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Background: Obesity (body mass index ≥ 30 kg/m2) is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and affects most patients with HFpEF. Patients living with obesity may experience delays in HFpEF diagnosis and management. We aimed to understand the clinical journey of patients with obesity and HFpEF and the role of primary care providers (PCPs) in diagnosing and managing patients with both conditions. Methods: An anonymous, US population-based online survey was conducted in September 2020 among 114 patients with self-reported HFpEF and obesity and 200 healthcare providers, 61 of whom were PCPs who treat patients with HFpEF and obesity. Results: Half of patients (51%) with HFpEF reported waiting an average of 11 months to discuss their symptoms with a PCP; 11% then received their diagnosis from a PCP. PCPs initiated treatment and oversaw the management of HFpEF only 35% of the time, and 44% of PCPs discussed obesity treatment medication options with their patients. Only 20% of PCPs indicated they had received formal obesity management training, and 79% of PCPs indicated they would be interested in obesity management training and support. Conclusion: PCPs could play a valuable role in addressing obesity and referring patients with obesity and signs and symptoms of HFpEF to cardiologists. Increased awareness of HFpEF and its link to obesity may help PCPs more quickly identify and diagnose their patients with these conditions. Plain Language Summary: Heart failure with preserved ejection fraction (HFpEF) is a common form of heart failure. Many patients who have HFpEF also have obesity or excess weight. We wanted to understand the medical experience of patients with HFpEF and obesity and the role that primary care providers (PCPs) play in managing patients with these diseases. We surveyed 114 patients with HFpEF and obesity and 200 healthcare providers who treat patients with HFpEF and obesity, 61 of whom were PCPs. One-quarter of patients had a major heart-related event that led to their HFpEF diagnosis. Half of the patients said they had an initial discussion about HFpEF symptoms with a PCP, but only one in ten were diagnosed by a PCP. Few PCPs said they received obesity management training, but most were interested in receiving more obesity management training and support. PCPs play an important role in organizing care for patients with HFpEF and obesity. However, there is room to improve HFpEF awareness and access to obesity management tools and strategies among PCPs. [ABSTRACT FROM AUTHOR]

Background: A fistula is an unusual communication between the skin and an inward organ or between the organs. The current study aimed to determine the role of magnetic resonance imaging (MRI) in the diagnosis, description, and classification of fistula-in-ano. Additionally, the study aimed to compare the MRI findings with the operative findings, which is considered the gold standard in our study. Methods: The present study is a prospective study and was carried out on a group of 61 patients: 52 males and 9 females with a mean age of 41 years, who were suspected to have perianal fistulae presented clinically with discharge or localized pain or were asymptomatic. A preoperative MRI was conducted for fistula-in-ano evaluation in these patients from October 2019 till the end of October 2021. A surgeon conducted a physical examination of all patients to document the number and location of cutaneous openings following a full medical history. The MRI images were evaluated and interpreted by multiple expert radiologists who had more than 5 years of experience in analyzing MRI. In the cases (in 3 cases, 4.92%) where there were discrepancies in their interpretations, a senior radiologist's evaluation was considered the final result and was confirmed surgically. Subsequently, the MRI findings were correlated with surgical findings to indicate the specificity, sensitivity, and accuracy of such MRI findings. Results: The MRI technique was the routine (i.e., without contrast administration) technique in 36 (59.02%) patients, with contrast administration in 21 (34.43%) patients and with anesthesia/sedation (uncomfortable, anxious, and claustrophobic patients need to minimize their motion artifact to improve the quality and obtain more detailed images) in 4 (6.56%) patients. The MRI pathology of the studied patients revealed normal findings in 1 (1.64%) patient, anal fissure/early developing tract in 6 (9.84%) patients, and established tract (sinus/fistula) in 54 (88.52%) patients. Park's and St. James's University Hospital classifications were utilized to categorize the patients, with the most common fistula types based on the Park's classification: intersphincteric (44.3%) and transsphincteric (29.5%). Based on the St. James's classification, grade 1 (intersphincteric (34.4%)) and grade 4 (transsphincteric with abscess/side branch (16.4%)) were the most prevalent. A substantial consensus was reached between MRI and surgery findings for classifying tracts, side branches, and abscesses formation with sensitivity, specificity, and accuracy of 100%, 85.71%, and 98.36%, respectively. Conclusions: MRI is a valuable tool in managing patients with perianal fistulas due to its ability to detect hidden areas of infection (such as abscesses) and secondary extensions. These factors contribute to the high recurrence rate after surgery. Additionally, MR imaging can define the anatomical relationships between the fistula and anal sphincters, helping to predict the likelihood of fecal incontinence following surgery. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional, case-control study aimed to explore the psychodynamic characteristics that influenced adolescents' mental health during the COVID-19 pandemic. Methods: Personality structure impairments, psychodynamic conflicts, defense styles, and mental health issues were examined using the OPD-Structure- and Conflict-Questionnaires, the Defense Style Questionnaire, and the Patient Health Questionnaire in adolescents before (n = 288) and after (n = 451) the COVID-19 pandemic in Germany. Results: Adolescents with mental health issues exhibited greater impairments in personality structure, more immature defense styles, and higher levels of psychodynamic conflicts both before and after the pandemic onset. Comparisons between pre-pandemic and pandemic samples indicated a lower level of the conflict of taking care of oneself versus being cared for in passive mode among adolescents during the pandemic. In-depth analysis of adolescents with mental health issues from the pandemic group revealed significant associations between personality structure impairments and a maladaptive defense style with somatoform, depressive, anxiety, eating, and alcohol use disorders. Conclusion: The findings provide clinically relevant insights into the psychodynamic factors that contributed to the psychological vulnerability of adolescents during the COVID-19 pandemic. These insights can guide the development of targeted psychodynamic interventions to support adolescents' mental health in similar future crises. [ABSTRACT FROM AUTHOR]

It is estimated that globally, millions of adolescents experience mental health problems, especially anxiety and depression. Adolescents with high perceptions of stress often encounter mental issues, have negative thoughts or are dissatisfied with daily life events. This study employed a quasi-experimental design with two groups and repeated measures to test an innovative nursing intervention, the Be Aware of Stress Smartphone Application. This application aims to increase positive thinking and reduce perceived stress among at-risk adolescents aged 13 to 16, and we sought to determine their satisfaction with its usability. The study was conducted with 44 junior high school students from an opportunity expansion high school in Eastern Thailand, who were randomly assigned to experimental and comparison groups (22 each). Data were collected between December 2023 and February 2024 using the General Information Questionnaire, Positive Thinking Test, Perceived Stress Questionnaire, and Satisfaction of Application Usability scale. The outcomes were measured at baseline, after completing the program at week 4, and at week 8 after using the application. The chi-square test and repeated measures analysis of variance were used to analyze the data. The results of this study have important implications for future research. They indicate a significant improvement in positive thinking and a reduction in perceived stress within the experimental group, compared to the comparison group, at weeks 4 and 8. Moreover, the experimental group reported high satisfaction with the application's usability. These findings suggest that the Be Aware of Stress application is beneficial for community nurses and others to prevent adolescent stress. The study also highlights the need for future research to enhance the application's functionality and compatibility with various phone operating systems to ensure widespread and effective use. [ABSTRACT FROM AUTHOR]

Background: Advanced Trauma Life Support was originated mainly to train doctors who don't manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023. Methods: This is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done. Result: A total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn't take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS. Conclusion: Overall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It's advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school's curriculum. [ABSTRACT FROM AUTHOR]

