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Objective: To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. Methods: Population‐based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi‐square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. Results: Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower‐risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13–1.32)), 39 (aOR 1.31(1.23–1.40)), 40 (aOR 1.42(1.35–1.50)), and 41 weeks of gestation (aOR 1.43(1.35–1.51)). Perinatal mortality was rare in both groups and non‐significantly lower in the induced group at most gestations. Discussion: For lower‐risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. Design and setting: Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019–21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. Cases: The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. Measurements Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non‐Hispanic Black, non‐Hispanic White) was based on the death certificate. Findings In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40–50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5–0.9; 2020: OR = 0.5, 95% CI = 0.4–0.7; 2021: OR = 0.6, 95% CI = 0.5–0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. Conclusion: After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people. [ABSTRACT FROM AUTHOR]

Introduction: Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking. Methods: Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all‐cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow‐up (within 8–30 days of ablation). Results: After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65–0.88; p <.001) and extended follow‐up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65–0.98; p =.032). This was driven by a lower rate of vascular complications during early follow‐up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52–0.83; p <.001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58–0.92; p =.007) and extended follow‐up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43–0.86; p =.005). Conclusion: Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD. [ABSTRACT FROM AUTHOR]

Background: In recent decades, progress has been made in the care of people with polyhandicap/profound intellectual and multiple disabilities (PIMD) through a better understanding of the pathophysiology and the development of new care management and rehabilitation strategies adapted to these extreme pathologies. Although there is a lack of knowledge about the health status and care management of the oldest people, a better understanding of the natural course of life of people with polyhandicap/PIMD would consequently allow the optimisation of preventive and curative care management strategies. Few robust data on mortality and life expectancy have been documented for this population in France. Our aims are to estimate the median survival time and assess the factors associated with mortality in people with polyhandicap/PIMD receiving care in France. Methods: This study included people with polyhandicap/PIMD, followed by the French national cohort 'Eval‐PLH' since 2015. These individuals were included in specialised rehabilitation centres and residential institutions. The people included in the first wave of the cohort (2015–2016) were eligible for the present study. Vital status on 1 January 2022 (censoring date) was collected in two ways: (1) spontaneous reporting by the participating centre to the coordinating team and (2) systematic checking on the French national death platform. According to the vital status, survival was calculated in years from the date of birth to the date of death or from the date of birth to the censoring date. The factors associated with mortality were evaluated using the Cox proportional regression hazards model. Results: Data from 780 individuals aged between 3 and 67 years were analysed. At the censoring date, 176 (22.6%) had died, and the mean survival was 52.8 years (95% confidence interval: 51.1–54.5). Mortality was significantly associated with a progressive aetiology, recurrent pulmonary infections, drug‐resistant epilepsy and a higher number of medical devices. Conclusions: This study shows for the first time the survival and impact of factors associated with mortality in people with polyhandicap/PIMD in France. Highlights: This study is the first to examine and estimate the median survival of people with polyhandicap/profound intellectual and multiple disabilities in France.Data from a national cohort include a large number of people with polyhandicap/profound intellectual and multiple disabilities.The first results from robust mortality data on people with polyhandicap/profound intellectual and multiple disabilities cared for in France.The instability of this disorder and the high number of medical devices are the main factors associated with earlier mortality in people with polyhandicap/profound intellectual and multiple disabilities. [ABSTRACT FROM AUTHOR]

Objective: To validate the level of agreement between self‐report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self‐report among women aged 60 and older. Methods: A cross‐sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF‐T index) and the use of dental prostheses. The self‐reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information. Results: Ninety‐nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self‐reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self‐reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels. Conclusions: Our findings suggest that the participants' socio‐economic position might influence their self‐reported number of teeth. [ABSTRACT FROM AUTHOR]

