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In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. ACTRN12619000344190 [ABSTRACT FROM AUTHOR]

Background: The study tests the effects of data collection modes on patient responses associated with the multi-item measures such as Patient-Reported Outcomes Measurement System (PROMIS®), and single-item measures such as Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), and Numerical Rating Scale (NRS) measures. Methods: Adult cancer patients were recruited from five cancer centers and administered measures of anxiety, depression, fatigue, sleep disturbance, pain intensity, pain interference, ability to participate in social roles and activities, global mental and physical health, and physical function. Patients were randomized to complete the measures on paper (595), interactive voice response (IVR, 596) system, or tablet computer (589). We evaluated differential item functioning (DIF) by method of data collection using the R software package, lordif. For constructs that showed no DIF, we concluded equivalence across modes if the equivalence margin, defined as ± 0.20 × pooled SD, completely surrounds 95% confidence intervals (CI's) for difference in mean score. If the 95% CI fell totally outside the equivalence margin, we concluded systematic score difference by modes. If the 95% CI partly overlaps the equivalence margin, we concluded neither equivalence nor difference. Results: For all constructs, no DIF of any kind was found for the three modes. The scores on paper and tablet were more comparable than between IVR and other modes but none of the 95% CI's were completely outside the equivalence margins, in which we established neither equivalence nor difference. Percentages of missing values were comparable for paper and tablet modes. Percentages of missing values were higher for IVR (2.3% to 6.5% depending on measures) compared to paper and tablet modes (0.7% to 3.3% depending on measures and modes), which was attributed to random technical difficulties experienced in some centers. Conclusion: Across all mode comparisons, there were some measures with CI's not completely contained within the margin of small effect. Two visual modes agreed more than visual-auditory pairs. IVR may induce differences in scores unrelated to constructs being measured in comparison with paper and tablet. The users of the surveys should consider using IVR only when paper and computer administration is not feasible. [ABSTRACT FROM AUTHOR]

Background: The internet can provide evidence-based patient education to overcome time constraints of busy ambulatory practices. Health informationprescriptions (HIPs) can be effectivelyintegrated into clinic workflow, but compliance to visit health information sites such as Medline Plus is limited.Objective: Compare the efficacy of paper (pHIP)and email (eHIP) links to deliver HIPs; evaluate patient satisfaction with the HIP process and MedlinePlus information; assess reasons for noncompliance to HIPs.Method: Of 948 patients approached at two internal medicine clinics affiliated with an academic medical centre, 592 gave informed consent after meeting the inclusion criteria. In this randomised controlled trial, subjects were randomised to receive pHIP or eHIP for accessing an intermediate website that provided up to five MedlinePlus links for physician-selected HIP conditions. Patients accessing the intermediate website were surveyed by email to assess satisfaction with the health information.Survey non-responders were contacted by telephone to determine the reasons for no response.Results: One hundred and eighty-one patients accessed the website, with significantly more 'filling' eHIP than pHIP (38% vs 23%; P < 0.001). Most(82%) survey respondents found the website information useful, with 77% favouring email for future HIPs delivery. Lack of time, forgot, lost instructions or changed mind were reasons given for not accessing the websites.Conclusions: Delivery of MedlinePlus-based HIPs in clinic is more effective using email prescriptions than paper. Satisfaction with the HIP information was high, but overall response was low and deserves further investigation to improve compliance and related outcomes. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. Methods: We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). Results: Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = −0.04, 95%CI −0.16, 0.09, P =.58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. Conclusions: Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice. [ABSTRACT FROM AUTHOR]

The rising prevalence of obesity in children calls for new strategies for the provision of effective care by a multidisciplinary team. Telemedicine has overall proven to be an effective tool for promoting a healthy lifestyle. The main objective of the current paper is to present the protocol of our ongoing CardioMetabolic Prevention (CAMP) study and compare its design with published studies on telemedicine in paediatric obesity. Additionally, we analysed the preliminary anthropometric and laboratory data to test the efficacy of our 12-week intensive program that combines in-person and telemedicine support. The program demonstrated a positive impact on body mass index (BMI) and its z-scores in 21 adolescents, and BMI in 18 participating parents. However, we found no effect on body composition, waist circumference, cardiometabolic parameters, or fitness evaluated via a 6-min walk test in adolescents. In conclusion, the combination of in-person and telemedicine intensive support over 35 h delivered by a multidisciplinary team can be beneficial not only for adolescents with obesity but also for their parents. The ongoing CAMP study serves as a platform for precision medicine in future decisions regarding anti-obesity medication in adolescents with obesity. [ABSTRACT FROM AUTHOR]

Objective. This paper aims to systematically evaluate the intervention effect of mind-body exercise on cancer-related fatigue in breast cancer patients. Methods. Databases including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and SINOMED were retrieved to collect randomized controlled trials on the effects of mind-body exercise on relieving cancer-related fatigue in breast cancer patients. The retrieval period started from the founding date of each database to January 6, 2021. Cochrane bias risk assessment tools were used to evaluate the methodological quality assessment of the included literature, and RevMan 5.3 software was used for meta-analyses. Results. 17 pieces of researches in 16 papers were included with a total of 1133 patients. Compared with the control group, mind-body exercise can improve cancer-related fatigue in breast cancer patients. The combined effect size SMD = 0.59, 95% CI was [0.27, 0.92], p < 0.00001. Doing Tai Chi for over 40 minutes each time with an exercise cycle of ≤6 weeks can improve cancer-related fatigue in breast cancer patients more significantly. Sensitivity analysis shows that the combined effect results of the meta-analysis were relatively stable. Conclusion. Mind-body exercise can effectively improve cancer-related fatigue in breast cancer patients. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP. Methods: The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors' GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen's kappa (κ) coefficients for each category of cardiovascular problems. Results: We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32). Conclusions: Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Background: While research has explored the risk of periodontal disease in various eye conditions, the link between dry eye and periodontal disease remains underexplored, especially in Japanese adults. This study aims to investigate the association between dry eye and periodontal disease in community-dwelling Japanese adults. Methods: This study is a subset of the Uonuma cohort study, which includes Japanese adults aged 40 years and older residing in the Uonuma area of Niigata Prefecture, Japan. Participants completed a self-administered, paper-based questionnaire. Statistical analyses, including the chi-square test, independent t test, ANOVA test, and logistic regressions, were employed to assess the association of periodontal disease with independent variables. Results: Among 36,488 participants (average age 63.3 years, 47.4% men), 39.3% had a history of periodontal disease, and gender differences were statistically significant (p < 0.001). Significant associations were found between periodontal disease and dry eye diagnosis or symptoms. Univariable logistic regression revealed links between periodontal disease and age, gender, living status, alcohol consumption, remaining teeth, bite molar availability, and history of dry eye disease or symptoms. Multiple-adjusted regression found that doctor-diagnosed dry eye was associated with a higher likelihood of periodontal disease (odds ratio, 1.12; 95% confidence interval, 1.03–1.22). Participants who never experienced dryness or foreign body sensation had lower ORs of periodontal disease than those who always experienced such symptoms across all models. Conclusion: A significant correlation was found between dry eye and periodontal disease in Japanese adults. Regular check-ups, early detection, and effective management of both conditions are strongly recommended. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy remains a major global health issue, increasing the risk of complications during pregnancy and childbirth in mothers and babies. In Tanzania, adolescent pregnancy threatens girls' education and makes it difficult for them to obtain a proper job; hence, the majority fall into poverty. Previous studies have developed and conducted reproductive health education for adolescent students; however, they evaluated only the effect immediately after education. Therefore, this study investigated the effects of reproductive health education on attitudes and behaviors toward reproductive health among adolescent girls and boys one year after the intervention in rural Tanzania. Methods: A longitudinal quasi-experimental study was conducted with 3295 primary and secondary students (2123 in the intervention group, 1172 in the control group) from three purposefully selected wards in Korogwe District. In the intervention group, the students received reproductive health education. We used paper-based questionnaires to evaluate the effect of the adolescent education program on attitudes and behaviors toward reproductive health education. To analyze the association between the intervention and each outcome, mixed-effect multiple regression analyses was conducted. Results: The mean age, primary school proportion, and female proportion of the intervention and the control group was 13.05 (standard deviation (SD) 1.59), 14.14 (SD 1.7), 77.9% and 34.3%, and 54.2% and 52.6%, respectively. There was no statistically significant effect of reproductive health education on adolescent health attitudes and behaviors in the multiple regression analyses (coefficient: − 0.24 (95% confidence interval (CI): − 0.98 to 0.50), coefficient: 0.01 (95%CI: − 0.42 to 0.43)). Conclusion: A statistically significant effect of reproductive health education on adolescent health attitudes and behaviors was not found. An effective reproductive health education intervention to improve the attitude and behaviors of reproductive health among Tanzania adolescents in the long term remain to be determined, particularly in real-world settings. Trial registration The National Institute for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol. IX988). Plain Language Summary: Adolescent pregnancy increases the risk of complications during pregnancy and childbirth, which could cause death among 15–19-year-old girls. In Tanzania, one in four adolescents aged 15–19 began childbearing. However, there is no officially recognized curriculum for reproductive health in schools. Additionally, cultural and traditional norms prevent parents from discussing sexuality with their children. A solution to this issue is for a third party, such as a non-profit organization, to provide adolescents with adequate reproductive health education in schools. Previous studies have developed and evaluated a reproductive health education program and found significant effects on improved knowledge and behavior among adolescent girls and boys immediately after the intervention. This study examined the effects of reproductive health education on adolescents' attitudes and behavior toward reproductive health one year after the intervention in rural Tanzania. We could not find a statistically significant effect of reproductive health education on adolescents' attitudes and behavior during a one-year period in the multiple regression analyses. These results could have been influenced by the location of the intervention, contents, period of evaluation, and other potentially unknown factors. [ABSTRACT FROM AUTHOR]

