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Magnolia Cardona,1,2 Adem Sav,3 Zoe A Michaleff,1 Sarah T Thomas,2 Claudia C Dobler1,4 1Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia; 2Gold Coast Hospital and Health Service, Southport, Queensland, Australia; 3School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; 4The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AustraliaCorrespondence: Magnolia Cardona, Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine Level 4, HSM Building 5, Bond University, Robina, Queensland, 4226, Australia, Tel +61 7 5595 0170, Email mcardona@bond.edu.auPurpose: To identify and rank areas of treatment burden in chronic heart failure (CHF), including solutions, that should be discussed during the clinical encounter from a patient, and doctors’ perspective.Patients and Methods: Patients with CHF and clinicians managing heart failure were invited. Nominal group technique sessions held either face to face or online in 2021– 2022, with individual identification of priorities and voting on ranking.Results: Four patient groups (N=22) and one doctor group (N=5) were held. For patients with heart failure, in descending order of priority Doctor-patient communication, Inefficiencies of the healthcare system, Healthcare access issues, Cost implications of treatment, Psychosocial impacts on patients and their families, and Impact of treatment work were the most important treatment burdens. Priorities independently identified by the doctors aligned with the patients’ but ranking differed. Patient solutions ranged from involvement of nurses or pharmacists to enhance understanding of discharge planning, through to linkage between health information systems, and maintaining strong family or social support networks. Doctors’ solutions covered timing medicines with activities of daily living, patient education on the importance of compliance, medication reviews to overcome clinical inertia, and routine clinical audits.Conclusion: The top treatment burden priorities for CHF patients were related to interaction with clinicians and health system inefficiencies, whereas doctors were generally aware of patients’ treatment burden but tended to focus on the complexity of the direct treatment work. Addressing the priority issues identified here can commence with clinicians becoming aware of the issues that matter to patients and proactively discussing feasible immediate and longer-term solutions during clinical encounters.Keywords: patient priorities, barriers, qualitative studies, older adults

Adem Sav,1 Sarah T Thomas,2 Magnolia Cardona,3,4 Zoe A Michaleff,4,5 Claudia C Dobler3,4,6 1School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; 2Gold Coast University Hospital, Southport, Queensland, Australia; 3Evidence-Based Practice Professorial Unit, Gold Coast Hospital, Southport, Queensland, Australia; 4Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia; 5Northern NSW Local Health District, Lismore, New South Wales, Australia; 6The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, AustraliaCorrespondence: Adem Sav, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia, Tel +61 7 3138 5795, Email adem.sav@qut.edu.auPurpose: Many people with chronic obstructive pulmonary disease (COPD) feel overburdened with the treatment and management of their illness. Although research has begun to shed light on how COPD patients experience treatment burden, most of what we know is limited to personal experiences of patients. The aim of this study is to identify and prioritise areas of treatment burden that should be discussed during the clinical encounter from the perspectives of COPD patients, carers, and respiratory physicians.Patients and Methods: Data were collected from participants using the nominal group technique. Five nominal group sessions were conducted in total (n = 31); three sessions with patients (n = 18), one with carers (n = 7) and another with respiratory physicians (pulmonologists or chest physicians) (n = 6). Each session was recorded and analyzed using thematic analysis.Results: Going beyond understanding patients’ and carers’ experiences of treatment burden, this study offers a practical viewpoint of what should be discussed in a clinical encounter. Each group of participants contextualized treatment burden issues for discussion from their own perspectives. There was strong agreement, however, across the groups that difficulties accessing healthcare, lack of education and information, and worry about COPD treatment and prognosis were the most important treatment burden priorities for discussion.Conclusion: Understanding and creating opportunities to discuss these issues in a clinical encounter is important in not only reducing treatment burden but also improving health outcomes and quality of life for COPD patients and their carers.Keywords: COPD, burden of treatment, treatment burden, nominal group technique