Aim: This retrospective cohort study investigated the relationship between sarcopenia and Activities of Daily Living capacity after discharge from convalescent rehabilitation wards. Methods: We included consecutive patients discharged from three convalescent rehabilitation wards in a hospital in Japan between December 2018 and October 2020. Sarcopenia was diagnosed based on the criteria of the 2019 Asian Working Group for Sarcopenia, utilizing skeletal muscle mass index and handgrip strength. Statistical analyses were carried out separately for men and women. The primary outcome was a higher motor domain (motor Functional Independence Measure [mFIM]) and a higher cognitive domain (cognitive Functional Independence Measure [cFIM]) of the FIM score 1 month after discharge. The secondary outcomes were higher mFIM and cFIM scores 6 months after discharge, analyzed using binary logistic regression. Results: Among 305 participants (mean age 70.0 years, 148 men), 93 were identified as having sarcopenia. The prevalence of sarcopenia was 16% for outpatient rehabilitation services, 59% for home‐visit rehabilitation services and 50% for older adult day care. Logistic regression analyses showed that sarcopenia at discharge was not an independent variable for mFIM at 1 month (odds ratio [OR] 20, 95% confidence interval [CI] 0.31–1300 for men, OR 0.51, 95% CI 0.11–2.4 for women) and cFIM (OR 0.63, 95% CI 0.10–3.8 for men, OR 5.3, 95% CI 0.81–34 for women). At 6 months, sarcopenia at discharge was not an independent variable for mFIM (OR 0.30, 95% CI 0.02–3.6 for men, OR 0.40, 95% CI 0.06–2.5 for women) and cFIM (OR 0.16, 95% CI 0.01–2.4 for men, OR 0.00, 95% CI 0.00–1.1 for women). Conclusions: Sarcopenia at the time of discharge from convalescent rehabilitation wards does not independently predict FIM 1 month or 6 months after discharge. Geriatr Gerontol Int 2024; 24: 715–721. [ABSTRACT FROM AUTHOR]

Pressure injuries are a significant comorbidity and lead to increased overall healthcare costs. Several European and global studies have assessed the burden of pressure injuries; however, no comprehensive analysis has been completed in the United States. In this study, we investigated the trends in the burden of pressure injuries among hospitalised adults in the United States from 2009 to 2019, stratified by sociodemographic subgroups. The length of admission, total cost of hospitalisation, and sociodemographic data was extracted from the National Inpatient Sample provided by the Healthcare Cost and Utilisation Project, Agency for Healthcare Research and Quality. Overall, the annual prevalence of pressure injuries and annual mean hospitalisation cost increased ($69,499.29 to $102,939.14), while annual mean length of stay decreased (11.14–9.90 days). Among all races, minority groups had higher average cost and length of hospitalisation. Our findings suggest that while the length of hospitalisation is decreasing, hospital costs and prevalence are rising. In addition, differing trends among racial groups exist with decreasing prevalence in White patients. Further studies and targeted interventions are needed to address these differences, as well as discrepancies in racial groups. [ABSTRACT FROM AUTHOR]

