross-motor subscale scores were fairly comparably affected yet physical therapy/recreational therapy were less received versus occupational therapy. These findings explain the paucity of physical therapy/recreational therapy and physical activity programs for individuals with autism spectrum disorder and the need for movement experts to receive appropriate access and training to work with individuals with autism spectrum disorder. There are clear disparities in motor services provided to children with autism spectrum disorder (physical and recreational therapies) compared to their standard therapies (speech-language and occupational therapies). Children with autism spectrum disorder need greater access to and funding for motor services (physical and recreational therapies) and physical activity programs. Movement experts including PTs, adapted physical educators, and community exercise/sports coaches/professionals need basic, specialized, and continuing education training to meet the needs of children and adults with autism spectrum disorder not only for providing early developmental and school-based services but also for ensuring appropriate built environments and providing general physical therapy/adapted physical education services as well as physical activity programs. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment. Design: Pre-planned secondary analysis of a randomized controlled, non-blinded trial. Setting: Outpatient clinic of a German university hospital. Subjects: Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups. Interventions: Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months. Main measures: Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed. Results: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: −5 [SD 1.436]; therapeutic exercise: −4 [SD 1.798]; combination: −3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (−6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment. Conclusions: Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache. [ABSTRACT FROM AUTHOR]

Objective: To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications. Design: A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer. Setting: Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023. Subjects: Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription. Interventions: All the patients included in the research were prescribed with their first pair of therapeutic footwear. Main measures: Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day. Results: The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5–8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities. Conclusions: Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations. [ABSTRACT FROM AUTHOR]

Background: Despite the prevalence of proximal hamstring avulsion injuries (PHAIs), the understanding of rerupture risk factors and the influence of injury chronicity on these rates remain limited. Purpose: To investigate the rerupture rate after PHAI repair and identify its associated risk factors and the optimal time to primary surgery. Study Design: Case-control study; Level of evidence, 3. Method: This is a retrospective analysis of prospectively collected data from the French Proximal Hamstring Avulsion Surgery Cohort Study targeting patients surgically treated for PHAI between 2002 and 2022. The primary outcome measure of this study was the rerupture rate of PHAI repair. The secondary outcome measures included the assessment of the potential risk factors for rerupture as well as the investigation of the incidence rate of rerupture for 100 person-years depending on various injury-surgery delay definitions. Results: This study analyzed 740 patients with a mean age of 45.9 years (SD, 13.6 years) and followed up for a mean of 4.9 years (SD, 3.9 years). The rerupture rate was 4.59% (34/740). Most reruptures (75%) occurred within the first 6 months after surgery (median, 88.5 days; interquartile range, 39.5-182 days), and 74% were atraumatic. Univariate analysis identified potential risk factors: longer initial surgery delay (hazard ratio [HR], 1.03; 95% CI, 1.01-1.04; P =.04) and initial complete ruptures (HR, 4.47; 95% CI, 1.07-18.7; P =.04). Receiver operating characteristic curve analysis found the optimal injury-surgery delay cutoff predicting rerupture to be 32 days (area under the curve, 0.62; 95% CI, 0.53-0.71). The relative Youden index was calculated at 0.24, corresponding to a sensitivity of 65% and a specificity of 59%. Surpassing this cutoff showed the highest HR (2.56), narrowest 95% CI (1.27-5.17), and highest incidence of rerupture (1.42 per 100 person-years) (P =.01). In the multivariate analysis, an injury-surgery delay of >32 days (HR, 2.5; 95% CI, 1.24-5.06; P =.01) and initial complete ruptures (HR, 4.33; 95% CI, 1.04-18.08; P =.04) emerged as significant risk factors for rerupture. Conclusion: This study found a 4.59% rerupture risk after PHAI repair. Most reruptures (75%) occurred within the first 6 months after surgery. Risk factors for rerupture included chronicity and initial complete injury. The optimal threshold for chronicity of PHAI lesions, based on rerupture rate, was marked by an injury-surgery delay of >32 days. [ABSTRACT FROM AUTHOR]