The frequency of opportunistic fungal infections in critically ill patients whose intensive care unit stays are prolonged due to coronavirus disease 2019 (COVID-19) is higher than in the period before COVID-19. We planned this study to improve the management of Candida infections by defining the Candida species, the etiology of infections caused by Candida species, and the antifungal susceptibility of the species. This retrospective study included patients older than 18 hospitalized in the intensive care unit (ICU) with a definitive diagnosis of COVID-19 for seven months (from March 2021 to September 2021). All study data that we recorded in a standard study form were analyzed with TURCOSA (Turcosa Analytics Ltd. Co., Turkey, www.turcosa.com.tr) statistical software. The patients were evaluated in four groups as group 1 (candidemia patients, n = 78), group 2 (candiduria patients, n = 189), group 3 (control patients, n = 57), and group 4 (patients with candidemia in urine cultures taken before Candida was detected in blood culture, n = 42). Candida species were identified using both conventional and VITEK® 2 (BioMérieux, France) methods. The antifungal susceptibility of fungi was determined using the E test method. Of the 5,583 COVID-19 patients followed during the study period, 78 developed candidemia, and 189 developed candiduria. The incidence of candidemia (per 1,000 admissions) was determined to be 1.6. As a result of statistical analysis, we found that Candida albicans was the dominant strain in candidemia and candiduria, and there was no antifungal resistance except for naturally resistant strains. Candida strains grown in blood and urine were the same in 40 of 42 patients. Mortality was 69.2% for group 1, 60.4% for group 2, and 57.8% for group 3. Antifungals were used in 34 (43.5%) patients from group 1, and 95 (50.2%) from group 2. In the candidemia group without antifungal use, mortality was quite high (77.2%). Antifungal use reduced mortality in the group 2 (p < 0.05). Length of ICU stays, comorbidity, broad-spectrum antibiotics, and corticosteroids are independent risk factors for candidemia in critically ill COVID-19 patients. Our study contributes to the knowledge of risk factors for developing COVID-19-related candida infections. The effect of candiduria on the development of candidemia in critically ill COVID-19 patients should be supported by new studies.

Research that examines lived experience and how emerging adults seek to create wellbeing in their daily lives through nature is limited. This paper addresses this gap by providing unique insights into how emerging adults perceive and experience nature as a beneficial resource for their wellbeing. Data were collected using photo-elicitation interviews, where 18 emerging adults took photographs that represented their views on and experiences of wellbeing, and during the follow-up interviews discussed the meaning of their photographs. Without a priori mention, 14 participants identified contact with various elements of nature as important resources in supporting their wellbeing. It is the results of these 14 interviews that are discussed in this paper with a focus on (i) the elements of nature which these emerging adults identify as important resources for their wellbeing, (ii) experiences and the perceived pathways between these elements of nature and wellbeing. Thematic analysis revealed four distinct perceived pathways connecting nature to wellbeing, including symbiotic nurturing, building social glue, maintaining a positive outlook, and centreing yourself. Four elements of nature facilitated these pathways: domesticated fauna, domesticated flora, wild fauna and wild surrounding nature. The findings help build understanding of how emerging adults perceive elements of nature as resources for wellbeing and can inform the development of nature-oriented interventions.

This paper aims to investigate the effectiveness of personal protective equipment (PPE) in reducing firefighter exposure to various hazardous chemicals from the smoke emitted during fires. A systematic review of peer-reviewed articles was undertaken utilizing five databases: Medline, Embase, Web of Science, Scopus, and CINHAL. Studies published between 2013 and 2023 that investigated the effectiveness of PPE in reducing firsthand exposure to at least one chemical were included. Extracted data were grouped into two overarching themes related to PPE: (a) Respiratory Protection and (b) Personal Protective Clothing (PPC). Overall, 21 studies met the inclusion criteria and were considered for further analysis. Respiratory protection, particularly self-contained breathing apparatus (SCBA), offered the most protection in preventing inhalation exposure to chemical hazards. There was limited evidence on the effectiveness of firefighter turnout gear in reducing skin contamination. Combustion contaminants, especially highly volatile compounds like benzene, were found to permeate and penetrate through and around the protective clothing. In conclusion, certain respirators, particularly SCBA, provided the best protection against inhalation exposure to chemicals; however, PPC did not appear to provide complete protection, particularly against the more volatile chemicals like benzene. [ABSTRACT FROM AUTHOR]