Background and Design: Hematological parameters have been used as laboratory markers to evaluate the systemic inflammation in several rheumatic disease. The aim of this study is to determine the difference of hematological parameters between the patients who have been just fulfilled the Behçet's disease (BD) criteria and patients with recurrent aphthous stomatitis (RAS). Materials and Methods: Twenty patients with newly diagnosed BD and 47 patients with RAS whose oral ulcerations appeared at least three times a year were enrolled in this cross-sectional study. Demographic and clinical characteristics of patients, complete blood count, C-reactive protein (CRP) and erythrocyte sedimentation rate were recorded. Results: Patients' characteristics including gender, age, duration, and frequency of oral aphthous ulcerations in both study groups were comparable (p>0.05). CRP was significantly higher in newly diagnosed BD group when compared to the RAS group (p=0.001). CRP value higher than 2.7 g/dL, mean platelet volume (MPV) value higher than 7.58 fL and lymphocyte count higher than 2.85 103/μL were found to be the markers for distinguishing patients with BD from patients with RAS [odds ratio (OR): 12.76 (95% confidence interval (CI): 2.86-56.88), OR: 5.61 (95% CI: 1.11-28.42), OR: 15.24 (95% CI: 1.77-131.31), respectively]. Conclusion: The elevated CRP, MPV and lymphocyte count were associated with patients with newly diagnosed BD rather than patients with RAS. Further large prospective studies with the healthy control group are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Women's empowerment and health literacy are essential for fostering community well-being. Empowering women through education and diverse training plays a crucial role in ensuring their prosperity and overall health. This study investigates the satisfaction and experiences of underprivileged rural mothers participating in a functional literacy education program in the Kailali district, Nepal. We assess participants' perceptions of program effectiveness, examining training content, facilities, and trainers while exploring menstrual hygiene practices and maternal health awareness. Through convenience sampling, 141 underprivileged women from five rural villages near Tikapur were selected from literacy centers run by Mahima Group. Utilizing structured questionnaires and statistical analyses, including descriptive analyses, Spearman's rho correlation, and Pearson's chi-square test, we found that 65.2% of participants expressed high satisfaction levels. Moreover, 96.5% found the program highly effective, with 97.9% reporting improved literacy skills and 96.5% demonstrating increased awareness of menstrual hygiene practices. Additionally, 97.2% agreed that the program enhanced maternal and child health knowledge. Significant correlations were observed among the training course, facilities, trainers, and overall training perception. In line with this, significant associations were found between age groups (p = 0.003) and geographical areas (p = 0.023) with satisfaction levels with the literacy program. These results underscore the satisfaction of participants within the literacy program and its impact on their lives, and advocates for its broader implementation to empower marginalized communities for sustainable development. [ABSTRACT FROM AUTHOR]

(1) Background: The surgical procedure to create an arteriovenous fistula (AVF) can be performed in either an ambulatory or in-patient hospital setting, depending on the case's complexity, the anesthesia type used, and the patient's comorbidities. The main scope of this study is to assess the cost-effectiveness and clinical implications of surgically creating an AVF in both ambulatory and in-hospital settings. (2) Methods: We conducted a retrospective observational study, in which we initially enrolled all patients with end-stage kidney disease (ESKD) admitted to the Vascular Surgery Department, Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis, between January 2020 and December 2022. The primary endpoint of this study is to assess the cost-effectiveness of surgically creating an AVF in an ambulatory vs. in-hospital setting by comparing the costs required for the two types of admissions. Further, the 116 patients enrolled in this study were divided into two groups based on their preference for hospitalization: out-patients and in-patients. (3) Results: Regarding in-patient comorbidities, there was a higher prevalence of peripheral artery disease (PAD) (p = 0.006), malignancy (p = 0.020), and previous myocardial infarction (p = 0.012). In addition, active smoking (p = 0.006) and obesity (p = 0.018) were more frequent among these patients. Regarding the laboratory data, the in-patients had lower levels of white blood cells (WBC) (p = 0.004), neutrophils count (p = 0.025), lymphocytes (p = 0.034), and monocytes (p = 0.032), but there were no differences between the two groups regarding the systemic inflammatory biomarkers or the AVF type. Additionally, we did not register any difference regarding the outcomes: local complications (p = 0.588), maturation failure (p = 0.267), and primary patency (p = 0.834). In our subsequent analysis, we discovered no significant difference between the hospitalization type chosen by patients regarding AVF primary patency failure (p = 0.195). We found no significant association between the hospitalization type and the recorded outcomes (all ps > 0.05) in both multivariate linear regression and Cox proportional hazard analysis. (4) Conclusions: In conclusion, there are no significant differences in the clinical implications, short-term and long-term complications of AVF for out-patient and in-patient admissions. Additionally, we found no variation in the costs associated with laboratory tests and surgical supplies for an AVF creation. Therefore, it is safe to perform ambulatory AVFs, which can reduce the risk of hospital-acquired infections and provide greater comfort to the patient. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals appear to play a key role in shaping pregnant women's views and attitudes towards lifestyle issues, such as exercise. The aim of this study is to investigate the views and beliefs of Greek midwives and obstetricians regarding exercise during pregnancy. Methods: This is a cross-sectional study conducted during the period of January 2022–March 2023. For this study, 237 Greek midwives and obstetricians employed in healthcare settings in Attica, Greece completed an anonymous and self-report questionnaire. Four different/independent models of multivariate analyses of variance were conducted. Results: The vast majority of these healthcare professionals (88.6%) believed that exercise during pregnancy is generally beneficial. According to the multivariate analyses, healthcare professionals with postgraduate/doctoral studies were more likely to believe that (a) exercise is generally beneficial (p = 0.03), (b) pregnant women should be informed about it (p = 0.028), (c) informing pregnant women is necessary/useful (p = 0.023), and (d) pregnant women showed interest in it (p = 0.034). Also, freelance midwives were more likely to believe that pregnant women should be informed about exercise (p = 0.006), and that they showed interest in it (p = 0.034). In addition, (a) freelance midwives (p = 0.050), and those who had experience in antenatal counselling (p = 0.037), as well as (b) obstetricians who were largely experienced in monitoring normal pregnancies (p = 0.001), were less likely to associate exercise during pregnancy with the occurrence of placental abruption. Conclusion: Alongside healthcare professionals' educational level, their professional setting and professional experience emerge as key factors and need to be considered when designing innovative interventions to support exercise during pregnancy. [ABSTRACT FROM AUTHOR]

Background: In the wake of the coronavirus disease 19 (COVID-19) pandemic, affecting healthcare systems globally, urgent research is needed to understand its potential repercussions on the diagnosis and management of cardiovascular disorders. This emphasises the importance of detecting coronary artery anomalies (CAAs), rare conditions that can range from benign to potentially life-threatening manifestations. We aimed to retrospectively assess the impact of the COVID-19 pandemic on the detection of various coronary anomalies using Coronary Computed Tomography Angiography (CCTA) within a regional tertiary cardiology unit in north-eastern Romania, focusing on perceived occurrence in the population under study, types, and related demographic and clinical factors. Methods: We analysed CCTA scans and investigated the trends in CAA detection among cardiology patients over a decade. We compared pre-COVID-19 and pandemic-era data to assess the impact of healthcare utilisation, patient behaviour, and diagnostic approaches on anomaly detection. Results: Our analysis revealed a higher detection rate of CAAs during the pandemic (3.9% versus 2.2%), possibly highlighting differences in patient clinical profile and addressability changes presentation compared to the previous period. Origination and course anomalies, often linked to severe symptoms, were significantly higher pre-COVID-19 (64.1% versus 51.3%). Conversely, intrinsic CAAs, typically asymptomatic or manifesting later in life, notably increased during the pandemic (49.0% versus 61.4%; p = 0.020). Conclusions: Our study underscores a significant rise in CAA detection during the COVID-19 era, potentially linked to changes in cardiovascular and respiratory clinical patterns, with advanced imaging modalities like CCTA offering accuracy in identification. [ABSTRACT FROM AUTHOR]

Background: Pediatric colorectal specialists care for patients with a variety of defecation disorders. Anorectal (AR) manometry testing is a valuable tool in the diagnosis and management of these children. This paper provides a summary of AR manometry techniques and applications as well as a review of AR manometry findings in pediatric patients with severe defecation disorders referred to a pediatric colorectal center. This is the first study describing multi-year experience using a portable AR manometry device in pediatric patients. Methods: An electronic medical record review was performed (1/2018 to 12/2023) of pediatric patients with defecation disorders who had AR manometry testing. Demographics, diagnostic findings, and outcomes are described. Key Results: A total of 297 unique patients (56.9% male, n = 169) had AR manometry testing. Of these, 72% (n = 188) had dyssynergic defecation patterns, of which 67.6% (n = 127) had fecal soiling prior to treatment. Pelvic rehabilitation (PR) was administered to 35.4% (n = 105) of all patients. A total of 79.5% (n = 58) of the 73 patients that had fecal soiling at initial presentation and completed PR with physical therapy and a bowel management program were continent after therapy. AR manometry was well tolerated, with no major complications. Conclusions: AR manometry is a simple test that can help guide the management of pediatric colorectal surgical patients with defecation disorders. As a secondary finding, PR is a useful treatment for patients with dyssynergic stooling. [ABSTRACT FROM AUTHOR]