INTRODUCTION Perceptions, personal perspectives, and public awareness of e-cigarette information have a significant impact on e-cigarette smoking behavior, and provide comprehensive information that can help reduce interest in e-cigarette smoking and reduce the number of new smokers. This study aimed to investigate the perceptions towards e-cigarettes related to e-cigarette use and how that information related to people's use of them. METHODS The data for this cross-sectional study were collected via an online questionnaire. Thai nationals who were aged >18 years provided data between June 2021 and January 2022. Multivariable logistic regression and the chi-squared test were used to analyze the data. RESULTS There were 340 respondents, 76 e-cigarette users, and 264 non-e-cigarette users. Most of the perceptions of information that differed statistically significantly between e-cigarette users and non-e-cigarette users included information on regulations, products, health effects, and the effectiveness of smoking cessation. The association between factors and e-cigarette smoking behavior revealed that the perception of the product information and male gender were associated with e-cigarette smoking behavior (AOR=13.59; 95% CI: 2.35-78.60, and AOR=5.19; 95% CI: 2.87-9.40, respectively). CONCLUSIONS The perception of e-cigarette product information and male gender were associated with e-cigarette smoking behavior. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study examined the prevalence of tobacco exposure and drinking and ascertained the relationships between tobacco exposure, alcohol drinking, concurrent smoking and drinking, and hypertension in rural southwestern China. METHODS Data were collected from a cross-sectional health interview and examination survey, which included 7572 adults aged ≥35 years, in rural China. Participant demographic characteristics, smoking habits, exposure to secondhand smoke (SHS), and alcohol drinking habits were obtained using a standard questionnaire. Blood pressure (BP), height, weight, and waist circumference were measured for each participant. RESULTS The overall prevalence of smoking, SHS exposure, drinking, concurrent smoking and drinking, concurrent exposure to SHS and drinking, and hypertension was 37.7%, 27.4%, 16.2%, 12.6%, 1.6%, and 41.3%, respectively. Males had a significantly higher prevalence of smoking (74.1% vs 2.2%, p<0.01), drinking (31.1% vs 1.7%, p<0.01), and concurrent smoking and drinking than females (25.3% vs 0.3%, p<0.01). However, females had a higher prevalence of SHS exposure than males (30.2% vs 20.6%, p<0.01). Ethnic minorities had a higher prevalence of SHS exposure, drinking, and concurrent smoking and drinking, than Han participants (p<0.01). Participants with a higher education level had a higher prevalence of smoking, drinking, and concurrent smoking and drinking than their counterparts (p<0.01). In contrast, participants with a lower education level had a higher prevalence of SHS exposure than their counterparts (p<0.01). Multivariate logistic regression analysis found that smokers (AOR=1.31; 95% CI: 1.13-1.51), individuals exposed to SHS (AOR=1.24; 95% CI: 1.11-1.43), drinkers (AOR=1.31; 95%: CI: 1.15-1.50), and concurrent smokers and drinkers (AOR=1.45; 95% CI: 1.25-1.67) all had a higher probability of having hypertension (p<0.01). Additionally, concurrent smoking and drinking had the strongest association with the prevalence of hypertension (AOR=1.45; 95% CI: 1.25-1.67; p<0.01). CONCLUSIONS Socioeconomic factors play an important role in influencing the prevalence of smoking, exposure to SHS, and drinking in rural southwest China. Interventions to prevent and reduce hypertension should, in particular, focus on smokers, individuals exposed to SHS, drinkers, and, in particular, concurrent smokers and drinkers. [ABSTRACT FROM AUTHOR]

INTRODUCTION Withdrawal symptoms lead to smoking relapse and reduce the intention to quit. The present pilot RCT examined the effect of simple and very brief handgrip and isometric exercises on reducing withdrawal symptoms, measured by the strength of tobacco craving, Questionnaire of Smoking Urges-Brief (QSU-B), Mood and Physical Symptoms Scale (MPSS), and Positive and Negative Affect Schedule (PANAS). METHODS In this 2-arm, open-labeled pilot RCT, 30 current smokers who had abstained from tobacco for at least 9 hours were randomly assigned (allocation ratio 1:1) to either the intervention group that watched a 5-minute video and did 5-minute handgrip and isometric exercises (pulling and pushing) or control group that watched 10-minute healthy-diet videos. Measurements were taken before, immediately after, and 10 minutes post-intervention. Outcomes were self-reported strength of tobacco craving, QSU-B, MPSS, and PANAS scores. The effect size for group-by-time interaction was assessed using Cohen's f² (small=0.02, medium=0.15, large=0.35). RESULTS Group-by-time interactions showed that the intervention group showed larger reductions than the control group in the strength of tobacco craving (Cohen's f²=0.54, 95% CI: 0.52-0.57), QSU-B (Cohen's f²=0.77; 95% CI: 0.74-0.80), and MPSS (Cohen's f²=0.51; 95% CI: 0.46-0.56) over the three measurement points. CONCLUSIONS This RCT showed that simple and brief handgrip and isometric exercises could immediately reduce withdrawal symptoms and up to 10 minutes. CLINICAL TRIAL REGISTRATION: in https://clinicaltrials.gov/IDENTIFIER: NCT04059497 [ABSTRACT FROM AUTHOR]

This paper investigates the interplay between environmental factors (socioeconomic status (SES) and parenting) and temperament in the development of inhibitory control (IC) at 2 years of age. We administered to toddlers (n = 59) a delay of gratification task which measures IC in the context of self-regulation. Parents reported their toddlers' temperament, parenting strategies, and SES. We hypothesized that poorer IC would be associated with more reactive temperament, less effortful control, lower SES and inconsistent/coercive parenting practices. Finally, we explored the interaction between temperament, parenting and SES. We found that both coercive parenting and low-SES were negatively correlated to IC at the age of 2 years. Temperamental reactivity was unrelated to IC, whereas temperamental effortful control (EC) was positively associated with IC. Results revealed a moderation effect of EC on the influence of coercive parenting and SES in toddlers' IC. Toddlers from lower SES backgrounds and with lower EC were more affected by inconsistent/coercive parenting practices and showed the poorest IC. In contrast, toddlers exhibiting high and average levels of EC seemed to be protected from the detrimental effect of low-SES and inconsistent/coercive parenting on IC. These results suggest that strengthening toddlers' EC and improving parents' parenting skills might be especially relevant for the development of IC in the context of self-regulation, particularly by preventing self-regulatory problems in children from socioeconomically deprived environments. Future studies with larger samples, focusing on populations from severe socioeconomically deprived environments, or intervention studies will be needed in order to confirm and expand our findings. [ABSTRACT FROM AUTHOR]

The current paper explores the relationship between technological knowledge, beliefs about technology use in education, beliefs about the limits of technology use with respect to children with disabilities, self-efficacy beliefs, and their effects on technology use or teacher practices in the special education setting regarding mathematics education. Research was conducted via an online questionnaire. A total of 83 teachers working in the field of special education answered the questionnaire. The answers were analyzed via quantitative and qualitative analyses. In addition, correlational analyses were conducted. A prediction model that included all the aforementioned variables was tested. Our regression analysis evidenced the strong predictive value of technology-related knowledge with respect to technology integration practices but not toward the other models that included beliefs. Through mediation analysis, we found that technology-related knowledge mediates the relationship between self-efficacy and technology integration practices. The qualitative findings provided information on the interplay between knowledge, practice, and beliefs that are contextualized; on the specificity of technology-related knowledge. Implications are discussed with reference to factors important for the professional development of teachers with regard to technology integration. [ABSTRACT FROM AUTHOR]