Background and Purpose: Candidemia remained important in the intensive care units(ICU) during the COVID-19 pandemic. This study aimed to investigate the clinical and laboratory data on candidemia in COVID-19 patients.Materials and Methods: The baseline characteristics, as well as laboratory and clinicalfindings of candidemia and non-candidemia patients, were compared. Candidemia was defined as the isolation of Candida spp. from blood cultures. The isolates were identified by VITEK® 2 (bioMérieux, France) commercial method. Antifungal susceptibility was assessed using the E-test method. Univariate and multiple binary logistic regression analyses were performed to compare the variables.Results: In total, 126 patients with the COVID-19 disease were included. Candidemiawas diagnosed in 44 (35%) of the patients. The number of patients with diabetes mellitus and chronic renal failure was higher in the candidemia group. In the candidemia group, the duration of ICU stay of patients, the 30-day mortality rate, mechanical ventilation therapy, and systemic corticosteroids (Prednisone) usage were significantly higher in candidemia patients. Moreover, the median white blood cell, neutrophils, and lactate dehydrogenase were higher in the candidemia group. Univariate and multiple binary logistic regression analyses were performed to compare the variables. Isolated species were identified as Candida albicans (n=12, 41%), Candida parapsilosis (n=7, 24%), Candida glabrata (n=6, 21%), Candida tropicalis (n=3, 10%), and Candida dublinensis (n=1, 3%). In total, three isolates of six C. glabrata species had dose-dependent sensitivity to fluconazole, and one C. parapsilosis was determined to be resistant.Conclusion: The COVID-19 patients who are admitted to ICU have many risk factors associated with candidemia. The most common risk factors for the development of candidemia were mechanical ventilation, diabetes mellitus, neutrophilia, and low hemoglobin level. The most frequently isolated species was C. albicans. Moreover, caspofungin was found to be the most effective drug in vitro. No significant resistancepattern was detected against the isolated species. It should be noted that risk-stratified antifungal prophylaxis in the ICU is possible.

COVID-19 pandemic caused transformation by influencing the physical and psycho-social status of houses, and by introducing different functions and needs which led to or will lead to changes in individuals’ expectations from their houses. Drawing on this idea, this study allows for the detection of such changes through examination and for the consideration of future house arrangements, housing designs and their production by identifying the usage possibilities of existing houses. The research design is structured in three main steps. First step is the literature part that draws the conceptual framework of the study. Second step includes survey technique with use of panel design as a quantitative research method. In the research, third step has built with semi-structured interview to be deepen analyzing of the results of the quantitative part. The findings reached through this study have the potential to lead future house arrangements as well as housing production and design which are also significant in terms of innovative and creative housing designs studied within disciplines such as interior architecture and architecture. Sample of the research is the city of Istanbul which is first of the most affected cities from COVID-19 pandemic. Selecting a big and multi-component metropolis like Istanbul as research area for residential spaces brought different difficulties in the application processes of research methods while allowing the multidimensional examination of the subject. The research design proposed by this study possess the quality of a guiding sample for future scientific studies.

Objectives The treatment workload associated with end-stage kidney disease (ESKD) is high. The treatment burdens experienced by patients with ESKD are not well understood. In this study, we aimed to elucidate the most important areas of treatment burden for discussion in a clinical encounter from the perspectives of patients with ESKD and nephrologists. We sought to explore possible solutions to these high priority treatment burden challenges.Design Nominal group technique (NGT) sessions.Setting and participants Three in-person NGT sessions were conducted with 19 patients with dialysis-dependent ESKD from one tertiary treatment centre (mean age 64 years; range 47–82). All patients were either retired or on a disability pension; 74% perceived moderate or severe treatment burden; and 90% spent more than 11 hours on treatment-related activities per week (range 11–30). One online NGT session was conducted with six nephrologists from two Australian states.Main outcome measures The primary outcome was a ranked list of treatment burden priorities. The secondary outcome was potential solutions to these treatment burden challenges.Results Every patient group ranked health system issues as the most important treatment burden priority. This encompassed lack of continuity and coordination of care, dissatisfaction with frequent healthcare encounters and challenges around healthcare access. Psychosocial burdens on patients and families were perceived to be the most important area of treatment burden by physicians, and were ranked the second highest priority by patients.Conclusions Discussing treatment burden in a clinical encounter may lead to a better understanding of patients’ capacity to cope with their treatment workload. This could facilitate tailored care, improve health outcomes, treatment sustainability and patients’ overall quality of life.