A non‐exercise method equation using seismocardiography for estimating V̇O2peak (SCG V̇O2peak) has previously been validated in healthy subjects. However, the performance of the SCG V̇O2peak within a trained population is unknown, and the ability of the model to detect changes over time is not well elucidated. Forty‐seven sub‐elite football players were tested at the start of pre‐season (SPS) and 36 players completed a test after eight weeks at the end of the pre‐season (EPS). Testing included an SCG V̇O2peak estimation at rest and a graded cardiopulmonary exercise test (CPET) on a treadmill for determination of V̇O2peak. Agreement between SCG V̇O2peak and CPET V̇O2peak showed a large underestimation at SPS (bias ± 95% CI: −9.9 ± 1.8, 95% Limits of Agreement: 2.2 to −22.0 mL·min−1 kg−1). At EPS no interaction (p = 0.3590) but a main effect of time (p < 0.0001) and methods (p < 0.0001) was observed between SCG and CPET V̇O2peak. No correlation in V̇O2peak changes was observed between SCG and CPET (r = −20.0, p = 0.2484) but a fair agreement in classifying the correct directional change in V̇O2peak with the SCG method was found (Cohen's κ coefficient = 0.28 ± 0.25). Overall, the SCG V̇O2peak method lacks accuracy and despite being able to estimate group changes, it was incapable of detecting individual changes in V̇O2peak following a pre‐season period in sub‐elite football players. The SCG algorithm needs to be further adjusted and the accuracy and precision improved for the method to be applicable for use within a trained population. Highlights: This is the first time a non‐exercise method using seismocardiography for the estimation of V̇O2peak has been validated in sub‐elite football players.The seismocardiography V̇O2peak method lacks accuracy within a trained population as it underestimates V̇O2peak compared to the gold standard measurement in sub‐elite football players.The seismocardiography V̇O2peak method can estimate the group changes in V̇O2peak following the pre‐season training period in sub‐elite football players. However, it is incapable of detecting individual changes.Adjustment of the seismocardiography V̇O2peak algorithm is needed and the accuracy and precision improved for the method to be applicable for use within a trained population. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether genes in the Wnt pathway, which have been previously associated with both oral clefts and oral squamous cell carcinoma, are also associated with oral potentially malignant disorders (leukoplakia, erythroplakia and lichen planus). Materials and Methods: Case–control study: Dataset consisted of clinical information linked to DNA samples from affected subjects diagnosed with oral potential malignant disorders and oral cancer and their matched controls. Individual samples, clinical history, and potential risk factors were obtained through the Dental Registry and DNA Repository project of the School of Dental Medicine, University of Pittsburgh. The rs1533767 (WNT11), rs9879992 (GSK3B), and rs3923087 (AXIN2) were tested. After genomic DNA had been extracted, genotyping was performed blindly to clinical diagnosis status. Representation of genotypes and alleles in affected subjects in comparison to the unaffected individuals was determined using PLINK. Additional analysis was performed to investigate associations between environmental (socioeconomic/lifestyle) risk factors and the oral pathologies studied using STATA. Results: Two of the SNPs tested (rs9879992 in GSK3B and rs3923087 in AXIN2) were statistically, significantly associated with the pathologies studied (p = 0.039 and 0.038, respectively). Conclusion: Single‐nucleotide polymorphisms in genes in the Wnt pathway were associated with oral potentially malignant disorders. [ABSTRACT FROM AUTHOR]

Background: Treatment of anorexia nervosa (AN) sometimes requires hospitalisation, which is often lengthy, with little ability to predict individual trajectory. Depicting specific profiles of treatment response and their clinical predictors could be beneficial to tailor inpatient management. The aim of this research was to identify clusters of weight recovery during inpatient treatment, and their clinical predictors. Methods: A sample of 181 inpatients who completed a treatment programme for AN was included in a retrospective study. A latent class mixed model approach was used to identify distinct weight‐gain trajectories. Clinical variables were introduced in a multinomial logistic regression model as predictors of the different classes. Results: A four‐class quadratic model was retained, able to correctly classify 63.7% of the cohort. It encompassed a late‐rising, flattening, moderate trajectory of body mass index (BMI) increase (class 1), a late‐rising, steady, high trajectory (class 2), an early‐rising, flattening, high trajectory (class 3) and an early‐rising, steady, high trajectory (class 4). Significant predictors of belonging to a class were baseline BMI (all classes), illness duration (class 2), and benzodiazepine prescription (class 3). Conclusion: Predicting different kinetics of weight recovery based on routinely collected clinical indicators could improve clinician awareness and patient engagement by enabling shared expectations of treatment response. Highlights: Treatment of anorexia nervosa lacks tailored strategies to optimise individual patients' management.Latent class mixed model approach is a promising strategy to analyse treatment response as a dynamic entity.Baseline body mass index, duration of illness and benzodiazepine prescription are significant indicators of distinct weight recovery profiles. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine determinants of undernutrition among children under 2 years of age. Design and Methods: A matched case‐control study design was conducted to recruit 300 mothers comprising 100 mothers with an undernourished child (case group) and 200 mothers with a healthy child (control group). Measurements consisted of demographic characteristics of children data, mother's data, household data, mother's knowledge of child undernutrition, mother's knowledge of nutrition, complementary feeding practices, and undernutrition parameters of the children. A conditional logistic regression was used to identify determinants of undernutrition. The risk of undernutrition was estimated by odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was defined as any p value of <.05. Results: Findings showed that mother's knowledge of undernutrition (AOR: 0.95; 95% CI: 0.91−0.98), mother's knowledge of nutrition (AOR: 0.90; 95% CI: 0.85−0.96), and mother's knowledge (AOR: 0.78; 95% CI: 0.67−0.91) and behavior of complementary feeding practices (AOR: 0.97; 95% CI: 0.94−0.99) were significant determinants of undernutrition (p <.05). Practice Implications: Mothers with high scores on knowledge of undernutrition, knowledge of nutrition, and knowledge and behaviors of complementary feeding practices would benefit the children under 2 years to reduce the risk of undernutrition. Healthcare professionals (i.e., pediatric nurses and community health nurses) should provide early assessment of knowledge related to undernutrition, nutrition, and complementary feeding practices for mothers with children under 2 years. [ABSTRACT FROM AUTHOR]