Orthodontic treatment is a common dental treatment. A complete treatment often takes several years and is costly. In order to increase the degree of satisfaction and reduce the gap between the expectations of the patient and the limitations of orthodontics, orthodontists and patients should have sufficient communication. A simulation system can provide a good channel for communication between orthodontists and patients. This paper proposes a 3D dentist–patient communication system for the simulation of orthodontics in advance. The system collects the clinical paradigms of orthodontic cases, which must contain photos from before, during, and after maxillofacial treatment. This research simulates treatment processes by tuning a 3D virtual model of the oral and maxillofacial areas, including the face, mouth, and teeth, to demonstrate the processes of clinical paradigms. These 3D models could be edited and synthesized to generate new 3D models for simulation with the 3DS Max tool. In addition, the proposed system provides a function for the orthodontist to manually operate the 3D virtual model, such as tooth arrangement, morphing of the gums with movement of the teeth, the placement (attachment) of arch-wires and brackets, and changes of facial appearance. The orthodontist can demonstrate the treatment processes, show movements of the teeth, and answer possible questions from the patient about the treatment processes by using the 3D model. To show the effectiveness of the proposed system, a questionnaire about the system was also used to demonstrate its acceptance, usability, and validity. Qualitative interviews with dentists and questionnaires for patients about the system are both performed. The results showed that the proposed system is an effective vehicle for communication between patients and orthodontists. [ABSTRACT FROM AUTHOR]

Exposure to allergens could be life-threatening for people with food allergies. Restaurants and cafes are challenging environments for accommodating food allergies. This study aimed to measure King Saud University female students' awareness about food allergens on restaurants' and cafes' menus. This cross-sectional study was conducted on 379 students aged 18 years and above. A paper-based questionnaire was used, which comprised 16 questions related to the definition of food allergies, food allergens, and food allergy symptoms; the definition and prevention of cross-contact of food allergies; emergency treatment procedures for food allergies; strategies for the prevention of food allergy reactions; customer expectations towards restaurants; and preventive measures taken for food allergies. The results indicate that the overall average score of food allergen awareness was 10.90, which falls in the higher range. Furthermore, female students in the age groups of 23 to 27 years and 33 to 37 years had higher levels of awareness than female students in the age group of 18 to 22 years. The results also showed that the level of awareness among science college and health college students was statistically significantly higher (p < 0.05) than that among humanities college students. Post-graduate students also showed a higher level of awareness of food allergens than bachelor's students. These findings also indicate that listing all allergens in the restaurants and cafes' menus statistically significantly (p < 0.05) increased the level of awareness of female students about food allergens on restaurants' and cafes' menus, compared to restaurants and cafes that do not list all allergens on their menus. In general, female students at King Saud University showed a high level of awareness about food allergies on restaurants' and cafes' menus. The study recommends assessing the impact of awareness of female students with and without food allergies on their practices and behaviors. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the effect of hardiness on the perceived military performance of reservists, i.e., young people who have full-time jobs in a civilian sector and perform military training as a part of their civic duty. We proposed the conceptual model with conditional indirect effects of the hardiness on personal military performance, where mediated moderation effects are observed from personality traits and variables important for military service: team cohesion, perceived stress, and psychological resilience. The final dataset was comprised of 384 self-reported paper–pencil questionnaires filled out by reserve soldiers, and PROCESS Macro 3.5 Model 7 and Model 14 were used for the analysis. The results revealed that perceived stress (Model 1) and psychological resilience (Model 2) have a statistically significant moderate mediating effect on the interlink between hardiness and performance when personality traits and team cohesion are taken into consideration. The change in R2 is statistically significant and explains how perceived stress and psychological resilience affect individuals. When psychological hardiness is low, the level of perceived stress has a statistically significant moderating effect, i.e., it reduces the effect of hardiness on performance. When comparing the effects of perceived stress and psychological resilience, the latter has a stronger moderating effect on performance. Specifically, the moderating effect of resilience was more evident in Model 2 (66.9% variance, r = 0.818) for the military performance of the reservists than the perceived stress in Model 1 (52.5% variance, r = 0.724). This means that resilience increases the accountability of Model 2 compared to Model 1 by 14.4%. We conclude that resilience training could statistically significantly increase the military performance of reserve soldiers as a tactical population. [ABSTRACT FROM AUTHOR]

Eating disorders (ED) in adolescents represent a significant problem in today's society, with multiple factors influencing them, such as predisposing factors, precipitating factors and perpetuating factors. Objective: This paper aimed to determine the relationships between some of the factors considered to be predisposing and precipitating in terms of the development of ED in adolescents and to relate them to the SCOFF index. Participants: The sample was made up of 264 subjects aged between 15 and 19 (48.8% females and 51.1% males). Methods: This study was conducted in two phases. In the first study phase, a descriptive analysis of the sample was performed, encompassing the frequencies of the independent variables and dependent variable (ED). In the second phase of study, we created several linear regression models. Results: A total of 11.7% of adolescents are at high risk for ED, and the variables that predict the variability of manifesting the danger of ED are the following: physical self-conception and family relationships. Conclusions: This work shows the need to approach eating disorders in a multidisciplinary way (biological and social), since this will enable the disease to be better conceptualized and prevention guidelines to be more effective. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking prevalence is high in China, and healthcare workers are important for tobacco control. This study aimed to determine the smoking status, cognition of tobacco hazards, and smoking cessation-related knowledge among respiratory healthcare workers, and to explore their ability to provide smoking cessation assistance. METHODS A cross-sectional study was conducted in 2021 among 1028 respiratory healthcare workers from 89 hospitals in Fujian Province, China. A self-designed electronic questionnaire was used to collect data on smoking status, knowledge of smoking hazards, and smoking cessation knowledge. Descriptive statistics were calculated for all questions. Logistic regression analysis was used to explore the relationship between awareness of the tobacco control goals of Healthy China 2030 and demographic characteristics. RESULTS Among the healthcare workers surveyed, 3.4% were smokers, all of whom were male. Most respondents (99.4%) were aware of smoking as a cause of lung cancer, but awareness of smoking as a cause of non-respiratory cancer was lower. The awareness rate of smoking cessation support was high (>90%), but only 40.0% of participants were aware of the Healthy China 2030 tobacco control targets. Male (HR=2.16; 95% CI: 1.69-2.80) and participation in the cessation clinic (HR=1.47; 95% CI: 1.10-1.96) were associated with higher awareness of the targets. CONCLUSIONS Respiratory healthcare workers in Fujian Province demonstrated a high level of awareness regarding behavioral and pharmacotherapy support for smoking cessation. In order to enable healthcare workers to play a more active role in tobacco control, there is a need to increase public awareness of smoking cessation services in Fujian Province. [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany. [ABSTRACT FROM AUTHOR]

Documentation of clinical outcomes is increasingly expected in delivery of prosthetic services and devices. However, many outcome measures suitable for use in clinical care and research have not been psychometrically tested with prosthesis users. The aim of this study was to determine test-retest reliability, mode of administration (MoA) equivalence, standard error of measurement (SEM), and minimum detectable change (MDC) of standardized, self-report instruments that assess constructs of importance to people with limb loss. Prosthesis users (N = 201) were randomly assigned to groups based on MoA (i.e., paper, electronic, or mixed mode). Participants completed two surveys 2 to 3 d apart. Instruments included the Prosthetic Limb Users Survey of Mobility, Prosthesis Evaluation Questionnaire--Mobility Subscale, Activities-Specific Balance Confidence Scale, Quality of Life in Neurological Conditions--Applied Cognition/General Concerns, Patient-Reported Outcomes Measurement Information System, and Socket Comfort Score. Intraclass correlation coefficients indicated all instruments are appropriate for group-level comparisons and select instruments are suitable for individual-level applications. Several instruments showed evidence of possible floor and ceiling effects. All were equivalent across MoAs. SEM and MDC were quantified to facilitate interpretation of outcomes and change scores. These results can enhance clinicians' and researchers' ability to select, apply, and interpret scores from instruments administered to prosthesis users. [ABSTRACT FROM AUTHOR]

FFQ are commonly used to examine the association between diet and disease. They are the most practical method for usual dietary data collection as they are relatively inexpensive and easy to administer. In Australia, the Cancer Council of Victoria FFQ (CCVFFQ) version 2 and the online Commonwealth Scientific and Industrial Research Organisation FFQ (CSIROFFQ) are used. The aim of our study was to establish the level of agreement between nutrient intakes captured using the online CSIROFFQ and the paper-based CCVFFQ. The CCVFFQ and the online CSIROFFQ were completed by 136 healthy participants. FFQ responses were analysed to give g per d intake of a range of nutrients. Agreement between twenty-six nutrient intakes common to both FFQ was measured by a variety of methods. Nutrient intake levels that were significantly correlated between the two FFQ were carbohydrates, total fat, Na and MUFA. When assessing ranking of nutrients into quintiles, on average, 56 % of the participants (for all nutrients) were classified into the same or adjacent quintiles in both FFQ, with the highest percentage agreement for sugar. On average, 21 % of participants were grossly misclassified by three or four quintiles, with the highest percentage misclassification for fibre and Fe. Quintile agreement was similar to that reported by other studies, and we concluded that both FFQ are suitable tools for dividing participants’ nutrient intake levels into high- and low-consumption groups. Use of either FFQ was not appropriate for obtaining accurate estimates of absolute nutrient intakes. [ABSTRACT FROM PUBLISHER]