Aim: The aim of this study was to determine the diagnostic utility of chromosomal microarray analysis (CMA) in daily pediatric neurology practice and to identify the guiding clinical parameters for patients requiring this test. Material and Methods: The CMA results for 91 patients with global developmental delay/intellectual disability (GDD/ID) admitted to our pediatric neurology clinic for various reasons between 2018 and 2020 were examined. Demographical and clinical data for 34 patients (37.4%) in whom del/dup was determined at CMA and 57 patients (62.6%) with normal CMA were compared. Results: There was no statistically significant difference between two groups in terms of demographic characteristics such as age, gender, type of delivery, gestational age, etc. Dysmorphisms, hypotonia, myelination abnormalities were significantly more frequent in patients with del/dup than in patients with normal result. The frequency of macrocephaly and obesity was higher in the normal group, and that of generalized seizures was higher among epileptic patients in this group. Nineteen (55.9%) of the 34 cases who have del/dup detected at analysis were regarded as pathogenic, 15 (44.1%) as uncertain clinical significance (likely pathogenic, likely benign and no subclassification). Conclusion: Since CMA is an expensive, laborious, and time-consuming test, considering clinical parameters when requesting CMA will yield high diagnostic efficiency. A high possibility of copy number variants may be predicted in GDD/ID patients with dysmorphisms, hypotonia, and myelination delay. CMA should represent the genetic analysis of choice in pediatric neurology practice in case of no finding suggesting a different etiology in these patients.

Introduction: This study examines the health problems and healthcare needs of refugee and asylum‐seeker children and aims to develop strategies for improvement. Methods: Based on quantitative data from 448 refugee and asylum‐seeker children and 222 non‐refugee local children, this study was conducted at Düzce University, Department of Paediatrics, between 2010 and 2021. The refugee children originated from three countries: Iraq (n = 304), Syria (n = 101) and Afghanistan (n = 43). The data were analysed using the SPSS data analysis program. Ethical clearance was obtained from the Ethics Committee of Düzce Üniversity. Results: The results suggest that refugee and asylum‐seeker children have significantly higher rates of acute illness or infection, malnutrition (p < 0.001) and anaemia (p < 0.001) than local children as a result of living in overcrowded families (p = 0.017) and unhealthy conditions. Adolescent pregnancy (p = 0.049) emerges as an important social problem as a result of child marriage among refugee children, mostly in the form of consanguineous marriages (p < 0.001). The rate of having at least two adolescent pregnancies (under 18) was highest among Syrian refugee girls (p = 0.01). Although refugee and asylum‐seeker children have higher rates of health insurance (between 74% and 95%), they have lower rates of insurance compared to local children. This research also compares the data from three nationalities, including Syria, Afghanistan and Iraq children; Iraqi and Afghan children under the international protection (IP) system with limited social support and rights had worse health conditions compared to other groups. Although Iraqi children had the highest rates of health insurance on admission (p < 0.001), they also had higher rates of chronic diseases (p = 0.001), infections (p = 0.004), allergic rhinitis (p = 0.001) and malnutrition (p < 0.001). The youngest age of admission (p = 0.006) and the shortest length of stay (p = 0.004) were for Afghan children who also had higher rates of upper respiratory infections (p = 0.021). Conclusions: This study highlights the urgent need for improved screening programmes and the importance of collaborative efforts to address the specific health needs of these populations. Addressing the health status of child refugees is a complex and multifaceted task that requires the active participation of healthcare professionals, policymakers and researchers, each of whom has a crucial role to play. [ABSTRACT FROM AUTHOR]

Abstract Background Transgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies. Methods Using a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide. Results Of 928 participants, 85% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p

Abstract Background Despite numerous national and international efforts to alleviate child growth faltering, it remains a global health challenge. There is a growing body of literature that recognizes the importance of women’s empowerment in a wide range of public health topics, such as the utilization of maternal healthcare services, agricultural productivity, and child nutrition. However, in Ethiopia, the relationship between women’s empowerment and child nutritional status is not studied at the national level. This study aimed to determine the association between women’s empowerment and growth faltering in under-5 children in Ethiopia. Methods The data source for this analysis is the 2016 Ethiopian Demographic and Health Survey (EDHS): a nationally representative household survey on healthcare. The EDHS employed a two-stage stratified cluster sampling technique. We computed standard women’s empowerment indices, following the Survey-based Women’s emPowERment index approach. A multilevel logistic regression model that accounted for cluster-level random effects was used to estimate the association between women’s empowerment and child growth faltering (stunting, wasting and underweight). Results Attitude to violence, social independence, and decision-making were the three domains of women’s empowerment that were associated with child growth faltering. One standard deviation increase in each domain of empowerment was associated with a reduction in the odds of stunting: attitude towards violence (AOR = 0.92; 95% CI 0.88–0.96; p