Objectives: To investigate gender‐specific factors associated with case complexity in a population‐based sample of middle‐aged and older adults using a holistic approach to complexity. Methods: Data were derived from the 8‐year follow‐up home visits of the ESTHER study—a German population‐based study in middle‐aged and older adults. Cross‐sectional analyses were conducted for 2932 persons (aged 57–84). Complexity was assessed by the well‐established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio‐psycho‐social variables and case complexity was analyzed using gender‐specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). Results: Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05–3.30; OR men: 3.19, 1.25–8.12), higher total somatic morbidity (women: 1.08, 1.04–1.12; men: 1.06, 1.02–1.11), higher depression severity (women: 1.34, 1.28–1.40; men: 1.35, 1.27–1.44), and higher loneliness scores (women: 1.19, 1.05–1.36; men: 1.23, 1.03–1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11–2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09–3.74) higher odds for complexity only in men. Conclusions: This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle‐aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle‐aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies. Key points: Prevalence of complexity was found to be 8.3% with significantly higher prevalence in women (10.6%) compared to men (5.8%) (p < 0.001).Being divorced, higher total somatic morbidity, higher depression severity, and higher loneliness scores were associated with higher odds for complexity in both genders.Obesity was linked to higher odds for complexity only in women, while high oxidative stress was linked to complexity only in men.This study expands the holistic understanding of complexity by identifying novel variables associated with complexity in middle‐aged and older adults, including loneliness for both genders and high oxidative stress for men. [ABSTRACT FROM AUTHOR]

Introduction: Hypothermia is a well‐recognised finding in trauma patients, which can occur even in warmer climates. It is an independent predictor of increased morbidity and mortality. It is associated with pre‐hospital intubation, although the reasons for this are likely to be multifactorial. Core temperature drop after induction of anaesthesia is a well‐known phenomenon in the context of elective surgery, and the mechanisms of this are well established. Methods: We conducted a prospective observational study to examine the behaviour of core temperature in patients undergoing pre‐hospital anaesthesia for traumatic injuries. Results: Between 2017 and 2021 data were collected on 48 patients. The data from 40 of these were included in the final analysis. Discussion: Our data do not show a decrease in the core temperatures of patients who receive pre‐hospital anaesthesia, unlike patients who are anaesthetised without pre‐warming, in operating theatres. The lack of a change could relate to patient, anaesthetic or environmental factors. [ABSTRACT FROM AUTHOR]