Individuals' gender development is influenced by the characteristics of personal and contextual environments. However, the role of sibling contexts in shaping gender norms has rarely been studied among Chinese youth at early adolescence as most of them were the only child. The aim of this paper is to compare perceived gender norms among adolescents aged 10–14 with different sibling configurations, to help inform and tailor guidance for sexual and reproductive health education in the future. We used the Global Early Adolescent Study baseline data collected from Shanghai, China. The sample for analysis was 1615 students. We used univariate analysis and multivariate ordinal logistic regression to compare perceived gender-stereotyped traits and gender role attitudes, stratified by age and sex. The results showed that sibling context was more influential for boys than girls at early adolescence in their gender socialization process. Among boys those who were with mixed-sex siblings scored higher on gender-stereotyped traits (ORonly-childvs. mixed-sex siblings = 0.67, 95% CI: 0.48–0.94, p = 0.019; ORsame-sex siblingsvs. mixed-sex siblings = 0.59, 95% CI: 0.37–0.96, p = 0.033). Younger early adolescents aged 10–12 who were the only child or who had mixed-sex siblings perceived more traditional gender role attitudes than those living with same-sex siblings (ORonly-childvs. same-sex siblings = 1.71, 95% CI: 1.06–2.75, p = 0.028; ORmixed-sex siblingsvs. same-sex siblings = 1.74, 95% CI: 1.03–2.94, p = 0.037). Comprehensive sexuality education with gender and power components being well addressed, both in and out of the family, is needed to provide extra gender-inclusive and gender-egalitarian environments for youth. [ABSTRACT FROM AUTHOR]

INTRODUCTION To explore the current situation of exposure of Korean adolescents to secondhand smoke (SHS) in households our study aimed to determine the relationship between family member smoking status, exposure to tobacco information through mass media, and household SHS exposure. METHODS The present study uses pooled data from the Korean adolescent health behavior online survey conducted in 2015, 2018 and 2021, with 157944 participants. The regression models were used to explore the association between the smoking status of households, and exposure to tobacco information through mass media, and household SHS exposure in adolescents, controlling for potential confounding factors. RESULTS SHS exposure duration of Korean adolescents in households was 0.88 days per week. The households with smokers including the father (β=1.087; 95% CI: 1.0--1.126), mother (β=1.461; 95% CI: 1.379-- 1.543), siblings (β=0.545; 95% CI: 0.493--0.597), grandparents (β=0.224; 95% CI: 0.174--0.272), and other relatives (β=0.170; 95% CI: 0.126--0.214), showed a positive association with SHS exposure in adolescents within the household. At the same time, information about anti-smoking ads on television (β= -0.042; 95% CI: -0.069 -- -0.015) and public transportation (β= -0.031; 95% CI: -0.054 -- -0.010), showed a negative association with SHS exposure in adolescents. However, broadcasts, online, and newspaper non-smoking ads were not associated with SHS exposure (p>0.05). In addition, regression models revealed that exposure to cigarette advertising in magazines (β=0.131; 95% CI: 0.097--0.166), networks (β=0.151; 95% CI: 0.127-- 0.175), convenience stores (β=0.061; 95% CI: 0.035--0.087), and supermarkets (β=0.133; 95% CI: 0.108--0.158) is associated with SHS exposure in adolescents. Finally, our study showed stronger ties between SHS exposure, family smoking, and tobacco ads in girls. The link between maternal smoking, supermarket ads, and adolescent SHS exposure intensified in 2021 compared to 2015. CONCLUSIONS Family and media were identified as potential factors associated with SHS exposure in adolescents. Therefore, publicity and education regarding household SHS hazards, and smoking bans in media, can be helpful in protecting adolescents from SHS. [ABSTRACT FROM AUTHOR]

INTRODUCTION The global tobacco epidemic poses a notable challenge to global health due to its association with various tobacco-related diseases. Although tobacco smoking is associated with depression, the exact mechanism by which tobacco smoking increases the risk of depression is unclear. This study explored the potential effects of tobacco smoking on depression. METHODS We used data in the analysis from the Taiwan Biobank of 27916 individuals recruited from 2015 to 2020. To investigate the associations between tobacco use and depression, the results of the depression-measuring subscale of the Patient Health Questionnaire-4 as well as data on participants' tobacco consumption and other relevant covariates, were analyzed. RESULTS Participants who smoked were more likely to report depression than those who did not smoke (AOR=1.50; 95% CI: 1.21-1.86). Furthermore, depression was significantly higher in women who smoked than in their male counterparts (females: AOR=1.68; 95% CI: 1.27-2.23, and males: AOR=1.32; 95% CI: 0.96- 1.80). Women aged <55 years and who smoked were more likely to report depression, whereas this trend was not observed in those aged ≥55 years (<55 years: AOR=1.75; 95% CI: 1.23-2.48), and ≥55 years: AOR=1.58; 95% CI: 0.97- 2.56). CONCLUSIONS Tobacco smoking is a significant factor associated with depression, particularly in younger women. The increasing prevalence of tobacco use for years among younger women in Taiwan might contribute to shifts in the associations between depression and tobacco use in women. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to investigate the prevalence, emotional and follow‐up burden of insulin injection‐related needle‐stick injuries among clinical nurses. Background: needle‐stick injures introduce statistically significant occupational hazards to healthcare workers. Although the large proportion of the needles injuries attributed to insulin injection, research evidence about the prevalence, emotional and follow‐up burden of such injures is lacking. Design: Cross‐sectional study. Methods: 5389 nurses were recruited from 45 hospitals in Shaanxi, China, from November 2018 to July 2019. Participants were administrated with a questionnaire specifically developed for this study. Descriptive statistics were used to present the findings. Results: All 5,389 nurses responded to the survey, of which 396 (7.4%) participants experienced 620 insulin injection‐related needle‐stick injuries in the past year, representing an annual prevalence of 115.0 per 1000 nurses. The annual prevalence of infection caused by the injuries was 18.7 per 1000 nurses. The injuries occurred most frequently when nurses were recapping the needle (42.4%). In the majority (98.4%) of the injuries, the hurt nurses took proper immediate actions. However, only 30.3% of nurses reported the injuries to the administrative staff, and in 43.2% of the injuries, the nurses refused or discontinued the suggested follow‐up. A large proportion (58.6%) of the hurt nurses experienced emotional changes. Multivariate logistic regression showed that department, removing and/or setting back needle caps with bare hands, frequency of insulin pen and syringes are associated with the incidence of insulin injection‐related needle‐stick injuries. This paper is reported following the STROBE recommendations. Conclusions: This survey demonstrated a considerably high prevalence of insulin injection‐related needle‐stick injuries among clinical nurses. Even though the majority of the hurt nurses took proper immediate actions, a large quantity of them failed to report the accidents to the administrative staff and complete the suggested follow‐up. Nurses who suffered from insulin injection‐related needle‐stick injuries were subject to various negative emotional changes. It portends a statistically significant risk to occupational health management for nurses. Relevance to clinical practice: Scientific preventive and management strategies are desirable in order to minimize the consequences of insulin injection‐related needle‐stick injuries. [ABSTRACT FROM AUTHOR]

Objective: Community day-care centers (or crèches) are gaining popularity; access to these centers can reduce cognitive gaps. This paper describes the sustained impact of enrollment in day-cares on cognitive gains. Methods: As part of a larger study, a census of all children was conducted in 2012–2013 to identify children between 9 and 17 months of age in rural Bangladesh. A sub-sample of children (n = ~1000) were assigned to receive either a day-care or playpen. Children from two sub-districts were randomly selected and assessed at 9–17 months of age for cognitive and behavioral domains using the Ages and Stages Questionnaire-III. The same children were then followed-up with after one year to see if the scores obtained by the children in the day-care intervention were different from those enrolled in the playpen intervention using a difference-in-difference estimator. Results: Children enrolled in the day-care intervention performed better (in communication, gross-motor, personal-social, and problem-solving domains) than children enrolled in the playpens when followed up with after a one-year period. Total scores were 0.31 (95% CI 0.141–0.472) higher (p value < 0.001) among children in the day-cares. Family care indicators as well as the child's and mother's weight were significantly associated with sustained and increased cognitive gains. Conclusion and relevance: The cognitive and psychosocial improvements seen with short-term exposure to structured ECD programs (day-care) were observed to be sustained over time with continued exposure. Home stimulation and parental involvement add to the long-term benefits of ECD. [ABSTRACT FROM AUTHOR]