Summary: Training accurate and robust machine learning models requires a large amount of data that is usually scattered across data silos. Sharing or centralizing the data of different healthcare institutions is, however, unfeasible or prohibitively difficult due to privacy regulations. In this work, we address this problem by using a privacy-preserving federated learning-based approach, PriCell, for complex models such as convolutional neural networks. PriCell relies on multiparty homomorphic encryption and enables the collaborative training of encrypted neural networks with multiple healthcare institutions. We preserve the confidentiality of each institutions’ input data, of any intermediate values, and of the trained model parameters. We efficiently replicate the training of a published state-of-the-art convolutional neural network architecture in a decentralized and privacy-preserving manner. Our solution achieves an accuracy comparable with the one obtained with the centralized non-secure solution. PriCell guarantees patient privacy and ensures data utility for efficient multi-center studies involving complex healthcare data. The bigger picture: High-quality medical machine learning models will benefit greatly from collaboration between health care institutions. Yet, it is usually difficult to transfer data between these institutions due to strict privacy regulations. In this study, we propose a solution, PriCell, that relies on multiparty homomorphic encryption to enable privacy-preserving collaborative machine learning while protecting via encryption the institutions' input data, the model, and any value exchanged between the institutions. We show the maturity of our solution by training a published state-of-the-art convolutional neural network in a decentralized and privacy-preserving manner. We compare the accuracy achieved by PriCell with the centralized and non-secure solutions and show that PriCell guarantees privacy without reducing the utility of the data. The benefits of PriCell constitute an important landmark for real-world applications of collaborative training while preserving privacy.

Objectives: Globally, female workers workforce in Oil, Gas, and Mining (OGM) industry have increased significantly. The complexities of the OGM operations and the extensive exposure to workplace hazards potentially affect the health status of workers, including sexual and reproductive health (SRH) outcomes of female workers. Yet, the current state of knowledge on SRH issues in OGM contexts seems to be limited and fragmented. This scoping review aims to identify the occupational factors that influence women’s SRH outcomes in OGM industry.Methods: This scoping review followed the Joanna Briggs Institute’s guidelines (PRISMA) and was conducted in five databases, including the citation chaining via Google Scholar and manual search through relevant organisations and Government websites. Sixteen articles met the inclusion criteria and were analysed.Results: Despite the scarcity of evidence, chemical and physical are found to be the predominant factors greatly influencing women workers’ SRH outcomes in OGM. Most studies showed menstrual and cycle disorders, and risky pregnancy as key SRH issues. However, menstruation disorder was considerably linked with psychological and organisational factors.Conclusion: This review suggests further empirical research on the relationship between OGM occupational hazards and women workers’ SRH. This will contribute to improvements in workplace safety legislations, measures, policies, and management systems taking into account women’s needs.

Background and Purpose: Scedosporium apiospermum complex as a ubiquitous environmental mold is increasingly reported to cause an invasive fungal infection in immunosuppressive hosts. Herein, we present the case of an immunosuppressive 54-year-old man who developed S. apiospermum complex lung infection and pulmonary adenocarcinoma. Case report: The patient had some complaints of dyspnea and cough during a neutropenic episode. The computed tomography (CT) scan of the patient revealed pleural effusion. After culturing the pleural fluid sample, the fungus was identified by microscopic examination and ITS sequencing. In addition, antifungal susceptibility testing was performed using the M38-A2 microdilution method. The minimum inhibitory concentrations of amphotericin B, voriconazole, posaconazole, and caspofungin were obtained as > 64, 0.06, 0.06, and 0.03 μg/mL, respectively. Voriconazole (administered in two doses of 6 mg/kg and a maximum of 250 mg) was preferred for treatment. The patient received antifungal treatment for 2 months; however, he was lost to follow-up. Conclusion: Scedosporium apiospermum complex should be considered a cause of systemic fungal infections in neutropenic patients. Furthermore, the determination of the in vitro antifungal susceptibilities of clinical strains may contribute to the development of therapeutic approaches.