Aim: This Study Aimed to Assess the Intention to Have a Third Child among Millennial Parents (25–40 years old) with Two Children in a City in Eastern China and to Explore the Influencing Factors Related to Fertility Intention. Design: A cross‐sectional design study. Methods: A convenience sampling method was used to enrol participants of childbearing age who visited two tertiary hospitals in Hang zhou, a city in eastern China, from June 2021 to March 2022. We conducted a face‐to‐face questionnaire survey with 520 participants and calculated the prevalence of intention‐related factors. Multivariate logistic regression was used to analyse the independent influencing factors of fertility intention. Results: In total, 105 (20.2%) participants had the intention to have a third child. The results showed that 'employment status', 'age', 'reasons for wanting a third child', the considered 'biggest barrier to having a third child', 'views on the three‐child policy', 'desired free services', 'supporting work policies' and 'assistance policies' were significant independent influencing factors of intention to have a third child (p‐value < 0.05). The intention of the participants 'over 30 years old' was 2.466 times that of those '30 years old and under', and 'older age/personal health status' was considered the 'biggest barrier to having a third child'. Regarding policy and social reasons, the participants who need 'medical assistance' policy negatively affect the intention to have a third child (OR = 0.453, 95% CI = 0.247–0.830). Implications for Healthcare/Nursing: Nursing plays an important role in health promotion. Nurses can help couples make wise decisions about fertility by providing professional consultation, education, evaluation and support. They can also provide corresponding nursing and guidance to improve couples' health quality and overall reproductive success. Conclusions: The general level of intention to have a third child of Millennial parents with two children is still low. The participants who are 'housewives/househusbands', 'over 30 years old', and satisfied with the state of 'medical assistance' have higher fertility intentions. Patient or Public Contribution: It is particularly meaningful for the policymakers to improve the social support system and raise universal awareness to encourage childbirth. [ABSTRACT FROM AUTHOR]

Ecologists and evolutionary biologists are regularly tasked with the comparison of binary data across groups. There is, however, some discussion in the biostatistics literature about the best methodology for the analysis of data comprising binary explanatory and response variables forming a 2 × 2 contingency table.We assess several methodologies for the analysis of 2 × 2 contingency tables using a simulation scheme of different sample sizes with outcomes evenly or unevenly distributed between groups. Specifically, we assess the commonly recommended logistic (generalised linear model [GLM]) regression analysis, the classical Pearson chi‐squared test and four conventional alternatives (Yates' correction, Fisher's exact, exact unconditional and mid‐p), as well as the widely discouraged linear model (LM) regression.We found that both LM and GLM analyses provided unbiased estimates of the difference in proportions between groups. LM and GLM analyses also provided accurate standard errors and confidence intervals when the experimental design was balanced. When the experimental design was unbalanced, sample size was small, and one of the two groups had a probability close to 1 or 0, LM analysis could substantially over‐ or under‐represent statistical uncertainty. For null hypothesis significance testing, the performance of the chi‐squared test and LM analysis were almost identical. Across all scenarios, both had high power to detect non‐null effects and reject false positives. By contrast, the GLM analysis was underpowered when using z‐based p‐values, in particular when one of the two groups had a probability near 1 or 0. The GLM using the LRT had better power to detect non‐null results.Our simulation results suggest that, wherever a chi‐squared test would be recommended, a linear regression is a suitable alternative for the analysis of 2 × 2 contingency table data. When researchers opt for more sophisticated procedures, we provide R functions to calculate the standard error of a difference between two probabilities from a Bernoulli GLM output using the delta method. We also explore approaches to compliment GLM analysis of 2 × 2 contingency tables with credible intervals on the probability scale. These additional operations should support researchers to make valid assessments of both statistical and practical significances. [ABSTRACT FROM AUTHOR]

Objective: The objective of this pilot study was to explore the impact of interpreter format (virtual vs in person) on clinical outcomes in patients with non-English language preference (NELP) and type 2 diabetes mellitus (T2DM) in a primary care setting. We hypothesized that NELP patients utilizing in person interpreters would have improved HbA1c values, better follow-up rate, and more complex care plans compared to patients utilizing virtual interpreters. Methods: We completed a retrospective chart review of 137 NELP patients with T2DM who required a medical interpreter (February to June 2021). We calculated univariate and bivariate statistics to characterize the sample and assess the extent to which measures of continuity (follow-up visit rate and time to follow-up visit), quality (change in HbA1c), and complexity (medication intervention complexity) were associated with interpreter type. Results: There was no statistically significant difference in follow-up rate or average days to follow-up visit for NELP patients with in person as opposed to virtual interpreters. Patients with virtual interpreters demonstrated a non-statistically significant decrease in HbA1c compared to those with in person interpreters. Finally, there was no statistically significant association between interpreter format and intervention complexity. Conclusions: Quality medical interpretation contributes to optimal health outcomes in NELP patients with diabetes. Our study suggests that both in person and virtual interpreters can be effective in providing care for NELP patients, especially for chronic disease management in the context of a primary care relationship. It also highlights the importance of pursuing additional qualitative and mixed method studies to better understand the benefits of various interpreter formats across different visit types. [ABSTRACT FROM AUTHOR]

Background: Parents of children suffering from congenital heart disease experience high levels of stress and negative emotions. Therefore, recognition of parents' emotional states and their ways of coping with it is becoming more and more important. Methods: The study group consisted of 154 parents of newborns and infants with cyanotic congenital heart disease, before and after cardiac surgery (partial or full). To assess parental negative emotions, the level of stress, and strategies of coping with it, standardized questionnaires, such as HADS-M, PSS-10, and COPE, were used. Results: Stress levels in parents were high and associated with negative emotions (anxiety, depression, irritability), as well as the choice of non-constructive coping strategies, which was observed especially in younger parents. Conclusions: Assessing parents' stress levels and ways of coping with stress can improve family functioning and provide better development conditions for the child. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about male nurses not only exacerbate the gender imbalance in the nursing profession but also negatively impact male nurses embarking on their careers. Currently, no tool exists to measure the gender biases toward males in nursing among nursing students in China. Consequently, the primary objective of this study is to assess the validity and reliability of the Chinese translation of the Gender Misconceptions of Men in Nursing (GEMINI) scale among nursing students. Methods: This cross-sectional study involved 1,102 nursing students from China who participated online. We utilized the Brislin translation technique with a forward-backward approach. To determine the factor structure within the Men in Nursing Gender Misconceptions Scale's Chinese version, both exploratory (EFA) and confirmatory factor analysis (CFA) were applied. The scale's internal consistency was measured through the Cronbach's alpha coefficient, corrected item-total correlation, and a retest reliability assessment. Results: The scale showed a content validity index of 0.938 and a retest reliability of 0.844. EFA indicated a two-factor structure for the translated instrument. CFA revealed a chi-square/degree of freedom of 3.837, an incremental fit index (IFI) of 0.952, a goodness-of-fit index (GFI) of 0.910, a comparative fit index (CFI) of 0.952, and an RMSEA of 0.073, all of which were within acceptable limits. The scale's Cronbach's α was 0.953, and the corrected item-total correlations ranged between 0.539 and 0.838. Gender-based misconceptions about men in nursing among students appeared to be influenced by their gender and whether they considered a nursing program as their first choice when applying for a major. Misconceptions about male nurses are greater among men and those who do not consider nursing programs as their first choice when applying for a major. Conclusions: The Chinese adaptation of the GEMINI scale showcased high reliability and validity. It stands as a potential instrument to gauge gender misconceptions concerning male nurses among Chinese nursing students. [ABSTRACT FROM AUTHOR]