We investigated whether mood and lifestyle-related indicators of physical health are differentially expressed according to self-reported levels of depressive symptoms among young adults with a current episode of major depression. In a cross-sectional study, we recruited 94 young adults (females = 67, 71.3%; males = 27, 28.7%; aged 18–35 years) with a current episode of major depression. We assessed their mood with the Profile of Mood States (POMS), and Beck Anxiety Inventory-(BAI), sleep with the Pittsburgh Sleep Quality Index (PSQI), physical activity with the Simple Physical Activity Questionnaire (SIMPAQ), and their cardiorespiratory fitness. Participants' depression levels were classified as follows using established cut-points: (a) Mild Depressive Symptoms (MIDS, BDI-II 14-19 points, n = 17), (b) Moderate Depressive Symptoms (MODS, BDI-II 20–28 points, n = 37) or (c) Severe Depressive Symptoms (SEDS, BDI-II 29–63 points, n = 40). As expected, we found that young adults with SEDS, when compared to those with MODS and MIDS, showed higher depressive mood on the POMS, and they exhibited greater anxiety symptoms, lower reported 'vigor' on physical activity measures, worse sleep quality as expressed by their global score sleep; daytime dysfunction; and sleep disturbance, and they showed lower cardiorespiratory fitness. Those with moderate depressive symptoms only differed from those with mild symptoms with respect to hostility, fatigue and mood disturbance. Although there was a gradient whereby worse mental and physical health indicators were more closely related to the SEDS depression categorization, while healthier indicators were associated with the MIDS category, some parameters were not different between the MDD severity groups, particularly when comparing MIDS and MODS. Clinicians treating patients with MDD should consider these factors when designing lifestyle-based interventions. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effect of lullabies and classical music on preterm neonates' cerebral oxygenation, vital signs, and comfort during orogastric (OG) tube feeding. Methods: This was a parallel-group pretest-posttest randomized controlled study. The research was conducted between December 2020 and May 2022. The sample consisted of 51 preterm neonates hospitalized in the neonatal intensive care unit (NICU) of Selçuk University Faculty of Medicine Hospital in Konya, Türkiye. Participants were randomized into three groups (17 preterm infants in each group). The first group listened to lullabies sung by their mothers and the second group listened to classical music during OG tube feeding. The control group received routine care with no music. Data were collected using a Neonatal Identification Information Form, Physiological Parameters and rSO2 Monitoring Form, and the Newborn Comfort Behavior Scale (Comfort-Neo). The study was registered on the ClinicalTrials database (NCT05333575). Results: The lullaby group had stable peak heart rates and oxygen saturation levels (p =.002). Both lullaby and classical music groups had significantly higher cerebral oxygenation levels than the control group. The classical music group had the highest cerebral oxygenation level (p =.001). Both lullaby and classical music groups had significantly higher mean Comfort-Neo scores than the control group. The classical music group had the highest mean Comfort-Neo score (p =.040). Conclusion: Preterm neonates who listen to lullabies and classical music are likely to have higher cerebral oxygen and comfort levels. Listening to lullabies helps stabilize vital signs. These results suggest that healthcare professionals should encourage parents to get their preterm neonates to listen to lullabies and classical music. [ABSTRACT FROM AUTHOR]