ABSTRACT Introduction: Glomerular hyperfiltration may lead to proteinuria and chronic kidney disease in unilateral multicystic dysplastic kidney (MCDK). We aimed to investigate the urine neutrophil-gelatinase-associated lipocalin (NGAL), netrin-1, hepcidin, and C-C motif chemokine ligand-2 (MCP-1/CCL-2) levels in patients with MCDK. Methods: Thirty-two patients and 25 controls were included. The urine hepcidin, netrin-1, NGAL, and MCP-1/CCL-2 levels were determined by ELISA. Results: The patients had higher serum creatinine (Cr) levels, urine albumin, and netrin-1/Cr ratio with lower GFR. There were positive correlations between urine protein/Cr, MCP-1/CCL-2/Cr, and netrin-1 with NGAL (r = 0.397, p = 0.031; r = 0.437, p = 0.041, r = 0.323, p = 0.042, respectively). Urine netrin-1/Cr was positively correlated with MCP-1/CCL-2/Cr (r = 0.356, p = 0.045). There were positive associations between the presence of proteinuria and netrin-1/Cr, MCP-1/CCL-2/Cr, and NGAL/Cr [Odds ratio (OR): 1.423, p = 0.037, OR: 1.553, p = 0.033, OR: 2.112, p = 0.027, respectively)]. ROC curve analysis showed that netrin-1/Cr, MCP-1/CCL-2/Cr, and NGAL/Cr had high predictive values for determining proteinuria p = 0.027, p = 0.041, p = 0.035, respectively). Urine hepcidin/Cr was negatively correlated with tubular phosphorus reabsorption and was positively correlated with urine NGAL/Cr (r = -0.418, p = 0.019; r = 0.682, p = 0.000; respectively). Conclusions: MCP-1/CCL-2 may play a role in the development of proteinuria in MCDK. Netrin-1 may be a protective factor against proteinuria-induced renal injury. Urine hepcidin/Cr may reflect proximal tubule damage in MCDK. Urine NGAL/Cr may be a predictor of tubule damage by proteinuria.

Objective:Type 1 diabetes (T1D) is a disease characterized by severe insulin deficiency. In 2008 our group studied the prevalence of diabetes in adults between 20-80 years of age in Cyprus but data regarding this incidence in the pediatric population is lacking. The objective of this study was to report the incidence of T1D among permanent inhabitants aged 16 years or younger between 2001-2016 in Cyprus.Methods:This study was a retrospective analysis. The patients were mainly evaluated and recorded at Dr. Burhan Nalbantoğlu Hospital, Nicosia. Data was also reviewed from Famagusta Government Hospital, Kyrenia Government Hospital, Near East University Hospital and the Cyprus Turkish Diabetes Association.Results:A total of 107 subjects were diagnosed as T1D between 2001 and 2016 in the pediatric age group. Forty-nine (45.7%) were girls and 58 (54.3%) were boys. Of these 38.7% were resident in Nicosia, 30.2% Famagusta, 12.3% Kyrenia, 9.4% Guzelyurt and 7.5% Iskele. The proportion of newly diagnosed T1D was highest among children aged 9-12 years (35.5%) followed by children aged 5-8 years (32.7%). Newly diagnosed T1D most frequently presented in March and April. The overall mean incidence rate was 11.1/100,000 between 2001 and 2016. The incidence rates were similar and comparable among the years.Conclusion:This study is the first to analyze the incidence of T1D in Cyprus. Compared to other countries the incidence rate is intermediate. Our findings are similar to the incidence rates of T1D in South Cyprus and Turkey.

Abstract Background Congenital malformations are structural, functional, and metabolic defects that develop during the organogenesis period and present at birth or later in life. There has been little research on congenital malformations in Ethiopia, knowledge on the incidence of birth defects at birth is unknown and the etiologies of the anomalies are limited. This study, therefore, aimed to assess the modifiable risks of congenital anomalies among women in Bale zone hospitals, Ethiopia. Methods An unmatched case-control study was conducted from February 2018 to January 2019 in the Bale zone; namely Goba referral hospital, Robe, Ginnir and Dolomena hospitals. A total of 409 women were selected. Mothers who gave birth with any type of congenital malformation were assigned as cases and those who gave live births without any congenital abnormalities were assigned as controls. Controls were selected by the lottery method from the labor ward. For each case, two consecutive controls were included. Data were entered into Epi-data 3.1 and exported into Statistical Package for the Social Sciences (SPSS) version 21 for analysis. Logistic regression was conducted to analyze the data. Results Alarmingly, women who had been exposed to pesticides during the current pregnancy were two times more prone to give congenital malformed infants than their counterparts (AOR = 3.19; 95% CI = 1.31, 10.96). Additionally, those women who chewed khat during the periconceptional period were two times more likely to have congenital malformed infants as compared to women who did not engage in this activity (AOR = 2.40; 95% CI = 1.11, 5.19). Conclusions Urgent attention needs to be given by public health professionals and services to khat chewing and maternal exposure to pesticides during pregnancy to reduce the risk of congenital malformations.