Introduction: Urolithiasis is one of the most common urological problems worldwide. The fastest treatment modality to achieve stone clearance of ureteral stones is Ureteroscopic Lithotripsy (URSL). However, it is negated by both the cost burden and potential risk to the patient. Medical Expulsive Therapy (MET) is a treatment option for upto 10 mm stones but has failure rates of 40-60% in the literature. Aim: To analyse the various indications for surgery, whether MET was used or not, if used-its details, operative findings at ureteroscopy including the reason for the failure of MET. Materials and Methods: A cross-sectional study consisting of 72 patients with ureteric calculi undergoing URSL was analysed from June 2017 to December 2018 at Mazumdar Shaw Medical Centre, Bangalore, Karnataka, India. Indications were assessed at the time of admission. During ureteroscopy, factors like impaction, distal obstruction, and unusual findings were studied, which could have contributed to the failure of MET. The Chi-square test was used as a test of significance for categorical data. The Analysis of Variance (ANOVA) test was used as a test of significance to identify the mean difference between continuous variables. The p-value of <0.05 was considered statistically significant. Results: The mean age in the study was 41.65±13.4 years (range 20-69 years), and the mean stone size was 10.03±3.34 mm. Large stone was the most common indication (41, 56.9%, p=0.004), followed by failed MET (35, 48.6%). Even though MET could have been continued for four weeks in 17 patients (23.6%), they were taken up for surgery. The impaction rate was 70.8% (51), with 48.6% (35) being large impacted stones and 22.2% (16) being small impacted stones. The overall stone clearance rate was 68 out of 72 (94.4%). Conclusion: Large stone size (=10 mm) and failed MET were the main indications for surgery. One reason for the failure of MET was not waiting for a duration of four weeks. During ureteroscopy, impaction of the stone, irrespective of size, was the most common finding and was the reason for the failure of MET. Ureteric stones on MET should not be neglected as there are reasons for the failure of MET, and they will require URSL after four weeks. [ABSTRACT FROM AUTHOR]

Background: In Iran, there is a lack of information and studies on acute rheumatic fever (ARF), a global health issue. The limited understanding of ARF's prevalence and primary clinical symptoms has led to confusion. This research investigates the characteristics of children aged 3-17 years who experience ARF with monoarthritis as their initial symptom. Methods: A retrospective evaluation of medical records of children diagnosed with ARF was conducted. The study aimed to determine the prevalence of monoarthritis as the first manifestation of ARF and its association with age, gender, family history, and cardiac involvement. Categorical variables were analyzed using the chi-square test with a significance level of < 0.05 and a confidence interval of 95%, using SPSS software (Version 23). Results: The study included 62 patients with ARF, comprising 41 (66.1%) boys with an average age of 8.48±3.27 years. Among these patients, 12 exhibited cardiac involvement according to the revised Jones criteria, with 5 clinical carditis and 7 cases of subclinical carditis. Monoarthritis was the initial symptom in seven patients (11.29%); five (71.4%) also had carditis. There was a significant association (p<0.001) between monoarthritis and carditis. Conclusion: The study concludes that monoarthritis may be an early sign of ARF in children and correlates significantly with cardiac involvement. However, more extensive research with more significant participant numbers is necessary to understand ARF in Iran comprehensively. A thorough cardiac examination is also crucial for patients with ARF and monoarthritis. [ABSTRACT FROM AUTHOR]

Background: Palliative care (PC) focuses on relieving pain and difficult symptoms rather than treating disease or delaying its progress. Palliative care views death as a natural process and allows patients to live the last phase of their existence in the best possible way, encouraging them to express their opinions and wishes for a good death. Interventions are advocated to control symptoms and distress and promote wellbeing and social functioning. A multidisciplinary approach to support patients receiving palliative care is encouraged. Objective: The aims of this study were to investigate the facilitators and barriers to PC in people with kidney disease from a nursing perspective and to explore predictive factors associated with nurse-perceived facilitators and barriers to PC in people with kidney disease. Design: This study is a survey that adopted a questionnaire created in 2021 with Delphi methology, which included 73 statements divided into 37 facilitators and 36 barriers to PC in patients with kidney disease, to be scored using a Likert scale. Participants and Measurements: Participants were obtained through the membership database of the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) of 2020. Inclusion criteria included being registered as a nurse, an EDTNA/ERCA member and understanding of the English language. The questionnaire was sent via email. Results: Three profiles of respondents were found: the first group was characterized by the highest agreement percentages of facilitators and with an average value of 53.7% in barriers; the second was characterized by a lower endorsement of facilitators and similar agreement to the first group for barriers; the third group had a high probability (>80%) of items endorsing both barriers and facilitators. Predictive variables were significantly associated with "Years in nephrology" and "macro geographic area". Conclusions: This study demonstrates variation in PC practice across Europe. Some professionals identified fewer barriers to PC and appeared more confident when dealing with difficult situations in a patient's care pathway, while others identified more barriers as obstacles to the implementation of adequate treatment. The number of years of nephrology experience and the geographical area of origin predicted how nurses would respond. This study was not registered. [ABSTRACT FROM AUTHOR]

Introduction: Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by partial or total airway obstruction during sleep. Studies have shown variability in the level of knowledge and awareness about OSAS among pediatricians. The management of childhood obstructive sleep apnea syndrome (OSAS) depends on the severity of the disease, the presence of comorbidities, and the child's age. The American Pediatric Academy recommends a multidisciplinary approach involving a pediatrician, a sleep specialist, and an otolaryngologist to provide comprehensive care for children with OSAS. The aim of this cross-sectional study is to evaluate the level of knowledge among pediatricians in Italy regarding the diagnosis of pediatric OSAS. Material and Methods: An anonymized survey was conducted among Italian pediatricians. The survey was administered electronically using Google Forms, and a total of 350 pediatricians were invited to participate. Out of the 350 invitations, 299 pediatricians responded to the survey. The statistical analysis performed consisted of descriptive analysis. The study included 297 pediatricians. Results: Pediatricians demonstrated proficiency in identifying common nocturnal and day symptoms of OSAS. A majority (68.9%) considered the oral and otorhinolaryngologist areas during checkups. Approximately 70.6% took patient weight into account, and 62.8% were aware of the regional diagnostic-therapeutic-assistance pathway. Conclusions: According to the results of this manuscript, there is evidence of a good level of knowledge about OSAS, but disseminating more information about OSAS and all the health issues associated with this syndrome is suggested. This study also has limitations caused by the complexity of the pathology. [ABSTRACT FROM AUTHOR]

AIM The aim of this study was to evaluate the effects of a virtual mindfulness meditation intervention on stress and anxiety levels of 145 nursing students. BACKGROUND Because of the twin demands of classroom and clinical workloads, nursing students experience greater amounts of stress and anxiety than the average college student. Mindfulness meditation is a promisingmethod to alleviate stress and anxiety. METHOD A pretest-posttest randomized controlled design was used. Participants received either weekly mindfulness meditation recordings or recordings on nursing information. Participants completed the Perceived Stress Scale and the Generalized Anxiety Disorder-7 Scale. RESULTS A two-way mixed analysis of variance and follow-up simple main effects tests revealed that participants in the experimental group, who received meditation recordings, experienced significantly lower levels of stress and anxiety on posttest surveys than the control group. CONCLUSION Mindfulness meditation can reduce stress and anxiety levels in nursing students. This can improve students' overall mental and physical well-being. [ABSTRACT FROM AUTHOR]

Background: Paediatric HIV data shows a variable and sometimes catastrophic response in the initial stage of ART regimen administration. The burden of disease that affects children in their first year of treatment is not comprehensively available. Objective: Objective of our study was to describe patterns of admission in children; before ART initiation, within the first six months, and post-six months of ART between 2001 and 2016. Methods: Principal caregivers of 260 children (45.7% females 54.2% males, all <15years) on ART for at least six months were interviewed about admissions of their children. Diagnoses were verified from the health passport books. Data on age, sex, date of ART initiation was obtained from the database of Baylor College of Medicine in Lilongwe. Data were analysed using Excel for descriptive analysis. Chi Square Test was used to test for significance. Results: There were more admissions before starting ART 74% (95%CI 68.67-79.33%) vs. 42% (95%CI 36.00-48.00%), after starting ART (p = <0.001 at 5% significance level); after six months of ART 34% (95%CI 28.24-39.76) vs. 20% (95% CI 15.51-24.86%) (p = <0.001 at 5% significance level). The commonest causes of admission were pneumonia, malaria, tuberculosis, anaemia; no difference in causes of admission within the first and after six months of ART initiation. Conclusion: ART significantly reduces admission in children living with HIV. The common causes of admission are HIV non-specific conditions. No difference between causes of admission within and after six months of ART. [ABSTRACT FROM AUTHOR]