Background: Anterolateral knee laxity (ALLx) has been linked to tears of the lateral meniscus (LM) and anterior cruciate ligament (ACL) injury. Purpose: To investigate the longitudinal relationship between the signal intensity (SI) of the repaired LM on magnetic resonance imaging (MRI) and residual ALLx after ACL reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 87 patients who underwent double-bundle ACLR and lateral meniscal repair (mean age, 23.5 years; body mass index, 23.7 kg/m2; 56 women) at a single institution between 2010 and 2019. Proton density-weighted (PDW) and T2-weighted (T2W) MRI was performed at 3, 6, and 12 months postoperatively, and the SI ratio (SIR) was calculated as (SI of the repaired LM)/(SI of the posterior cruciate ligament). At the 12-month follow-up, ALLx was evaluated using the pivot-shift test; an International Knee Documentation Committee grade ≥1 indicated residual ALLx. Results: Overall, 12 patients (13.8%) exhibited ALLx at 12 months postoperatively. At 3 months postoperatively, the SIR on PDW images (SIR-PDW) was significantly higher in patients with ALLx versus those without ALLx (1.98 ± 0.77 vs 1.49 ± 0.52, respectively; P = .007); there was no difference in the SIR on T2W images between the groups. SIR-PDW at 3 months postoperatively was correlated negatively with patient age (r = -0.308, P = .004). When patients were stratified into a younger (≤22 years; n = 53; ALLx = 7 [13.2%]) and an older (>22 years; n = 34; ALLx = 5 [14.7%]) group, the area under the receiver operating characteristic curves (AUCs) for SIR-PDW in the younger group were statistically significant for predicting the prevalence of ALLx at all follow-up times (AUCs, 0.733-0.788) with optimal cutoff values of 2.00 at 3 months, 1.50 at 6 months, and 1.50 at 12 months. Logistic regression analysis revealed that if younger patients consistently had higher SIR-PDW values than the cutoff values, they were more likely to have residual ALLx (odds ratios, 10.24-23.57). Conclusion: For younger patients who underwent both ACLR and lateral meniscal repair, higher MRI SI of the repaired LM was associated with a higher prevalence of residual ALLx. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is a potentially effective non-pharmacological treatment for insomnia. Objective: We observed the responses of patients with insomnia to acupuncture in routine clinical practice. In addition, we explored patient characteristics that might affect the treatment response to acupuncture for insomnia. Methods: Medical records of patients with insomnia in a Korean medicine clinic with baseline Insomnia Severity Index (ISI) scores ⩾8 and Pittsburgh Sleep Quality Index (PSQI) scores ⩾5 were reviewed. Acupuncture was applied at ST43, GB41, ST41, SI5, HT3, KI10, HT7 and ST3, for 1–2 months. The ISI and PSQI were measured monthly to assess insomnia severity. The effect of acupuncture over time was analyzed using a multilevel linear model for repeated measures. In addition, logistic regression was used to explore predictors of treatment response. Results: A total of 91 patients with insomnia aged 59.2 ± 12.5 years (mean ± standard deviation (SD)) (90.1% female) were included in the analysis. After the acupuncture treatment, ISI scores were significantly reduced by −3.75 (95% confidence interval (CI) = −4.99, −2.50) and −4.69 (95% CI = −6.22, −3.16) after the first and second month, respectively. The PSQI global scores also improved, and sleep duration showed a tendency to increase by 0.35 h (95% CI = −0.17, 0.86) after acupuncture treatment. Three cases of mild fatigue were reported. In addition, higher baseline pain/discomfort predicted a greater likelihood of response after acupuncture treatment (odds ratio (OR) = 1.66, 95% CI = 1.10, 2.60). Conclusion: In a real-world setting, the insomnia of outpatients in a clinic was slightly alleviated after acupuncture treatment. These findings require validation by randomized controlled trials. [ABSTRACT FROM AUTHOR]

Background: It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. Hypothesis: There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. Results: The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P <.001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P =.049) and ASES score (81.7 ± 17; P =.019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P <.001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P =.044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P =.059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P =.005 and P =.04, respectively). Conclusion: The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group. [ABSTRACT FROM AUTHOR]

Background: There are multiple recommended protocols for Vitamin D (VitD) supplementation in elderly; however, only a few studies achieved to examine the role of VitD supplements before intertrochanteric fracture surgery on mortality and complications after surgery. Methods: This single-center block-randomized double-blinded trial was conducted on 80 patients with intertrochanteric fractures and a sufficient level of 25 (OH) VitD. The intervention group received an intramuscular 300,000 IU VitD ampule before surgery. The primary outcome was a 6-month mortality rate, and the secondary outcomes were 1- and 2-year mortality rates and Harris Hip Score (HHS) in 6, 12, and 24 months after surgery. Chi-square, t-test, repeated measure ANOVA, and Cox regression survival model was used for statistical analysis. Results: 40 patients were allocated to each group. Demographic, clinical characteristics, and preoperative evaluations were not significantly different between the groups. Mortality rate 6-month after the surgery was 7.5% and 10% for the intervention and placebo groups respectively (P value =.71), 15% and 12.5% at 1-year (P value =.83), and 25% and 27.5% at 2-year (P value =.98). Based on the Cox regression model, only age was significantly associated with mortality (HR = 1.229, P value <.001). Significant HHS changes from baseline through 24 months after surgery were observed within both groups; however, mean differences were not significantly different between groups. Conclusions: A single preoperative 300,000 IU VitD did not significantly impact 2-year survival and HHS in patients with intertrochanteric fractures and sufficient serum VitD level. [ABSTRACT FROM AUTHOR]

The Structured Assessment of PROtective Factors for violence risk (SAPROF) is a widely used structured professional judgment (SPJ) tool. Its indices have predictive validity regarding desistance from future violence in adult correctional/forensic psychiatric populations. Although not intended for applied use with youth, SAPROF items lend themselves to an investigation of whether their operationalizations capture only strengths or also risks. With 229 justice-involved male adolescents followed for a fixed 3-year period, promotive, risk, and mixed effects were found. Most SAPROF items exerted a mixed effect, being associated with higher and lower likelihoods of violent and any reoffending at opposite ends of their trichotomous ratings. Summing items weighted using their promotive and risk odds ratios produced statistically significant improvements in predictive accuracy, improvements found also with a cross-validation sample of 171 justice-involved youth. The nature of strengths and implications for the development of SPJ tools and training in their use were discussed. [ABSTRACT FROM AUTHOR]