Background: Masculinising hormone therapy with testosterone is used to align an individual’s physical characteristics with their gender identity. Standard testosterone doses and formulations recommended for hypogonadal cisgender men are typically administered, although there are currently limited data evaluating the use of 1% testosterone gel in gender-affirming hormone therapy regimens. Objectives: The objective of the study was to assess the prescription patterns and serum total testosterone concentrations achieved with 1% testosterone gel in trans and gender diverse individuals. Materials and Methods: A retrospective cross-sectional analysis was undertaken of trans individuals at a primary and secondary care clinic in Melbourne, Australia. Sixty-seven individuals treated with 1% testosterone gel were included. Primary outcomes were testosterone dose and serum total testosterone concentration achieved. Results: Median age was 25 (22–30) years and median duration of testosterone therapy was 12 (7–40) months. Thirty-five (52%) individuals had a nonbinary gender identity. Initial median testosterone dose was 25 mg (12.5–31.3) daily. Fifty-two (78%) individuals commenced doses 0.5) was documented in eight of 138 (6%) laboratory results in six individuals. Discussion and Conclusions: One percent testosterone gel achieves serum total testosterone concentrations in the cisgender male reference range. A high proportion of individuals had a nonbinary gender identity and most individuals commenced a lower dose than that typically administered to hypogonadal cisgender men, potentially related to slow or ‘partial’ masculinisation goals.

Background: Overprescribing of opioids to patients following surgery is a public health concern, as unused pills may be diverted and contribute to opioid misuse and dependence. The objectives of this study were to determine current opioid-prescribing patterns for common surgical procedures, factors that affect surgeons' prescribing behaviour and their perceived ability to manage patients with opioid use disorder. Methods: Survey participants included all consultant and trainee surgeons at the University of Toronto. The survey, which was administered electronically, included 52 multiple-choice, rank-order and open-text questions eliciting information on current prescribing patterns, prescribing of adjunct pain medications, and education and other factors related to opioid prescribing. Staff surgeons were also asked about how they manage patients with a suspected opioid issue. Results: Eighty surgical trainees and 40 staff surgeons responded to the survey (response rate 32%). Five staff surgeons (12%) felt adequately educated to prescribe pain medications (including opioids) at discharge. Staff surgeons prescribed Tylenol 3 more frequently than other opioids. Twenty (51%) of 39 staff surgeons reported that they sought further help for their patients when an opioid use disorder was suspected. Conclusion: Our results support existing studies showing a large degree of variability in postoperative opioid prescribing. Institutional guidelines have been shown to be effective in curbing excessive opioid prescribing without increasing unnecessary emergency department visits for uncontrolled pain. Thus, there is an opportunity to develop institutional guidelines to educate surgical teams in the prescribing of opioids and about services available for patients with a substance use disorder. Contexte : La surprescription d'opioides aux patients apres une chirurgie represente un probleme de sante publique car il y a un risque que les comprimes inutilises soient detournes et utilises a mauvais escient, voire qu'ils causent la dependance. Cette etude avait pour objectif d'identifier les modes actuels de prescription des opioides pour les chirurgies courantes, les facteurs qui influent sur les habitudes de prescription des chirurgiens et leur capacite percue a prendre en charge les cas de mesusage des opioides. Methodes : Les participants au sondage etaient tous les chirurgiens en poste et en formation a l'Universite de Toronto. Ce sondage administre par voie electronique comprenait 52 questions (choix multiples, echelles ordinales et ouvertes) qui visaient a recueillir des renseignements sur les modes actuels de prescription, la prescription d'analgesiques d'appoint, l'enseignement au patient et autres elements relatifs a la prescription des opioides. Les chirurgiens en poste ont aussi ete interroges sur leur gestion des cas presumes de mesusage des opioides. Resultats : Quatre-vingt chirurgiens en formation et 40 chirurgiens en poste ont repondu au sondage (taux de reponse, 32 %). Cinq chirurgiens en poste (12 %) se sont estimes adequatement renseignes sur la facon de prescrire les analgesiques, (y compris les opioides) au moment du conge. Les chirurgiens en poste prescrivaient Tylenol 3 fois plus souvent que d'autres opioides. Vingt (51 %) chirurgiens en poste sur 39 ont dit consulter s'ils avaient besoin d'aide pour la prise en charge de patients soupconnes de presenter un probleme de mesusage des opioides. Conclusion : Nos resultats viennent etayer les conclusions d'etudes existantes selon lesquelles les modes de prescription des opioides en postoperatoire varient grandement. Il a ete demontre que l'adoption de lignes directrices institutionnelles permet de limiter efficacement la surprescription des opioides sans accroitre indument le nombre de consultations aux urgences pour douleur non maitrisee. Il y a donc la une possibilite d'adopter a plus grande echelle les lignes directrices institutionnelles pour sensibiliser les equipes chirurgicales a l'utilisation judicieuse des opioides et a l'existence des services a l'intention des patients qui presentent un probleme de mesusage., Recent studies have highlighted the practice of over-prescribing opioids to patients following surgery. (1-3) This topic has received much attention owing to public concern over the opioid epidemic. Overprescribing is [...]