Introduction: Dolutegravir + rilpivirine (DTG + RPV) is an effective antiretroviral therapy regimen approved in clinical guidelines as a switch therapy for virologically suppressed people with HIV. Our study aimed to compare the effectiveness and tolerability of DTG + RPV in women and men in real‐world clinical practice. Methods: This was a retrospective analysis of treatment‐experienced people with HIV from a large HIV unit who switched to DTG + RPV. We analysed treatment effectiveness, rates of adverse events and discontinuation, and metabolic changes after 48 weeks of treatment. HIV‐RNA levels <50 copies/mL were analysed at 48 weeks using both intention‐to treat analysis (where missing data were interpreted as failures) and per‐protocol analysis (excluding those with missing data or changes due to reasons other than virological failure). Outcomes were compared between women and men based on sex at birth. Results: A total of 307 patients were selected (71 women and 236 men). No transgender people were included. At baseline, women had lived with HIV infection and received antiretroviral therapy for longer than men (23.2 vs 17.4 years and 18.9 vs 14.2 years, respectively). In the intention‐to‐treat analysis, 74.6% (95% confidence interval [CI] 63.4–83.3%) of women and 83.5% (95% CI 78.2–87.7) of men had HIV‐RNA <50 copies/mL. In the per‐protocol analysis, 96.4% (95% CI 87.7–99) of women and 99% (95% CI 98.9–99.7) of men had HIV‐RNA levels <50 copies/mL. Two women and two men had HIV‐RNA >50 copies/mL at 48 weeks. Discontinuation due to adverse events was more frequent in women than in men: 12.7% vs 7.2% (p < 0.02). Neuropsychiatric and gastrointestinal events were the most frequently reported. A median (interquartile range) weight gain of 1.9 kg (0–4.2) in women and 1.2 kg (−1–3.1) in men was reported (median of differences between baseline visit and week 48); the remaining changes in metabolic parameters were neutral. Conclusions: DTG + RPV exhibited good and similar virological effectiveness in women and men in real‐world settings. However, poorer tolerability and more treatment interruptions were observed in women. [ABSTRACT FROM AUTHOR]