Background and Aims: There is limited research on the impact of COVID-19 pandemic on caregivers of patients with severe mental illness (SMI) during its late phase when sufficient and widespread knowledge about management and preventive aspects existed. We aimed to assess the impact of COVID-19 pandemic on caregivers of patients with SMI during Omicron wave. Methodology: We assessed 100 caregivers of patients with preexisting SMI diagnosed on the Diagnostic and Statistical Manual of Mental Disorders-5, 50 each of schizophrenia and related psychotic disorders (SCZ) and bipolar disorder (BD) from December 14, 2021, to February 9, 2022. We assessed symptoms of depression, anxiety, stress, and family burden in caregivers and their coping strategies by the Depression, Anxiety, and Stress Scale-21 Hindi version, Family Burden Interview Schedule (FBIS), and Brief-Coping Orientation to Problem Experienced, respectively. Results: Caregivers of SMI experienced symptoms of depression (51%), anxiety (72%), and stress (13%), with significantly more symptoms of depression (P = 0.002) and anxiety (P = 0.025) in caregivers of SCZ. High caregiver burden (score: 25.76, > half of the total score on FBIS) was found with no significant difference in the two groups. Caregivers of SCZ used a greater number of emotion-focused coping strategies, whereas those with BD used more problem-focused coping, but the difference was not significant. A significant association was seen between coping strategies of substance use and depressed symptoms (P = 0.003), substance use and anxiety symptoms (P = 0.007); anxiety symptoms with denial (P = 0.001) anxiety symptoms and venting (P = 0.008) in caregivers of BD. Conclusion: Caregivers of patients with preexisting SMI experienced depression, anxiety, and high family burden during Omicron wave. They used both emotion- and problem-focused coping strategies. [ABSTRACT FROM AUTHOR]

As turnover intention is a strong determinant of actual turnover behavior, scholars should identify the determinants of turnover intention. In this context, the aim of this study was to assess the effect of quiet quitting on nurses' turnover intentions. Additionally, this study examined the impact of several demographic and job characteristics on turnover intention. A cross-sectional study with 629 nurses in Greece was conducted. The data were collected in September 2023. Quiet quitting was measured with the "Quiet Quitting" scale. In this study, 60.9% of nurses were considered quiet quitters, while 40.9% experienced high levels of turnover intention. Multivariable regression analysis showed that higher levels of quiet quitting increased turnover intention. Moreover, this study found that turnover intention was higher among females, shift workers, nurses in the private sector, and those who considered their workplace understaffed. Also, clinical experience was associated positively with turnover intention. Since quiet quitting affects turnover intention, organizations, policymakers, and managers should address this issue to improve nurses' intentions to stay at their jobs. [ABSTRACT FROM AUTHOR]

aiman Hamdi31Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; 2Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; 3Faculty of Medicine, Jazan University, Jazan, Saudi ArabiaCorrespondence: Gassem Gohal, Email [email protected] Background: The prevalence of asthma among children has been on the rise worldwide, leading to significant morbidity and mortality. Our study was conducted to determine the prevalence of asthma and its related risk factors among school-age children in the Jazan Region, Saudi Arabia.Materials and Method: The study was a cross-sectional prospective study that used Phase I ISAAC protocol and was conducted from March to June 2023. The sample size was calculated to be 1600 among school-age children in the Jazan Region Saudi Arabia. This study complies with the Declaration of Helsinki. Data was analyzed using SPSS version 23.0, Descriptive statistics were calculated for study variables, and appropriate tests of significance were performed to determine statistical significance.Results: The total study population was 1368 the majority of them, 96.6% (n=1321), were Saudi nationals, and most of them lived in rural areas (70.6%, n=966). The prevalence of life-long wheezing, wheezing in the last 12 months, and exercise-induced wheezing was 28.0%, 29.2%, and 30.9%, respectively. Risk factors such as having indoor plants, having a pet, and a smoker in the household were reported by 48.0%, 24.6%, and 36.4% of participants, respectively. Living near an industrial area was determined as a risk factor in 98 (7.2%) of the children. Asthma-related symptoms were strongly correlated with all risk factors based on the chi-square test, and some risk factors based on multivariate linear regression.Conclusion: The prevalence of asthma among children in the Jazan Region is higher than previously reported, and the reported risk factors are significantly correlated with symptoms of asthma. [ABSTRACT FROM AUTHOR]

Background: Neuroimaging studies have demonstrated alterations in hippocampal volume and hippocampal subfields among individuals with amnestic mild cognitive impairment (aMCI). However, research on using hippocampal subfield volume modeling to differentiate aMCI from normal controls (NCs) is limited, and the relationship between hippocampal volume and overall cognitive scores remains unclear. Methods: We enrolled 50 subjects with aMCI and 44 NCs for this study. Initially, a univariate general linear model was employed to analyze differences in the volumes of hippocampal subfields. Subsequently, two sets of dimensionality reduction methods and four machine learning techniques were applied to distinguish aMCI from NCs based on hippocampal subfield volumes. Finally, we assessed the correlation between the relative volumes of hippocampal subfields and cognitive test variables (Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA)). Results: Significant volume differences were observed in several hippocampal subfields, notably in the left hippocampus. Specifically, the volumes of the hippocampal tail, subiculum, CA1, presubiculum, molecular layer, GC-ML-DG, CA3, CA4, and fimbria differed significantly between the two groups. The highest area under the curve (AUC) values for left and right hippocampal machine learning classifiers were 0.678 and 0.701, respectively. Moreover, the volumes of the left subiculum, left molecular layer, right subiculum, right CA1, right molecular layer, right GC-ML-DG, and right CA4 exhibited the strongest and most consistent correlations with MoCA scores. Conclusion: Hippocampal subfield volume may serve as a predictive marker for aMCI. These findings underscore the sensitivity of hippocampal subfield volume to overall cognitive performance. [ABSTRACT FROM AUTHOR]

Background: Neuromelanin- and iron-sensitive MRI studies in Parkinson’s disease (PD) are limited by small sample sizes and lack detailed clinical correlation. In a large case–control PD cohort, we evaluated the diagnostic accuracy of quantitative iron–neuromelanin MRI parameters from the substantia nigra (SN), their radiological utility, and clinical association. Methods: PD patients and age-matched controls were prospectively recruited for motor assessment and midbrain neuromelanin- and iron-sensitive [quantitative susceptibility mapping (QSM) and susceptibility map-weighted imaging (SMWI)] MRI. Quantitative neuromelanin–iron parameters from the SN were assessed for their discriminatory performance in PD classification using ROC analysis compared to those of qualitative visual classification by radiological readers of dierential experience and used to predict motor severity. Results: In total, 191 subjects (80 PD, mean age 65.0 years; 111 controls, 65.6) were included. SN masks showed (a) higher mean susceptibility (p < 0.0001) and smaller sizes after thresholding for low susceptibility (p < 0.0001) on QSM and (b) lower contrast range (p < 0.0001) and smaller sizes after thresholding for high-signal voxels (p < 0.0001) on neuromelanin-sensitive MRI in patients than in controls. Quantitative iron and neuromelanin parameters showed a moderate correlation with motor dysfunction (87.5%: 0.4< | r | <0.6, p < 0.0001), respectively. A composite quantitative neuromelanin–iron marker dierentiated the groups with excellent performance (AUC 0.94), matching the diagnostic accuracy of the best-performing reader (accuracy 97%) using SMWI. Conclusion: Quantitative neuromelanin–iron MRI is associated with PD motor severity and matched best-performing radiological PD classification using SMWI, with the potential to improve diagnostic confidence in the clinics and track disease progression and response to neuroprotective therapie. [ABSTRACT FROM AUTHOR]

Second-hand smoke (SHS) has adverse effects for pregnant women and foetuses. This controlled and randomized clinical trial evaluated the efficacy of a comic booklet intervention in promoting SHS avoidance among pregnant women and appropriate smoking behaviours among their male partners. We allocated 140 couples to the experimental group (EG), who received the comic booklet and a reminder sticker, and 146 couples to the control group (CG), who received usual care. The primary outcomes were women's self-reported SHS exposure and their male partners' smoking behaviours. Secondary outcomes included knowledge and awareness of SHS. Independent t-tests revealed that three months post-intervention, more male partners in the EG had appropriate self-reported smoking behaviours with a small effect size (Cohen's d = 0.35, 95% CI [0.08, 0.62], p-value = 0.01). Significantly more pregnant women in the EG recognised their partners' appropriate smoking behaviours with a nearly middle effect size (Cohen's d = 0.43, 95% CI [0.16, 0.70], p-value ≤ 0.01). Cues to action showed a significant difference between groups with a small effect size (Cohen's d = 0.36, 95% CI [0.09, 0.63], p-value = 0.01), as evaluated by male partners. These findings suggest that the comic booklet intervention might be effective against SHS exposure by providing several cues to action through knowledge and awareness of SHS. [ABSTRACT FROM AUTHOR]