Background: In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. Purpose: To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. Results: A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT (P =.001), SS (P <.001), acetabular version (P <.001), and acetabular inclination (P =.049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. Conclusion: After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction (ACLR) performed by high-volume surgeons/clinics has been associated with increased graft individualization and decreased operating times, complication rates, and total costs. Purpose: To investigate the influence of surgeon/clinic volume on subjective knee function and revision surgery rates at 2 years after primary ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Data from the Swedish National Knee Ligament Registry were used to study patients who underwent primary ACLR between 2008 and 2019. Surgeons/clinics were categorized based on a combination of total caseload volume (cutoff: 50 ACLRs/surgeon, 500 ACLRs/clinic) and annual volume (cutoff: 29 ACLRs/year/surgeon, 56 ACLRs/year/clinic). The thresholds of minimal important change (MIC), Patient Acceptable Symptom State (PASS), and treatment failure (TF) relative to the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS4 (mean score of the KOOS Pain, Symptoms, Sports/Rec, and QoL subscales) were applied. Adjusted multivariable logistic regression was performed to assess variables influencing the MIC, PASS, or TF of the KOOS and KOOS4. Adjusted Cox regression analysis was conducted to determine the hazard ratio of subsequent ACLR. Results: Of 35,371 patients, 16,317 had 2-year follow-up outcome data and were included. Patients who underwent primary ACLR by high-volume surgeons had significantly higher MIC and PASS rates and lower TF rates when compared with patients who underwent the procedure by low-volume surgeons: MICKOOS4: 70.6% vs 66.3%; PASSKOOS4: 46.0% versus 38.3%; and TFKOOS4: 8.7% versus 11.8% (all P <.02). Significantly decreased odds of achieving MICKOOS4 (OR, 0.74; 95% CI, 0.62-0.88) and PASSKOOS4 (OR, 0.71; 95% CI, 0.60-0.84) were found for ACLRs performed by low-volume surgeons. Clinic volume did not influence the odds of reaching MIC, PASS, or TF. Overall, 804 patients (2.3%) underwent subsequent ACLR at <2 years, with significantly higher revision rates among patients operated on at high-volume clinics (2.5% vs 1.7%; P <.001). However, in the adjusted Cox regression, surgeon/clinic volume had no influence on subsequent ACLR rates. High-volume surgeons/clinics had decreased time to surgery, operating time, perioperative complication rates, and use of thromboprophylaxis and nonroutine antibiotics (P <.001). Conclusion: Patients who underwent primary ACLR by high-volume surgeons experienced increased improvement and satisfaction regarding subjective knee function. Factors other than surgical volume influenced subsequent surgery rates. Patients might benefit from undergoing primary ACLR by high-volume providers. [ABSTRACT FROM AUTHOR]

Background: Aortic aneurysms represent a chronic degenerative disease with life-threatening implications. In order for patients to comprehend health related information, it must be written at a level that can be readily understood. Study Design: In January 2023, we searched "aneurisma aorta" and "endoprótesis aorta" terms on Google, Yahoo and Microsoft/Bing. The 31th websites provided by each search engine were analyzed. Four readability measures were used to evaluate websites regarding aortic aneurysm and their endovascular treatment in Spanish language: Flesch Index, Flesch-Szigriszt Index, Fernández-Huerta Index and grading Inflesz scale. The quality on information was evaluated by the HONcode seal, the DISCERN instrument and the JAMA benchmark criteria. Results: 180 websites containing the terms "aneurisma aorta" and "endoprótesis aorta" were analyzed. Among the websites retrieved, the mean Flesh index score (53.12 ± 6.09 and 47.48 ± 7.12, respectively; P =.019), the Flesch-Szigriszt index (56.39 ± 5.72 and 48.10 ± 8.33; P =.000), and the Fernández Huerta index (61.30 ± 5.59 and 53.19 ± 8.21; P =.000), corresponding to a "somewhat difficult" readability level. In addition, the Inflesz scale (2.62 ±.59 and 2.07 ±.61; P =.000) reported a "somewhat difficult" readability, higher for the websites regarding aortic aneurysm. The HONcode seal was only presented in websites regarding aortic aneurysm (16.7%), whereas none of the websites relating to aortic endoprostheses presented it (0%) (P =.000). Websites that presented the HONcode seal obtained higher DISCERN score (P =.000, 95% CI = 6.42-16.84) and JAMA score (P =.000, 95% CI = 3.44-11.32). Conclusion: Internet information on aortic aneurysms and aortic endoprostheses is too difficult to read for the general Spanish-speaking population and is lacking in quality. [ABSTRACT FROM AUTHOR]