Introduction: Secondary traumatic stress is highly prevalent among nurses, especially among nurses working within the emergency department (ED). Reducing healthcare worker secondary traumatic stress is important for ensuring the delivery of high quality, safe patient care. This paper reports on the development and implementation of a secondary traumatic stress reduction program. Methods: We used an adaption of a 5-week intervention based on the Accelerated Recovery Program to test whether there would be a reduction in secondary traumatic stress in a pilot sample of nine ED nurses. Outcomes were assessed using the Secondary Traumatic Stress Scale (STSS), Somatic Symptoms Scale (SSS), and Compassion Satisfaction subscale (CSS) measures. Results: Eight of nine nurses were able to complete at least three of the five sessions. Results indicate significant change in STSS (F[5,23] = 4.22, p =.007) and SSS (F[3,15] = 4.42, p =.02) scores, but not CSS (F[5,23] = 0.83, p =.54) scores. Pairwise comparisons revealed that the beneficial effects of the program happened early. For both STSS and SSS, scores at sessions 1 and 2 were generally higher than subsequent sessions. We also found a trend for continued effects on STSS at a four-month follow-up (t23 = 1.95, p =.064). Conclusion: Overall, results indicate the 5-week program was associated with a significant reduction in secondary traumatic stress and related somatic symptoms in healthcare workers. [ABSTRACT FROM AUTHOR]

INTRODUCTION The use of e-cigarettes has steadily increased, and vocational students are one primary target of e-cigarette marketing. This cross-sectional survey research aimed to explore e-cigarette use and examine the factors associated with it. METHODS Multistage cluster random sampling was employed to select 1536 students in vocational education institutions. A self-administered questionnaire was used to collect the data from September to December 2019. Multinomial logistic regression analysis was used to obtain the adjusted odds ratio (AOR) to determine the associated factors of e-cigarette use. RESULTS Altogether, 28.7% of the subjects were currently e-cigarette users, 7.4% used e-cigarettes only, and 21.3% were dual users. Various factors were found to be significantly associated with e-cigarette use by 43.7%. Those consisted of sex (male) (AOR=2.183; 95% CI: 1.510-3.157), grade point average (GPA) of <2.5 (AOR=2.363; 95% CI: 1.502-3.717), having neutral attitudes toward e-cigarette use (AOR=2.676; 95% CI: 1.499-4.779) and positive attitudes toward e-cigarette use (AOR=4.171; 95% CI: 2.250-7.734), moderate level of perceived behavioral control on e-cigarette use (AOR=3.520; 95% CI: 2.287-5.418) and low level of perceived behavioral control on e-cigarettes use (AOR=4.959; 95% CI: 3.274-7.511), moderate price of e-cigarettes (AOR=1.436; 95% CI: 1.009-2.044), and e-cigarette use of their parents (AOR=1.827; 95% CI: 1.137-2.938), close friends (AOR=4.327; 95% CI: 2.954-6.338) and idols (AOR=4.604; 95% CI: 1.844-11.497). CONCLUSIONS Students should be encouraged to develop negative attitudes toward e-cigarette use and increase their self-confidence to control the use of e-cigarettes. This can be achieved by regularly distributing information on the product's risks. Moreover, students can find inspiration and guidance from peers, close friends, or their idols, who will act as positive role models and inspire them not to initiate e-cigarette use. [ABSTRACT FROM AUTHOR]

Background: As a common social phenomenon, nurses' occupational burnout has a high incidence rate, which seriously affects their mental health and nursing level. The current assessment mostly uses the total score model and explores the influence of external factors on burnout, while the correlation between burnout items or dimensions is less explored. Ignoring the correlation between the items or dimensions may result in a limited understanding of nurse occupational burnout. This paper explores the item and dimension network structure of the Maslach Burnout Inventory-General Survey (MBI-GS) in Chinese nurses, so as to gain a deeper understanding of this psychological construct and identify potential targets for clinical intervention. Methods: A total of 493 Chinese nurses were recruited by cluster sampling. All participants were invited to complete the survey on symptoms of burnout. Network analysis was used to investigate the item network of MBI-GS. In addition, community detection was used to explore the communities of MBI-GS, and then network analysis was used to investigate the dimension network of MBI-GS based on the results of community detection. Regularized partial correlation and non-regularized partial correlation were used to describe the association between different nodes of the item network and dimension network, respectively. Expected influence and predictability were used to describe the relative importance and the controllability of nodes in both the item and dimension networks. Results: In the item network, most of the strongly correlated edges were in the same dimension of emotional exhaustion (E), cynicism (C) and reduced professional efficacy (R), respectively. E5 (Item 5 of emotional exhaustion, the same below) "I feel burned out from my work", C1 "I have become more callous toward work since I took this job", and R3 "In my opinion, I am good at my job" had the highest expected influence (z-scores = 0.99, 0.81 and 0.94, respectively), indicating theirs highest importance in the network. E1 "I feel emotionally drained from my work" and E5 had the highest predictability (E1 = 0.74, E5 = 0.74). It shows that these two nodes can be interpreted by their internal neighbors to the greatest extent and have the highest controllability in the network. The spinglass algorithm and walktrap algorithm obtained exactly the same three communities, which are consistent with the original dimensions of MBI-GS. In the dimension network, the emotional exhaustion dimension was closely related to the cynicism dimension (weight = 0.65). Conclusions: The network model is a useful tool to study burnout in Chinese nurses. This study explores the item and domain network structure of nurse burnout from the network perspective. By calculating the relevant indicators, we found that E5, C1, and R3 were the most central nodes in the item network and cynicism was the central node in the domain network, suggesting that interventions aimed at E5, C1, R3 and cynicism might decrease the overall burnout level of Chinese nurses to the greatest extent. This study provides potential targets and a new way of thinking for the intervention of nurse burnout, which can be explored and verified in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction Collabo RATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate Collabo RATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete Collabo RATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the Collabo RATE score. Results While Collabo RATE score increased only slightly with increasing patient age ( OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher Collabo RATE scores ( OR 1.224, 95% CI 1.073-1.397). Clinician also predicts Collabo RATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to Collabo RATE scores, with Site 3 scoring significantly higher than Site 1 ( OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that Collabo RATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. [ABSTRACT FROM AUTHOR]

INTRODUCTION Few studies have examined the effect of feedback based on oral-malodor measurements on the motivation to quit smoking. Therefore, this study examined whether oral-malodor measurements were associated with the intention to quit smoking. METHODS This retrospective, uncontrolled before-after study invited smokers to a workplace health event in 2019 and 2020 to motivate them to quit smoking. They attended seminars on oral health and smoking cessation aids, and then underwent respiratory function and oral-malodor measurements using exhaled and oral cavity air, respectively. Intention to quit smoking was evaluated by answers to questions regarding the intention to quit in the next 1 or 6 months in questionnaires collected before and after the event. This study analyzed 241 men aged 20-54 years (mean: 33.2 ± 10.5) to examine factors associated with the intention to quit in multivariable logistic regression analyses for age, tobacco type (cigarettes and heated-tobacco products), and category of tobacco consumption. RESULTS Before the event, 8.7%, 17.0%, and 74.3% of smokers had intended to quit in the next month, the next six months, or had no intention to quit, respectively. After the event, the respective percentages were 17.8%, 26.6%, and 55.6%. A higher methyl mercaptan concentration, a volatile sulfide component of oral malodor, was significantly associated with the intention to quit in the next month (adjusted odds ratio, AOR=4.24; 95% CI: 1.52-11.8, p=0.006). The participants with higher daily tobacco consumption were less likely to acquire the intention to quit in the next six months (A0R=0.37; 95% CI: 0.15-0.92, p=0.032). Other variables, such as lung age deficit, exhaled CO concentration, and hydrogen sulfide concentration (another component of oral malodor), were not significantly associated. CONCLUSIONS Oral-malodor measurement feedback may help motivate men to quit smoking in the next 1 month rather than in the next six months. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aimed to investigate the impact of smoking on physical activity level, emotional status, and cardiopulmonary endurance in healthy young Chinese college students in order to develop future nicotine dependence management solutions. METHODS This survey-based study was conducted in college students aged 19-26 years who were currently smoking. Cardio-respiratory endurance was assessed by estimating VO2max. Participants were given a questionnaire containing five factors from the Cigarette Dependence Scale-5 (CDS-5), also assessed were variables for physical activity level, using the Global Physical Activity Questionnaire (GPAQ), and emotional status. The sports training behavior was assessed using the Coaching Behavior Scale for Sport (CBS-S). RESULTS A total of 400 participants were randomly selected and included in the study. All of them were current smokers. The highest percentage of participants had a score of 4 on the CDS-5 (n=93, 23.2%), scored 3-5 on each module of sports training, and experienced negative emotions, particularly depression (n=172; 43.0%) and anger (n=162; 40.5%). VO2max levels were significantly lower in participants with high nicotine dependence (CDS-5 score 4-5), and they correlated negatively with CDS-5 scores (r= -0.883, p<0.001). Nicotine dependence scores were negatively correlated with physical activity levels (r= -0.830, p<0.001), and high nicotine dependence scores were independently related to low physical activity (adjusted odds ratio, AOR=14.66; 95% CI: 4.98- 43.19, p<0.001). CONCLUSIONS Tobacco smoking has a negative impact on emotional status. It also reduces cardiopulmonary endurance by reducing VO2max levels and negatively affects physical activity. Accordingly, it is critical to implement effective tobacco prevention programs for college students, such as a smoking warning system and physical exercise training, as well as to educate them on how to quit smoking. [ABSTRACT FROM AUTHOR]