Background: Postoperative hypocalcemia in laryngectomy patients can occur when part or whole of the thyroid gland has been removed. Preservation of the parathyroid glands in situ is considered one of the initial measures to prevent postoperative hypocalcemia even if all thyroid gland is removed. Our study aims to assess the efficacy of parathyroid gland preservation in situ to prevent postoperative hypocalcemia in cases where total laryngectomy is done with total thyroidectomy. Methods: The study included all laryngectomy patients done during a period from April 2020 to May 2021. Parathyroid gland preservation was done in both primary (12 cases) and salvage (16 cases). Both PTH and corrected calcium level were measured at different time points and used as a guide for further replacement. Results: We studied the association between outcome including recovery from transient hypocalcemia and certain variables like age, type of surgery, stage of tumor, and extent of neck dissection. Regarding type of surgery, all patients that underwent primary laryngectomy were totally recovered (n = 12, 100%); however, salvage cases were partially recovered (n = 10, 62.5%). Conclusion: Parathyroid preservation is achievable in cases of salvage laryngectomy in addition to primary laryngectomy with total thyroidectomy. Early monitoring of the patients PTH and Ca during their hospital stay is a good indicator of successful preservation. Long-term follow-up is advised for potential recovery from transient hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Existing research concerning the effects of the sitting birth position during the second stage of labour on maternal and neonatal outcomes remains controversial, and there is a lack of studies to explore its effect on the childbirth experience. The objective of this study is to explore whether the sitting birth position would influence maternal and neonatal outcomes, as well as the childbirth experience. The prospective cohort design was conducted in the study from February to June 2023, a total of 222 women (including primiparous women and multiparous women) were enrolled in our study, and they were divided into the sitting position cohort (n = 106) or the lithotomy position cohort (n = 116). The pre-designed questionnaire and Childbirth Experience Questionnaire (CEQ) were used for data collection during hospitalisation. Chi-square, Fisher's exact test, t-tests, or the Mann–Whitney U test were utilised to assess differences between groups. Multivariate linear regression and logistic regression were employed to control possible confounders. The study found that primiparous women in the sitting position cohort had a shorter duration of the second stage of labour, higher spontaneous vaginal birth rates, lower episiotomy rates, and a better childbirth experience (p < 0.01). After adjusting for confounding factors through multiple linear and logistic regression analyses, the results remained consistent with those reported above. No neonate in each cohort had Apgar scores at 1 min and 5 min postpartum less than 7 or a Cord artery pH less than 7.00, regardless of parity. Based on the findings, we recommend that women could take the sitting birth position into account when giving birth for a positive childbirth experience, especially for primiparous women. The study could also serve as a reference for healthcare providers in the management of childbirth positions and the development of high-quality maternal care. [ABSTRACT FROM AUTHOR]

Chronic low back pain (CLBP) is common in primary care, causing disability and economic burden globally. We aimed to compare socio-demographic, health, lifestyle, and psychological factors in people with and without CLBP and correlate them with clinical outcomes in people with CLBP. A total of 253 volunteers with and 116 without CLBP provided sociodemographic information, daily habits, medical history, subjective sleep complaints (Penn State Sleep Questionnaire), low back pain intensity, and disability (Quebec Back Pain Disability Scale), as well as the Zung Self-Rating Scale for self-assessment of depression and Self-Rating Anxiety Scale. CLBP diagnosis was linked with female gender and older age, as well as a higher level of sleep complaints such as sleepiness, OSA and insomnia symptoms, and a higher prevalence of moderate to severe depressive symptoms. The combination of moderate to severe depressive symptoms with obstructive sleep apnea or insomnia symptoms was the most important predictive factor for functional disability in CBLP patients (OR 13.686, 95% CI 4.581–40.885; p < 0.001). In conclusion, depressive symptoms and subjective sleep complaints appear to relate to greater CLBP intensity and/or CLBP-related disability in people with CLBP. A holistic approach is crucial for treating chronic CLBP patients, including psychological and sleep issue assessment and management, to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: No consensus currently exists among orthopaedic surgeons regarding the benefits of hip orthosis after routine hip arthroscopy. Purpose: To compare patient-reported outcome measures (PROMs) and reoperation rates between patients who were braced versus those who were not braced after routine hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted of 193 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) from January 1, 2018, to December 31, 2021, by 2 orthopedic surgeons at a single institution. Patients before July 1, 2019, were immobilized in a hip orthosis after hip arthroscopy (braced group; n = 101), whereas those after July 1, 2019, were not (nonbraced group; n = 92). Baseline PROMs (visual analog scale for pain, modified Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey [VR-12] Physical Component Summary and Mental Component Summary) were obtained for all patients and were repeated postoperatively at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and 2 years. The study groups were compared to evaluate differences in PROMs over time and 2-year postoperative reoperation rates. Group comparisons were also stratified by patient sex. Results: There were no significant differences on any PROM between the braced and nonbraced cohorts at any timepoint. There were also no significant group differences in reoperation rates, with 8 braced patients (7.9%) undergoing reoperation and 1 nonbraced patient (2.3%) undergoing reoperation (P =.208). In the sex-stratified analyses, nonbraced male patients had significantly higher VAS pain and lower VR-12 Mental Component Summary scores at 6 months postoperatively compared with braced male patients (P =.043 and.026, respectively). Conclusion: The study findings suggested that the use of an orthosis after routine hip arthroscopy for FAI does not improve patient-reported outcomes or negatively affect the 2-year reoperation rate. Postoperative bracing increases perioperative cost, and by foregoing routine bracing, patients may avoid the morbidity associated with wearing a brace for a prolonged period. [ABSTRACT FROM AUTHOR]

Background: Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D). Research design and methods: 101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes. Results: More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = −0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = −8.543, p = 0.002). Conclusions: Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D. [ABSTRACT FROM AUTHOR]

Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes. [ABSTRACT FROM AUTHOR]

Background: The first 1,000 days of a child’s life is a critical window for growth faltering, deficiencies, and common childhood illnesses. Even with optimum breastfeeding, children 6-23 months are at higher risk of being undernourished if they do not receive adequate and appropriate complementary feeding. Therefore, this study was carried out to assess the nutritional status of children 6-23 months and find the association between sociodemographic profile and nutritional status. Materials and Methods: Mothers of 411 children of age 6-23 months in an urban area of Raipur were interviewed using a pretested questionnaire based on the WHO indicators to record their complementary feeding practices. Weight, height, and mid-upper arm circumference (MUAC) was taken to assess the nutritional status. Overall and specific (sex-wise and severity-wise) prevalence rate of stunting, wasting, and underweight were calculated. The distribution of these according to various factors like infant and young child feeding practices, and details of study subject and family were calculated. Chi-square test of significance was applied to find the association between nutritional status and independent variables and their strength of association. Results: The prevalence of wasting was 25%, underweight 30%, and stunting 15%. Statistically significant association of underweight with age of the parents, both mother and father, was observed (P < 0.05). Minimum dietary diversity was achieved by only 4.1% and minimum acceptable diet by 2.4% children. Conclusions: The prevalence of wasting and undernutrition was assessed. Complementary feeding indicators were unsatisfactory among children. Ending all forms of malnutrition is the global goal. The Sustainable Development Goals (SDGs) that directly affect or indirectly influence nutrition have to be recalled at this stage and addressing malnutrition is a key element required to achieving them. [ABSTRACT FROM AUTHOR]