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Gender dysphoria describes the distress associated with having a gender identity that differs from one’s birth-assigned sex. To relieve this distress, transgender, and gender diverse (henceforth, trans) individuals commonly undergo medical transition involving hormonal treatments. Current hormonal treatment guidelines cater almost exclusively for those who wish to transition from male to female or vice versa. In contrast, there is a dearth of hormonal options for those trans individuals who identify as non-binary and seek an androgynous appearance that is neither overtly male nor female. Though prolonged puberty suppression with gonadotrophin releasing hormone agonists (GnRHa) could in theory be gender-affirming by preventing the development of unwanted secondary sex characteristics, this treatment option would be limited to pre- or peri-pubertal adolescents and likely have harmful effects. Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth. Given their unique range of pharmacodynamic effects, SERMs may represent a potential gender-affirming treatment for this population, but there is a lack of knowledge regarding their use and potentially adverse effects in this context.

BackgroundBarriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. ObjectiveThe objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. MethodsThis study used Research Electronic Data Capture (REDCap)—a secure web-based platform with built-in tools for data collection and storage—to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. ResultsA total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3%) and family members (109/187, 58.3%) consented to participate in the survey. Most patients (182/229, 79.5%) and family members (75/116, 64.7%) who completed the consent form did so remotely, with more family members (41/116, 35.3%) than patients (47/229, 20.5%) completing it in person. Of those who consented, 77.3% (167/216) of patients and 72.5% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5%) and family members (174/190, 91.6%) requested to receive the consent form and survey by email, and only 4.1% (19/462) and 3.2% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5%) and family members (42/79, 53.2%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. ConclusionsWhen offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic.

The Great Recession induced by the financial crisis accelerated the decades of declining state funding support for U.S. public higher education, while simultaneously bringing increased political pressures for demonstrating improvements in the operating efficiencies among all universities and colleges. The purpose of this paper is twofold. First, it provides estimates of those efficiencies and their changes over ten academic years, 2004 through 2013. Second, it provides estimates of the effects of state funding decreases on operating efficiencies, while also accounting for the large student enrollment recipients due to Pell Grant funds. A two stage data envelopment analysis is employed. First stage efficiencies enter the Tobit model in the second stage with state funding and Pell Grant measures as covariates. Panel data covers research, comprehensive, and associate institutions. Although the efficiency estimates are shown to vary widely across institutions, there is strong evidence that reversing state legislative decisions and increasing state funding would improve higher education efficiency.

Agricultural production and income are important for Mediterranean region of Turkey. The region and especially Antalya province is well-known with greenhouse production. For greenhouse production achieving sustainability is important for meeting domestic and foreign demand and security of production lands. In order to measure the potential for improving greenhouse operators 281 farmers were surveyed in 2015 in Antalya and profit inefficiency and factors affecting inefficiencies of operators were estimated using stochastic frontier approach. Accordingly, the average inefficiency level of operators was found as 57 %, signifying the potential for improvement. The main objective was to undermine the impact of landownership on this inefficiency level. Yet, the impact of other relevant factors referring to greenhouse structures and famers’ characteristics were estimated as well. While level of education seemed to reduce inefficiency, household size had appeared as an inefficiency rising factor referring to professional labour endowment of greenhouse production in Antalya. Being renter of land appeared as an inefficiency rising factor as well as holding plastic house or having located in the western parts of Antalya. These findings indicated importance of supporting improved production technologies and use of strengthened structures. In addition, it appeared as essential to provide incentives to renters to cope with their costs.