Objective: To assess whether systemic lupus erythematosus (SLE) may be genetically causally associated with migraine, including the two primary subtypes: migraine with aura (MWA) and migraine without aura (MWoA). Background: The association between SLE and migraine has been investigated extensively. Previous studies have shown a higher prevalence of migraine in patients with SLE, although the exact relationship remains unclear. This study investigated the potential causal association between SLE and migraine using the powerful analytical tool of Mendelian randomization (MR). Methods: We performed two‐sample MR analysis of publicly available summary statistic datasets using inverse variance‐weighted (IVW), weighted median, and MR‐Egger methods based on an SLE genome‐wide association study (GWAS; 5201 cases; 9066 controls; the exposure frequency is 36.5%) as an exposure and migraine GWAS (15,905 cases; 264,662 controls) in individuals with European ancestry as outcomes, focusing on the two migraine subtypes MWA (6780 cases; 264,662 controls) and MWoA (5787 cases; 264,662 controls). Thepleiotropy and heterogeneity were performed. Results: We selected 42 single‐nucleotide polymorphisms from SLE GWAS as instrumental variables (IVs) for SLE on migraine, and 41 SNP IVs for SLE on MWA or MWoA. The IVW (odds ratio [OR] = 1.01, 95% confidence interval [CI] = [0.99, 1.03], p = 0.271), weighted median (OR = 1.00, 95% CI = [0.97, 1.03], p = 0.914), and MR‐Egger (OR = 1.04, 95% CI = [0.99, 1.09], p = 0.153) methods showed no causal effect of SLE on migraine. A causal effect of SLE was observed on MWA (IVW: OR = 1.05, 95% CI = [1.02, 1.08], p = 0.001; weighted median: OR = 1.05, 95% CI = [1.01, 1.10], p = 0.018; MR‐Egger: OR = 1.07, 95% CI = [1.01, 1.14], p = 0.035 and pIVW < 0.017 [Bonferroni correction]) but not MWoA (IVW: OR = 0.99, 95% CI = [0.96, 1.02], p = 0.331; weighted median: OR = 0.98, 95% CI = [0.94, 1.03], p = 0.496; MR‐Egger: OR = 1.02, 95% CI = [0.95, 1.09], p = 0.652). The results showed no significant pleiotropy or heterogeneity. Conclusion: Our MR analysis demonstrated the complex relationship between SLE and migraine, suggesting a potential effect of SLE on the risk of MWA but not MWoA. These findings can aid in the development of improved subtype‐specific management of migraine in patients with SLE. Plain Language Summary: Using a method called Mendelian randomization, our study looked into whether there is a genetic relationship between systemic lupus erythematosus (SLE) and migraine. Our findings revealed a complex connection between SLE and migraine. It seems that having SLE could increase the likelihood of having migraine with aura; however, this doesn't seem to be the case for migraine without aura. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in incidence and mortality and evaluate overall survival (OS) of oral cancer in Singapore between 1968 and 2017. Methods: All diagnosed oral cancers by anatomical sites and population size were extracted from the Singapore Cancer Registry and the Department of Statistics Singapore. The trend of age‐standardized incidence rate (ASIR) and mortality rate (ASMR) (per 100 000 person‐years) of the lip, oral cavity and salivary gland cancers were evaluated by Prais‐Winsten regressions for each ethnicity and gender. Kaplan–Meier curves were performed to evaluate the OS by anatomical sites in each age group by ethnicity and sex. Results: Overall, 49, 3494 and 1066 people were diagnosed, and 28, 2310 and 476 died from lip, oral cavity and salivary gland cancers, respectively. The oral cavity cancer ASIR and ASMR reduced from 3.07 (1968–1972) to 2.01(2008–2012) and from 2.06 (1978–1982) to 1.21 (2013–2017) per 100 000 person‐years, respectively, with both highest in Indians throughout the whole period. Male:Female ratio ranged from 3.43 (1973–1977) to 1.75 (2013–2017) and from 3.41 (1978–1982) to 2.40 (2013–2017) for ASIR and ASMR, respectively. However, both salivary gland cancer ASIR and ASMR increased from 0.50 (1968–1972) to 0.80 (2008–2012) and from 0.18 (1968–1982) to 0.42 (1988–1992) per 100 000 person‐years, respectively, with both higher in males since 1993. Oral cavity cancer ASIR decreased for males aged ≥60, and Indian females ≥25, but increased among Chinese females aged ≥60. Oral cavity cancer ASMR decreased among Chinese aged 25–59, and among Malay males and Indian females. Salivary gland cancer ASIR increased among Chinese males aged ≥60 and Malay males aged 25–59; while ASMR increased among Chinese males aged ≥60. The median OS for oral cavity, lip and salivary gland cancers were 3.0, 9.3 and 18.1 years, respectively, with females surviving longer than males. Conclusions: Singapore has experienced a decline in the incidence and mortality of lip, oral cancer, an increase in in the incidence and mortality of salivary gland cancer, with an increase in the median overall survival rate. Monitoring the magnitude of oral cancer burden and the demographic, and temporal variations is necessary for tailoring health planning and setting priorities for future clinical care and research. [ABSTRACT FROM AUTHOR]