Background: The requirement to meet the palliative needs of acute hospital populations has grown in recent years. With increasing numbers of frail older people needing hospital care as a result of both malignant and nonmalignant conditions, emphasis is being placed upon understanding the physical, psychological and social burdens experienced by patients. This study explores the extent of burden in two large UK hospitals, focusing upon those patients who meet palliative care criteria. Furthermore, the paper explores the use of palliative services and identifies the most significant clinical diagnostic and demographic factors which determine physical and psychological burden. Methods: Two hospital surveys were undertaken to identify burden using the Sheffield Profile for Assessment and Referral to Care (SPARC). The Gold Standards Framework (GSF) is used to identify those patients meeting palliative care criteria. Participants were identified as being in-patients during a two-week data collection phase for each site. Data was gathered using face-to-face interviews or self-completion by patients or a proxy. Descriptive analyses highlight prevalence and use of palliative care provision. Binary logistic regression assesses clinical diagnostic predictor variables of physical and psychological burden. Results: The sample consisted of 514 patients and elevated physical, psychological and social burden is identified amongst those meeting palliative care criteria (n = 185). Tiredness (34.6%), pain (31.1%), weakness (28.8%) and psychological discomfort (low mood 19.9%; anxiety 16.1%) are noted as being prevalent. A small number of these participants accessed Specialist Palliative Care (8.2%). Dementia was identified as a predictor of physical (OR 3.94; p < .05) and psychological burden (OR 2.88; p < .05), being female was a predictor of psychological burden (OR 2.00; p < .05). Conclusion: The paper highlights elevated levels of burden experienced by patients with palliative care requirements. Moreover, the paper also indicates that a large proportion of such patients are not in receipt of palliative approaches to their care. Furthermore, the paper identifies that those with non-malignant illnesses, especially dementia, may experience high levels of physical and psychological burden. [ABSTRACT FROM AUTHOR]

Background: The prevalence of pediatric mental illnesses has been increasing in recent years, with a great potential to impact on individual's functionality and adaptation in adulthood. Objective: This study aims to assess emotional and behavioral problems among schoolchildren in Herat City of Afghanistan. Methods: This cross-sectional study was conducted on schoolchildren (grade 5-10), between September and November 2021. Sociodemographic data was collected using a paper-based 14-item structured questionnaire. Data on emotional and behavioral problems was collected using the Strengths and Difficulties Questionnaire (SDQ) based on teachers' and children's report. Statistical analyses were performed in IBM SPSS Statistics (version 27). Results: A total of 418 students, including 190 (45.5%) males and 228 (54.5%) females with a mean age of 14.1 ± 1.7 (11 < 18) years were included in the study. The prevalence of students' self-reported total difficulties and prosocial problem were 5.7% and 1.2%, respectively. An insignificant difference was observed between mean total difficulties scores between students' self-reported and teachers' reported SDQ. Gender, grade, concern about shortage of food, and concern about losing house were significantly predicting students' self-reported total difficulties scores. Conclusion: This is the first study to report the prevalence of emotional and behavioral problems among schoolchildren in Herat City, Afghanistan. This, together with relevant global literature, highlight the need to address pediatric mental health, and provide services aimed at preventing, and treating children with these problems around the world. [ABSTRACT FROM AUTHOR]

INTRODUCTION The home is the primary source of children's exposure to secondhand smoke. This study investigated the status and influencing factors of child exposure to secondhand smoke at home when people smoke in the household. METHODS Participants with at least one child living in their household from 10 communities in Chongqing were recruited and provided a self-administered questionnaire using a multistage proportional random sampling design from June to August 2021. The chi-squared test and binary logistic regression analyses were used to identify influencing factors. RESULTS The questionnaire completed by 1345 families showed that 631 (46.9%) families lived with smokers in their household, and 509 (80.7%) of those families reported that smoking occurred within the home while the children were present. Binary logistic regression analyses demonstrated that the time between waking up and household smokers having the first cigarette of the day (OR=0.44; 95% CI: 0.22-0.85), changes to smoking habits and behaviors within the last six months (OR=1.76; 95% CI: 1.06-2.90), attitudes towards tobacco control in the household (OR=2.91; 95% CI: 1.72-4.92), self-efficacy in maintaining a smoke-free home (OR=2.27; 95% CI: 1.36-3.79), having rules to maintain a smoke-free home (OR=3.25; 95% CI: 1.68-6.29), and the status of providing cigarettes to guests at home (OR=11.0; 95% CI: 1.33-90.8) were associated with exposure to SHS. CONCLUSIONS Education focusing on the impact of smoking on children's health should be encouraged. Smoke-free homes should be established, and smoking restrictions in the household should be enacted. Therefore, information about the available tobacco-control services should be given to family members and be used properly. It is an effective way to decrease the risk of at-home exposure to SHS for children, to overcome any obstacles in tobacco control. [ABSTRACT FROM AUTHOR]

INTRODUCTION Many studies have shown that training in smoking cessation care (SCC) is important for increasing the number and quality of delivered interventions by health professionals, and various training methods are available. The study aimed to identify the relationship between receiving training on SCC and the frequency of providing outpatient-based SCC among pulmonologists who were members of the Turkish Thoracic Society (TTS). METHODS For this cross-sectional study, a self-administered online questionnaire-based survey was conducted on a group of active pulmonologists who were members of the TTS, between April and October 2019. The survey included questions about demographics, smoking status, participation in SCC training, and providing outpatient-based SCC. RESULTS A total of 199 (53%) pulmonologists were actively taking part in outpatient-based SCC. Compared to those that were not providing outpatient-based SCC, median age, median time since graduation, and the number of non-academics, non-current smokers and recipients of smoking cessation care training were significantly higher in the group providing outpatient-based SCC (p<0.001, p<0.001, p=0.002, p=0.001, respectively). It was observed that having SCC training increased more than 6-fold the likelihood of providing outpatient-based SCC (AOR=6.45; 95% CI: 3.96--10.49; p<0.001). CONCLUSIONS The most crucial obstacle in providing smoking cessation is healthcare workers not providing smoking cessation to smokers. It is worthwhile to devote more tasks and resources to training physicians on smoking cessation care since this may increase their effective involvement in tobacco cessation. [ABSTRACT FROM AUTHOR]

Background: An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India.Methods: Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics.Results: We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking.Conclusions: This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness. [ABSTRACT FROM AUTHOR]

Background Unhealthy lifestyle and diet may contribute to the development of cardiovascular disease (CVD), but limited evidence exists regarding the association between sleep patterns, oxidative stress-related exposures to diet and lifestyle, and CVD risk. Methods We analysed data from 10212 adults in the National Health and Nutrition Examination Survey (NHANES) database (2005-2018). Self-report questionnaires were used to collect data on sleep duration, sleepiness, and trouble sleeping, classified into three categories: healthy, intermediate, and poor sleep patterns. Healthy sleep was defined as sleeping seven to nine hours per night with no self-reported sleepiness or trouble sleeping, while intermediate and poor sleep patterns indicated one and two to three sleep problems, respectively. The oxidative balance score (OBS) was calculated based on twenty oxidative stress-related exposures to dietary and lifestyle factors, with a higher score indicating greater antioxidant exposure. Survey-based multivariable-adjusted regression analysis was conducted to examine the association of sleep patterns or OBS alone and combined with the total and specific CVD risk. Results Participants with poor sleep patterns had a higher likelihood of developing CVD (odds ratio (OR)=1.76; 95% confidence interval (CI)=1.26-2.45, P<0.05), while an inverse association was found between OBS and CVD risk (quartile (Q) 4 vs Q1: OR=0.67; 95% CI=0.47-0.94, P=0.02, P for trend <0.05). There was an interaction between sleep patterns and OBS (P for interaction=0.03). Participants with unhealthy (intermediate and poor) sleep patterns and pro-oxidant OBS (Q1 and Q2) were significantly associated with increased risk of total CVD (OR=2.31; 95% CI=1.42-3.74, P<0.05), as well as angina and congestive heart failure, but not coronary heart disease (CHD). Stratified analysis showed that among individuals without hyperlipidaemia, participants with both unhealthy sleep patterns and pro-oxidant OBS exhibited a higher risk of CHD compared to those with healthy sleep patterns and antioxidative OBS. Conclusions Unhealthy sleep patterns and reduced oxidative balance are positively associated with an increased risk of overall and specific CVD. Interventions that target healthy sleep habits and antioxidant-rich diets and lifestyles may be important for reducing the risk of CVD. [ABSTRACT FROM AUTHOR]