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Background: Preoperative interscalene brachial plexus block (ISB) has been shown to reduce postoperative nausea and vomiting after shoulder arthroscopy performed under general anesthesia (GA), possibly via reduced consumption of opioids. Postoperative urinary retention (POUR) is another adverse effect after GA with higher incidence among the elderly patients. The aim of this study is to investigate the effect of preoperative ISB on POUR. Methods: A historical cohort analysis of patients receiving shoulder arthroscopy under GA was conducted. Included patients were allocated to ISB+GA or GA only group. The difference in incidence of POUR between groups were explored as well as intraoperative requirement of inhaled anesthetics and fentanyl. Potential risk factors of POUR were also assessed with multivariate logistic regression analysis. Results: There are 229 patients in ISB+GA group and 169 patients in GA only group. Patient characteristics shows no difference between groups. ISB+GA group required lower concentration of inhaled anesthetics (fraction of minimum alveolar concentration (fMAC) 0.71 (0.16) vs. 0.93 (0.15), p < 0.001) and less total fentanyl dose (mcg kg-1, 1.9 (0.7) vs. 2.7 (1.1), p < 0.001). The incidence of POUR is lower in ISB+GA group than GA only group (3.9% vs. 10%, p = 0.02) as well as the incidence of postoperative nausea (28.4% vs. 39%, p = 0.03), and postoperative vomiting (16.2% vs. 25%, p = 0.03). Multivariate analysis reveals increased age and intraoperative fentanyl dose are associated with increased POUR. Conclusion: Preoperative ISB is associated with decreased consumption of intraoperative opioids, which may contribute to a reduced incidence of POUR. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationships between protein intake from various food sources and cardiometabolic risk markers in Italian older adults. Design: Cross-sectional study. Setting: Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns). Participants: People 65+ years who provided a written informed consent. Measurements: Blood pressure (BP), blood glucose, total blood cholesterol, and anthropometric indices were assessed. Daily protein intake was estimated for 12 food items listed in a food frequency questionnaire. Results: Three-thousand four-hundred twenty-four older adults (mean age: 72.7 ± 5.7 years; 55% women) were included in the study. Results of linear regression analysis indicated that protein intake from several food sources was negatively associated with BP, waist and hip circumferences, and waist-to-hip ratio in both sexes. Blood glucose levels were inversely associated with many protein sources in women. Positive associations were observed between some protein sources and total blood cholesterol in both men and women. Conclusion: Our findings suggest that dietary protein is differentially associated with cardiometabolic risk factors depending on sex and food sources. [ABSTRACT FROM AUTHOR]

Introduction: Fracture Liaison Services (FLS) has been proven effective in reducing subsequent fractures and related mortality. However, more research is needed on the impact of FLS on the 30-day readmission rate and its effectiveness in rural hospitals. This study aims to assess the impact of FLS on clinical outcomes including readmission rates, subsequent fractures, and fracture-related mortality in rural areas of an Asain country. Materials and methods: In a rural hospital in Taiwan, we conducted a two-year prospective cohort study on elderly individuals with fragility hip fractures. The study compared the clinical outcomes between the control group and the FLS-cohort group. Logistic regression analysis was used to identify factors contributing to 1-year mortality after injury. Results: 556 patients were enrolled. (304 in the control group and 252 in the FLS group) The mean age was 79.8 years. The findings revealed that the introduction of FLS did not result in significant differences in mortality, readmission, complication, subsequent fractures, or secondary hip fractures. However, there were notable improvements in the length of hospital stay and the proportion of patients receiving surgery within 48 h following the implementation of FLS. Subgroup analysis showed that FLS patients who received anti-osteoporotic treatment had lower mortality and 30-day readmission rates. Factors associated with higher 1-year mortality included male, high ASA level, and delayed surgery. Discussion: This study provides the real-life evidence of the effect of intensive FLS model in a rural hospital in an Asian country. Conclusion: While FLS did not show significant differences in certain clinical outcomes, it led to shorter hospital stays and increased timely surgeries. FLS patients receiving anti-osteoporotic treatment had better mortality and readmission rates. Further research is necessary to gain a comprehensive understanding of the impact of FLS care in rural areas of Asia. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is a complex neurodegenerative disease with an elusive etiology that involves the interaction between genetic, behavioral, and environmental factors. Recently, epigenetic modifications, particularly DNA methylation, have been recognized to play an important role in the onset of PD. Glycoprotein non-metastatic melanoma protein B (GPNMB), a type I transmembrane protein crucial for immune cell activation and maturation, has emerged as a potential biomarker for the risk of PD. This research aims to investigate the influence of exercise and gender on the regulation of methylation levels of GPNMB cg17274742 in individuals. Methods: We analyze data from 2,474 participants in the Taiwan Biobank, collected from 2008 and 2016. Methylation levels at the GPNMB cg17274742 CpG site were measured using Illumina Infinium MethylationEPIC beads. After excluding individuals with incomplete data or missing information on possible risk factors, our final analysis included 1,442 participants. We used multiple linear regression models to assess the association between sex and exercise with adjusted levels of GPNMB cg17274742 for age, BMI, smoking, drinking, coffee consumption, serum uric acid levels, and hypertension. Results: Our results demonstrated that exercise significantly influenced the methylation levels of GPNMB cg17274742 in males (β = -0.00242; p = 0.0026), but not in females (β = -0.00002362; p = 0.9785). Furthermore, male participants who exercised showed significantly lower levels of methylation compared to the reference groups of the female and non-exercising reference groups (β = -0.00357; p = 0.0079). The effect of the interaction between gender and exercise on the methylation of GPNMB cg17274742 was statistically significant (p = 0.0078). Conclusion: This study suggests that gender and exercise can modulate GPNMB cg17274742, with hypomethylation observed in exercise men. More research is needed to understand the underlying mechanisms and implications of these epigenetic changes in the context of risk and prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Mindfulness yoga is a type of exercise that emphasizes the integration of mindfulness or meditation into yoga. The aim of this study was to determine the effectiveness of mindfulness yoga intervention on major depressive disorder (MDD) patients. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching nine databases, including PubMed, EMBASE, Web of Science, The Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang Data knowledge service platform, Chinese Biomedical Literature Database (CBM), and China Science and Technology Journal Database (VIP) from inception to April 2023. Primary outcomes included the severity of depression. Secondary outcomes included anxiety and rumination. Results: Nine RCTs met our inclusion criteria (n = 581). The meta-analysis showed that mindfulness yoga significantly has a significant effect on depression (SMD = -0.53; 95%CI = -0.96 to -0.11; P < 0.05) among MDD patients. The only two RCTs involved also showed that mindfulness yoga could alleviate the anxiety level of MDD patients after intervention (SMD = -1.08; 95%CI = -1.64 to -0.52; P < 0.05). Meta-analysis did not reveal positive effects of the mindfulness yoga groups on rumination after intervention based on three RCTs (SMD = -0.33; 95%CI = -0.89 to 0.23; P > 0.05), but found a significant difference in the follow-up period based on two RCTs (MD = -7.42; 95%CI = -11.27 to -3.56; P < 0.05), compared with the control groups. Conclusion: Although we were unable to provide conclusive evidence to support the effectiveness of mindfulness yoga in improving symptoms in MDD patients, we found the literature included in this study indicated that mindfulness yoga might have a potential benefit for MDD patients and should be a feasible, acceptable, and promising intervention. Highlights: Mindfulness yoga is a promising intervention for MDD patients. Larger sample size and well-designed RCTs are needed for future studies. Mindfulness yoga intervention, such as the form, intensity and period, require further clarification in the future studies. [ABSTRACT FROM AUTHOR]

Introduction: Researchers must concentrate their focus on whether patients understand various treatment options available among removable complete and partial denture patients and whether they are aware of the maintenance protocol of the prosthesis. Materials and Methods: All the patients who completed removable partial or complete denture treatment in a period of 6 months were included in the study. Collected data were statistically analyzed using Chi-square test at a significance level of P < 0.05. Results: Awareness needs to be increased regarding the treatment options available for removable complete and partial denture treatment causes because many subjects in this study were only aware of the removable partial denture and complete denture treatment for missing teeth and not the other options, especially among individuals in the lower socioeconomic group. Conclusion: The findings indicate that awareness needs to be increased regarding the functions of prostheses such as esthetics and phonetics because many subjects in this study were only aware of the masticatory function performed by prosthesis. [ABSTRACT FROM AUTHOR]

Aim: To compare the long‐term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI. Design: An explorative, register‐based cross‐sectional study. Methodology methods: A sample was drawn from the one university hospital's procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods. Findings results: Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non‐ST‐elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient‐centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care. Patient or public contribution: Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution. Implication for profession and patient care: This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient‐centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions. [ABSTRACT FROM AUTHOR]