Multiple imputation (MI) is one of the recommended techniques for handling missing data in ordinal factor analysis models. However, methods for computing MI-based fit indices under ordinal factor analysis models have yet to be developed. In this short note, we introduced the methods of using the standardized root mean squared residual (SRMR) and the root mean square error of approximation (RMSEA) to assess the fit of ordinal factor analysis models with multiply imputed data. Specifically, we described the procedure for computing the MI-based sample estimates and constructing the confidence intervals. Simulation results showed that the proposed methods could yield sufficiently accurate point and interval estimates for both SRMR and RMSEA, especially in conditions with larger sample sizes, less missing data, more response categories, and higher degrees of misfit. Based on the findings, implications and recommendations were discussed. [ABSTRACT FROM AUTHOR]

Background: Screen time (ST), mainly social media (SM), has increased during the coronavirus 2019 (COVID-19) pandemic, impacting mental and physical health. This study aims to analyze SM use in young adults ages 18 to 28 years and lifestyle changes during COVID-19 to provide a baseline on pandemic habits in the younger population. Methods: An international cross-sectional observational study was conducted from September 2020 to January 2021. Participants responded about their SM behavior, and activities they noticed they did less and more during COVID-19. A total of 183 responses were analyzed. Results: The top reason respondents increased SM was for entertainment. Many respondents increased ST, physical activity (PA), and sleeping habits during COVID-19, while many decreased socialization, PA, and going outdoors. PA had mixed results among participants, indicating some increased PA and some decreased. Evidence suggests that timing of quarantining during the pandemic significantly influenced variables, like ST (P =.004) and socialization (P =.037). Discussion and Conclusion: Respondents generally noticed increased SM use for various reasons, including socialization, potentially explaining why respondents feel they socialize less. ST use increased; some people reported increased PA while others reported a decrease. Altogether, this provides vital context on young adults' SM and lifestyle habits, highlighting potential areas for further research. [ABSTRACT FROM AUTHOR]

Introduction/Objective: Venous Leg Ulcers (VLU) present a challenging healing process. Attaining healing is a primary treatment objective, commonly pursued in Primary Health Care (PHC) or Specialist Wound Management Clinics. Our objective was to examine the association and interplay between sociodemographic, health, clinical, and care factors with the outcomes of VLU treatment in patients undergoing care at a Specialist Wound Management Clinic. Methods: Longitudinal, observational study took place in a center for the treatment of chronic injuries linked to PHC. The sociodemographic aspects, health status and habits, clinical and care aspects of patients with VLU were scrutinized over a 1-year period. Results: The sample comprised 103 participants, with some still under treatment (Treatment Group—TG/ n = 60) and others having achieved VLU healing (Healing Group—HG/ n = 43). An association between sociodemographic, health, clinical, and care factors and the healing outcome (HG) was identified. A moderate correlation was observed between factors predisposing to healing in the sociodemographic group and health habits. Notably, among sociodemographic factors, the older age group and improvements in health, particularly the reduced use of alcohol/smoking, appeared to exert the most significant influence on healing. Additionally, specialized service monitoring and the application of compression therapy were contributory factors. Conclusions: These findings substantiate the hypothesis that sociodemographic, health, clinical, and care-related aspects are intertwined with VLU healing. Protective factors associated with healing interacted synergistically, fostering a positive outcome over one year of treatment. [ABSTRACT FROM AUTHOR]

Child maltreatment (CM) is a major global public health issue, and a strong association exists between CM and aggression. However, the underlying mechanism of this association has not been understood to date. The objective of this study was to explore the mediating role of irritability in the association between CM and aggression in Chinese early adolescents. A cross-sectional study was conducted using a self-report questionnaire to evaluate the levels of CM, aggression, and irritability in 5,724 middle school students from the Anhui Province, China. Structural equation modeling was used to test the hypothesis of the mediating effect of irritability on the relationship between CM and aggression. We further investigated gender differences in this association using multiple group analyses. CM was positively related to both irritability and aggression, and irritability was positively associated with aggression (p <.01). The mediating effects of irritability between CM and aggression were significant (β =.107, 95% confidence intervals [CI]: 0.077–0.133, p <.05). Males had a higher indirect effect size of the pathway from CM to aggression via irritability compared with females. Overall, irritability was a crucial mediator in the relationship between CM and aggression in Chinese adolescents, and males were more prone to engage in aggression compared with females through the pathway of irritability. Therefore, early irritability characteristics should be carefully monitored in adolescents, and they should be provided adequate support to acquire critical emotion regulation skills. [ABSTRACT FROM AUTHOR]