Background Education levels play a critical role in the development of chronic obstructive pulmonary disease (COPD), which mainly affects the elderly, who generally have a low level of education in China. We aimed to investigate the association between education level and COPD clinical characteristics and outcomes, especially the effects of education level on the all-cause mortality of COPD in the Chinese population. Methods We retrieved data collected between December 2016 and June 2020 in the RealDTC, an ongoing multicenter, real-world study on the status of diagnosis and treatment of COPD. The patients were classified into low- and high-education groups. We extracted data on demographics, pulmonary function, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, modified Medical Research Council (mMRC) scores, COPD Assessment Test (CAT) scores, exacerbation history, therapy, and comorbidities, and on mortality during three years of follow-up. Results We included 4098 patients with COPD, of whom 3258 (79.5%) were of low education. This group had higher ages, CAT scores, mMRC scores, and numbers of exacerbations, as well as a greater proportion of females, never smokers, biofuel exposure, and GOLD grade 3. Logistic regression showed that being aged ≥65 years, being female, having biofuel exposure, having CAT scores of 20-29, and having ≥2 exacerbations were independently associated with having low education (P < 0.05). Furthermore, low-education COPD patients had a higher cumulative mortality risk during three years of follow-up than their high-education counterparts (hazard ratio (HR) = 1.75; 95% confidence interval (CI) = 1.17-2.61, P = 0.006). Conclusions Low-education COPD patients, who accounted for most of our sample, had a higher symptom burden, risk of exacerbation, and risk of all-cause mortality. Clinicians attending COPD patients should be more attentive of individuals with low education levels. [ABSTRACT FROM AUTHOR]

Background Health literacy is a global problem and is particularly relevant when making health care decisions about small children. We analysed how parents of preschool children assess health claims and explored the predictors of their assessment skill. Methods We conducted a survey with questions from the Claim Evaluation Tools (CET) database, part of the Informed Health Choices (IHC) project, in ten paediatric primary care practices of the Split-Dalmatia County Health Center, Split, Croatia, from 1 February to 31 March 2023. Eligible participants were parents accompanying preschool-aged children for check-ups. We also collected data on parents' and children's demographic and health characteristics (including the presence of any chronic illness in the child), visits to paediatric emergency service, hospitalisations, vaccination status, the presence of chronic illness of parents or relatives, and whether parents had to made treatment decisions for themselves and/or their family member. Results Overall, 402 parents of preschool children (median age 35 years (interquartile range (IQR) = 31.0-38.3)) had a median IHC CET test score of 10.0 (IQR = 8.0-11.0) out of 12 questions. The multiple regression analysis showed that female gender, higher level of education, being employed, and having a history of a visit to paediatric emergency service were significant predictors of the test score, explaining 21.9% of the variance. Conclusions Parents of preschool children have a very good ability for critical assessment of health-related statements in a complex health care system and an environment of generally unsatisfactory health literacy. Further studies should explore how parents understand health claims in different geographical, socio-economic and cultural setting, and explore educational interventions to increase critical thinking abilities and informed decision-making, especially among fathers, unemployed parents and those with lower levels of education. [ABSTRACT FROM AUTHOR]

Background Suboptimal health status (SHS) is a non-clinical or pre-disease state between optimal/ideal health and disease. While its etiology remains unclear, lifestyle is considered one of the most important risk factors. We aimed to examine the effects of lifestyles on SHS through a nationwide survey in China. Methods We conducted a cross-sectional survey in 148 cities across China between 20 June and 31 August 2022, on 30505 participants from rural and urban communities gathered through stratified quota sampling. We measured SHS with the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF). We gathered information on participants' lifestyles (ie, smoking, alcohol consumption, breakfast habits, weekly food delivery frequency, intermittent fasting, sleep duration and physical activities) through face-to-face interview. We determined the relationship between lifestyle and SHS logistic regression analysis by based on odds ratios (ORs) and 95% confidence intervals (CIs). Results We included 22897 participants (female: 13056, male: 9841), 12 108 (52.88%) of whom reported exposure to SHS. After adjusting for demographic characteristics, individuals who currently smoked (OR = 1.165; 95% CI = 1.058-1.283) and those who drank alcohol (OR = 1.483; 95% CI = 1.377.1.596) were at a higher risk of SHS than those who have never done either. In a dose-response way, takeaway food consumption was associated with a higher risk of SHS, while increased frequency of breakfast and mild-intensity exercise conversely reduced said risk. Individuals with shorter sleep duration had a higher risk of SHS when compared to those who slept for more than seven hours per day. Conclusions We observed a relatively high prevalence of SHS across China, highlighting the importance of lifestyle in health promotion. Specifically, adopting healthy dietary habits, engaging in regular physical activity, and ensuring high-quality sleep are key in preventing SHS. [ABSTRACT FROM AUTHOR]

Background: Mental disorders are largely socially determined, yet the combined impact of multidimensional social factors on the two most common mental disorders, depression and anxiety, remains unclear. Methods: We constructed a polysocial risk score (PsRS), a multidimensional social risk indicator including components from three domains: socioeconomic status, neighborhood and living environment and psychosocial factors. Supported by the UK Biobank cohort, we randomly divided 110 332 participants into the discovery cohort (60%; n = 66 200) and the replication cohort (40%; n = 44 134). We tested the associations between 13 single social factors with Patient Health Questionnaire (PHQ) score, Generalized Anxiety Disorder Scale (GAD) score and self-reported depression and anxiety. The significant social factors were used to calculate PsRS for each mental disorder by considering weights from the multivariable linear model. Generalized linear models were applied to explore the association between PsRS and depression and anxiety. Genome-wide environmental interaction study (GWEIS) was further performed to test the effect of interactions between PsRS and SNPs on the risk of mental phenotypes. Results: In the discovery cohort, PsRS was positively associated with PHQ score (β = 0.37; 95% CI = 0.35-0.38), GAD score (β = 0.27; 95% CI = 0.25-0.28), risk of self-reported depression (OR = 1.29; 95% CI = 1.28-1.31) and anxiety (OR = 1.19; 95% CI = 1.19-1.23). Similar results were observed in the replication cohort. Emotional stress, lack of social support and low household income were significantly associated with the development of depression and anxiety. GWEIS identified multiple candidate loci for PHQ score, such as rs149137169 (ST18) (Pdiscovery = 1.08 × 10-8, Preplication = 3.25 × 10-6) and rs3759812 (MYO9A) (Pdiscovery = 3.87 × 10-9, Preplication = 6.21 × 10-5). Additionally, seven loci were detected for GAD score, such as rs114006170 (TMPRSS11D) (Pdiscovery = 1.14 × 10-9, Preplication = 7.36 × 10-5) and rs77927903 (PIP4K2A) (Pdiscovery = 2.40 × 10-9, Preplication = 0.002). Conclusions: Our findings reveal the positive effects of multidimensional social factors on the risk of depression and anxiety. It is important to address key social disadvantage in mental health promotion and treatment. [ABSTRACT FROM AUTHOR]