Background. This study compared the ability of thermally treated files in shaping simulated canals with double curvature. Fifty-six canals were enlarged to a final size of 25 with ProTaper Next (PTN) or ZenFlex (ZF). Materials. Half of the samples were shaped with cooled files (nD14 each). The amount of removed resin was measured and canal deviation was determined at eight levels. Shaping time and maximum shaping torque values were also recorded. Data were statistically analyzed using analysis of variance and LSD, Kruskal-Wallis, and chi-square tests at a 0.05 significance level. Results. Compared to PTN and cooled PTN, ZF and cooled ZF required lesser time to shape the canals. The maximum torques were found comparable between the groups. All the groups generated negligible deviations at every canal level evaluated and maintained the canal geometry. Although not significant, the cooled PTN and ZF files exhibited lesser canal deviations than their counterparts. Conclusion. All groups demonstrated similar shaping ability whilst maintaining the original curvature of the canal in simulated canals with double curvature. However, ZF groups were able to shape the canals faster than PTN groups. There was a trend that cooled files made lesser canal deviations compared to their counterparts. [ABSTRACT FROM AUTHOR]

There are few estimates of the seroprevalence of SARS-CoV-2 antibodies among children in the United States. We measured vaccine and infection induced seroprevalence among nearly 5000 healthy 1 to 17-year-old children in Colorado from 2020 to 2021. By December 2021, 89% of older children, ages 12 to 18, had antibodies detected. The increase was largely driven from vaccination rather than infection. [ABSTRACT FROM AUTHOR]

Background and objective: This study aims to examine the role of neurovascular coupling (NVC) in vascular cognitive impairment (VCI) by investigating the relationship between white matter lesion (WML) burden, NVC, and cognitive deficits. Additionally, we aim to explore the potential of NVC as a tool for understanding the neural mechanisms underlying VCI. Methods: This study included thirty-eight small vessel disease cognitive impairment (SVCI) patients, 34 post-stroke cognitive impairment (PSCI) patients, and 43 healthy controls (HC). Comprehensive assessments, including neuroimaging and neuropsychological testing, were conducted to evaluate cognitive function. WML burden was measured and correlated with NVC coefficients to examine the relationship between white matter pathology and NVC. Mediation analysis was employed to explore the link relationship between NVC, WML burden, and cognitive function. Results: The present study showed that NVC was significantly reduced in the SVCI and PSCI groups compared with HCs at both whole-brain and brain region level. The analysis revealed notable findings regarding NVC in relation to WML burden and cognitive function in VCI patients. Specifically, reduced NVC coefficients were observed within higher order brain systems responsible for cognitive control and emotion regulation. Mediation analysis demonstrated that NVC played a mediating role in the relationship between WML burden and cognitive impairment. Conclusion: This study reveals the mediating role of NVC in the relationship between WML burden and cognitive function in VCI patients. The results demonstrate the potential of the NVC as an accurate measure of cognitive impairment and its ability to identify specific neural circuits affected by WML burden. [ABSTRACT FROM AUTHOR]

Objective: The risk of malignancy in pediatric thyroid nodules is higher compared to the risk in adults. Our aim was to investigate the clinical, radiological, and histopathological characteristics of pediatric thyroid nodules. Materials and Methods: The data of 132 children and adolescents who had thyroid nodules were collected retrospectively from medical records. Results: The mean age of the patients was 12.07 ± 4.08 years and 67% were female. Fine-needle aspiration biopsy was performed in 86 patients (65%) and the results were as follows: benign in 53.4% (n = 46), atypia or follicular lesion of undetermined significance in 3.5% (n = 3), suspicious for follicular neoplasia in 2.3% (n = 2), and malignancy in 32.5% (n = 28). The overall malignancy rate was 22.7% (n = 30). Malignancy was detected after surgery in 2 thyroid nodules belonging to the atypia or follicular lesion of undetermined significance category. Malignancy was detected in 7 patients who had autoimmune thyroiditis and in 1 patient who had congenital dyshormonogenesis. The malignancy rate of the nodules in the patients, who had autoimmune thyroiditis, was found to be 13.4%. Mixed echogenicity, microcalcifications, nodules larger than 10 mm, abnormal lymph nodes, and irregular borders were more common in the malignant group. The nodule size, abnormal lymph nodes, and irregular borders were found to be significant in terms of predicting malignancy. Conclusion: We found malignancy in 22.7% of the thyroid nodules, and the malignancy rate of nodules in the patients, who had autoimmune thyroiditis, was 13.4%. The nodule size, abnormal lymph nodes, and irregular nodule borders emerged as the most significant risk factors for malignancy. [ABSTRACT FROM AUTHOR]

Background: The Apolipoprotein E (ApoE) polymorphism plays an important role in the pathophysiology of end-stage renal disease (ESRD). Additionally, ApoE may contribute to the progression of oxidative stress. Thus, this study aimed to determine the ApoE gene polymorphism and evaluate the malondialdehyde (MDA) level in ESRD patients and healthy individuals. Methods: The present cross-sectional study was conducted at 2010 at Kermanshah University of Medical Sciences (Kermanshah, Iran). The study population comprised ESRD patients (n=136) and healthy individuals (n=137). The MDA level was assessed using high-performance liquid chromatography (HPLC), and the frequencies of ApoE gene alleles were analyzed using restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). The data were analyzed using Statistical Package for Social Sciences (SPSS), version 13. The significant differences of ApoE genotypes in case and control groups were assessed using Pearson's Chi square tests, and two-tailed Student's tests. A logistic regression model was used to calculate the odd ratio. P<0.05 was considered statistically significant. Results: According to the results, ESRD patients had a higher frequency of the E2/E3 genotype than the healthy group (P<0.001). The results indicated that E3/E4 genotype frequency in the patients' group was higher than that of the control group (P=0.026). Furthermore, the E3/E2 (OR=5.7, 95% CI=2.68-12.14) (P<0.001) and E3/E4 (OR=1.57, 95% CI=1.05-2.34) (P=0.029) genotypes were found to increase the risk of ESRD. Moreover, the MDA level in ESRD patients was higher than the healthy individuals (P<0.001). The patients with E3/E2 (P<0.001) and E3/E4 (P<0.001) genotypes had a higher level of MDA than the control group. Conclusion: According to the findings, patients with ESRD had higher genotypes of E3/E2 and E3/E4, which suggests a higher risk of developing ESRD. [ABSTRACT FROM AUTHOR]

This retrospective analysis examined the association between change in A1C and professional continuous glucose monitoring (p-CGM) use in patients with type 2 diabetes and poor glycemic control who were not using insulin. Data from 15,481 eligible patients (p-CGM users n = 707 and p-CGM nonusers n = 14,774) showed a greater decrease in A1C from baseline to the end of follow-up for p-CGM users, and differences favored p-CGM users regardless of whether they started insulin therapy during the follow-up period. These findings suggest that people with type 2 diabetes who have poor glycemic control using multiple noninsulin therapies may benefit from p-CGM, which can reduce A1C over a 6-month period compared with usual care. [ABSTRACT FROM AUTHOR]

Background: Psychological impact of COVID-19 is an emerging area of interest among researchers worldwide. We aimed to study the prevalence of anxiety and depression among COVID-19 survivors and its association with individual characteristics including demographic variables. Methods: One hundred and fifty COVID-19 survivors from a tertiary care hospital were contacted to collect information regarding anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) scale and Patient Health Questionnaire-9 (PHQ-9). The Pearson's Chi-square was used for univariate analysis of categorical variables. The Mann–Whitney test was used to check the significance between group medians. Results: 21.3% of the survivors (n = 32) reported postdischarge COVID-19 anxiety. Mild, moderate, and moderately severe anxiety was reported by 17.3%, 3.3%, and 0.7% of the patients, respectively, on using the GAD-7 questionnaire. PHQ-9 revealed that 29.3% (n = 44) had depression. Minimal, mild, moderate, and moderately severe depression was reported by 19.3%, 24.0%, 2.0%, and 3.3% of the respondents, respectively. None of the survivors had severe anxiety or depression. In both the questionnaires, variation in median scores was statistically significant with age, whereas for GAD-7 scores, the difference in median scores was statistically significant only for gender. On analysis, age above 40 years was a statistically significant determinant for both anxiety (P = 0.041) and depression (P = 0.018) while male gender showed a statistically significant association in case of anxiety (P = 0.028). The correlation between age and respective scores and GAD-7 scores and PHQ-9 scores was also found to be significant (P < 0.001). Conclusion: These preliminary screening results provide convincing evidence of anxiety and depression among COVID-19 survivors, thus reiterating the need of timely detection and management of mental health issues through formulation of strategies to tackle the concurrent psychological comorbidities amid the ongoing pandemic. [ABSTRACT FROM AUTHOR]