Background Liver fibrosis plays a key role in the progression of non-alcoholic fatty liver disease to cirrhosis. Considering weight change is known to be closely associated with increased risk of liver fibrosis, we aimed to address a gap in evidence regarding the existence of this association in patients with type 2 diabetes (T2D). Methods We included data on 622 T2D patients and 1618 non-T2D participants from the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). We assessed liver fibrosis by the median values of liver stiffness measurement (LSM). According to the participants' body mass index (BMI) at age 25 (early adulthood), 10 years prior (middle adulthood), and at the 2017-2018 cycle (late adulthood), we categorised weight change patterns into stable non-obese, weight loss, weight gain, and stable obese. We applied logistic regression to association analysis and used population attributable fraction (PAF) to analyses hypothetical prevention regimens. Results The prevalence of liver fibrosis was higher in T2D patients (23.04%) than in non-T2D participants (6.70%), while weight change was associated with a greater risk of fibrosis in the former compared to the latter group. Compared with T2D patients in the stable non-obese group, stable obese individuals from 10 years prior to the 2017-2018 cycle had the highest risk of developing liver fibrosis, corresponding to an adjusted odds ratio (aOR) of 3.13 (95% confidence interval = 1.84-5.48). Absolute weight change patterns showed that the risk of liver fibrosis was highest (aOR = 2.94) when T2D patients gained at least 20 kg of weight from 10 years prior to 2017-2018 cycle. Conclusions Obesity in middle and late adulthood is associated with an increased risk of T2D complicated with liver fibrosis. [ABSTRACT FROM AUTHOR]

Background The association between tea consumption and chronic kidney disease (CKD) remained inconsistent. We aimed to evaluate the association of tea consumption with new-onset CKD and examine the effects of common additives (milk and sweeteners) and genetic variations in caffeine metabolism on the association. Methods 176038 and 3104 participants free of CKD at baseline in the United Kingdom Biobank (UK Biobank) and Coronary Artery Risk Development in Young Adults (CARDIA) study were included, respectively. Dietary information was collected using 24-hour dietary recall questionnaires. The study outcome was new-onset CKD. Results In the UK Biobank, during a median follow-up of 12.13 years, 3535 (2.01%) participants developed CKD. Compared with tea non-consumers, the risk of new-onset CKD was significantly lower in unsweetened tea consumers (hazard ratio (HR)=0.84, 95% confidence interval (CI)=0.76-0.93), but not in sweetened tea consumers (HR=0.96, 95% CI=0.85-1.08), regardless of whether milk was added to tea. Accordingly, relative to tea non-consumers, the adjusted HRs (95% CIs) of new-onset CKD for participants who reported drinking unsweetened tea 1.5 or fewer, >1.5 to 2.5, >2.5 to 3.5, >3.5 to 4.5, and >4.5 drinks/d were HR= 0.86, 95% CI = 0.75-0.99; HR=0.88, 95% CI=0.78-1.00; HR=0.83, 95% CI=0.73-0.94; HR=0.83, 95% CI=0.72-0.95; and HR=0.86, 95% CI=0.75-0.99. Moreover, the association of unsweetened tea consumption with new-onset CKD was stronger among those with faster genetically predicted caffeine metabolism levels, although the interaction was insignificant (P-value interaction=0.768). Consistently, in the CARDIA study, compared with tea non-consumers, a significantly lower risk of new-onset CKD was found in unsweetened tea consumers (HR=0.80, 95% CI=0.65-0.98) but not in sweetened tea consumers (HR=0.97, 95% CI=0.70-1.34). Conclusions Compared with tea non-consumers, consumption of unsweetened tea, but not sweetened tea, was significantly associated with a lower risk of new-onset CKD, regardless of whether milk was added. [ABSTRACT FROM AUTHOR]

Background On May 31, 2021, the Chinese authorities announced that couples can have up to three children, aiming to stimulate a rise in fertility levels. However, there is limited research on second and third birth intentions of the childbearing-age population under China's three-child policy, and the existing results are inconsistent. Methods A cross-sectional survey was performed in Central China from June to August 2022. A total of 13 479 respondents aged 20-49 were enrolled in the study through a multi-stage sampling method. Data on the intentions to have a second or third child were collected using anonymized questionnaires. Descriptive statistics were performed to assess fertility intentions. Multivariate logistic regression analyses were used to assess the associations between fertility intentions and the related factors. Results Among families with a single child, 29.7% (1444 / 4859) of the respondents intended to have a second child, while among two-child families, 10.6% (750 / 7056) respondents intended to have a third child. Overall, participants indicated that the ideal number of children was 1.85 ± 0.52. The age-specific fertility intentions of the one-child families were always higher than those of two-child families; however, based on couples' age groups, the number of ideal children reported by two-child families was always higher than that of one-child families. Fertility intentions were influenced by the respondents' gender, age, residence, marital status, educational level, average working time, childcare support, marital satisfaction, accessibility of educational resources, health condition of both spouses, loan situation, size of living house and the gender of the first child or second child. Conclusions The general prevalence of the second and third birth intention of the childbearing-age population in Central China is not high. To increase the birth rate, it is necessary to create a favourable fertility context and offer supportive measures. [ABSTRACT FROM AUTHOR]

Background High particulate matter with an aerodynamic diameter of 2.5 ≥m or less (PM2.5) exposure levels posed a great risk to human health, but the protection effects of environmental protection on cardiovascular disease have not been systematically evaluated. This study aims to illustrate the effect of the decreased concentration of PM2.5 on blood pressure level in adolescents after enacting the protection measures of environment from a cohort study. Methods A quasi-experimental study including 2415 children from the Chongqing Children's Health Cohort, aged 7.32±0.60 years with normal blood pressure at baseline, with 53.94% males, were analysed. Both the generalised linear regression model (GLM) and Poisson regression model were used to calculate the impact of the declining exposure level of PM2.5 on blood pressure and the incidence of prehypertension and hypertension. Results The annual mean PM2.5 concentration in 2014 and in 2019 were 65.01±6.46 µgmes per cubic metre (μg/m3), 42.08±2.04 μg/m3 respectively, and the decreased PM2.5 concentration between 2014 and 2019 was 22.92±4.51 μg/m3. The effect of decreased PM2.5 concentration by 1μg/m3 on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and the difference of blood pressure (BP) indexes between 2014 and 2019 were all significant (P<0.001). The absolute differences of SBP (-3.598 mmHg; 95% confidence interval (CI)=-4.47,-2.72 mmHg), DBP (-2.052 mmHg; 95% CI=-2.80,-1.31 mmHg) and MAP (-2.568 mmHg; 95% CI=-3.27,-1.87 mmHg) in the group with a decreased level of ≥25.56 μg/m3 were more significant than those in a decreased concentration of PM2.5 for <25.56 μg/m3 (P<0.001). And the incidence of prehypertension and hypertension for three occasions blood pressure diagnose was 2.21% (95% CI = 1.37%-3.05%, P=0.001) in children with PM2.5 decreased level -25.56 μg/m3 (50%), which was significant higher than its' counterparts 0.89% (95% CI=0.37%-1.42%, P=0.001). Conclusions Our study found the etiological relationship between the declining PM2.5 concentration and the BP values and the incidence of prehypertension and hypertension in children and adolescents, suggesting continuous environmental protection measures in China have achieved remarkable health benefits. [ABSTRACT FROM AUTHOR]

Background Comparing body fat and the effect of body fat on metabolic abnormalities in Chinese and USA teenagers may provide clues for the early prevention and control of cardiovascular disease (CVD). We aimed to compare the prevalence of glucose and lipid metabolism abnormalities, body fat amount and distribution, and the effect of body fat on glucose and lipid metabolism in Chinese and US teenagers. Methods We included 5424 Chinese teenagers (48.5% male) from the China Child and Adolescent Cardiovascular Health (CCACH) study and 8704 USA teenagers (55.6% male) from the USA National Health and Nutrition Examination Survey (NHANES). Blood lipid, blood glucose, and body fat indicators were obtained using the same standardised measurements. Results The prevalence of dyslipidaemia in Chinese teenagers was of those in the USA (hypercholesterolaemia = 3.5% vs 7.4%; high low-density lipoprotein cholesterol (LDL-C) = 3.6% vs 5.0%; low high-density lipoprotein cholesterol (HDL-C)=9.9% vs 14.3%; hypertriglyceridaemia=3.7% vs 10.1%) (P<0.05). However, with the increase in body mass index (BMI), the prevalence of high LDL-C increased more in Chinese than in US teenagers, even exceeding them in the obese group (2.7% in non-overweight to 9.7% in overweight group in China, P<0.05; 3.5% in non-overweight to 6.5% in the obese group in the USA, P<0.05). The prevalence of impaired fasting glucose was higher in China than in the USA (28.0% vs 17.5%, P<0.05). Besides, Chinese adolescents are more likely to accumulate fat in the abdomen, and the per-unit fat increase would bring a higher risk of dyslipidaemia in Chinese boys than in USA boys. Conclusions Dyslipidaemia was more prevalent in US teenagers than in Chinese teenagers, but with the increase in BMI, the prevalence of high LDL-C increased more in Chinese than in US teenagers. Impaired fasting glucose (IFG) was significantly more prevalent in China than in the USA. The unfavoured body fat and higher risk of body fat on metabolic disorders in Chinese teenagers suggest that Chinese teenagers should pay more attention to the adverse effect of body fat on metabolic abnormalities. [ABSTRACT FROM AUTHOR]