Background: Patients who have recurrent atrial fibrillation (AF) following redo catheter ablation may eventually be managed with a pace-and-ablate approach, involving pacemaker implant followed by atrioventricular nodal ablation (AVNA). We sought to determine which factors would predict subsequent AVNA in patients undergoing redo AF ablation. Methods: We analyzed patients undergoing redo AF ablations between 2013 and 2019 at our institution. Follow-up was censored on December 31, 2021. Patients with no available follow- up data were excluded. Time-to-event analysis with Cox proportional hazard regression was used to compare those who underwent AVNA to those who did not. Results: A total of 467 patients were included, of whom 39 (8.4%) underwent AVNA. After multivariable adjustment, female sex (aHR 4.68 [95% CI 2.30-9.50]; p < 0.001), ischemic heart disease (aHR 2.99 [95% CI 1.25-7.16]; p = 0.014), presence of a preexisting pacemaker (aHR 3.25 [95% CI 1.10-9.60]; p = 0.033), and persistent AF (aHR 2.22 [95% CI 1.07-4.59]; p = 0.032) were associated with increased risk of subsequent AVNA requirement. Conclusion: Female sex, ischemic heart disease, and persistent AF may be useful clinical predictors of the requirement for subsequent AVNA and may be considered as part of shared clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Immunotherapy has revolutionized cancer treatment. Recent studies have suggested that the efficacy of immunotherapy can be further enhanced by the influence of gut microbiota. In this study, we aimed to investigate the impact of bacteria on the effectiveness of cancer immunotherapy by combining analysis of clinical samples with validation in animal models. Methods: In order to characterize the diversity and composition of microbiota and its relationship with response to immune checkpoint inhibitors (ICIs), 16S ribosomal RNA (rRNA) and GC–MS sequencing was performed on 71 stool samples from patients with advanced non‐small cell lung cancer (NSCLC) prior to treatment with immune checkpoint blockade (ICB). Furthermore, fecal microbiota transplantation (FMT) was performed from different patients into mice and a subcutaneous tumor model established using the Lewis lung cancer cell line to evaluate the therapeutic effect of PD‐1 on mice with varying gut microbiota. Results: The results demonstrated a significant association between elevated gut microbiota diversity and response to treatment with ICIs, p < 0.05. Faecalibacterium was markedly increased in the gut microbiota of responders (R), accompanied by increased short‐chain fatty acid (SCFA) levels, especially butanoic acid, acetic acid and hexanoic acid, p < 0.05. Additionally, FMT from R and nonresponders (NR) could promote an anticancer effect and reduce the expression of Ki‐67 cells in tumors in mice, p < 0.05. Moreover, R and NR FMT did not alter PD‐L1 expression in the tumor tissues of mice, p > 0.05. The diversity of gut microbiota consistently correlated with an optimistic prognosis in NSCLC patients with immunotherapy, which could be functionally mediated by SCFAs. Conclusion: The findings of the present study indicated that the diversity of gut microbiota and SCFAs is related to the efficacy of immunotherapy. FMT can effectively delay tumor progression, and enhance the effect of immunotherapy, thus providing evidence for improving the efficacy of immunotherapy in NSCLC patients. [ABSTRACT FROM AUTHOR]

Background and aims: Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in randomized controlled trials (RCTs) of pharmacological interventions for stimulant use disorder. Design: We conducted a secondary analysis of a pooled dataset of 13 RCTs. Setting and participants: Participants were individuals seeking treatment for cocaine or methamphetamine use disorders (N = 2062) in a wide range of treatment facilities in the United States. Measurements We validated reduced stimulant use against a set of clinical indicators drawn from harmonized measurements, including severity of problems caused by drug use, comorbid depression, global severity of substance use and improvement, severity of drug‐seeking behavior, craving and high‐risk behaviors, all assessed at the end of the trial, as well as follow‐up urine toxicology. A series of mixed effect regression models was conducted to validate reduction in frequency of use against no reduction in use and abstinence. Findings More participants reduced frequency of primary drug use than achieved abstinence (18.0% vs. 14.2%, respectively). Reduced use was significantly associated with decreases in craving for the primary drug [60.1%, 95% confidence interval (CI) = 54.3%–64.7%], drug seeking behaviors (41.0%, 95% CI = 36.6%–45.7%), depression severity (39.9%, 95% CI = 30.9%–48.3%), as well as multiple measures of global improvement in psychosocial functioning and severity of drug‐related problems, albeit less strongly so than abstinence. Moreover, reduced use was associated with sustained clinical benefit at follow‐up, as confirmed by negative urine tests (adjusted odds ratio compared with those with no reduction in use: 0.50, 95% CI = 0.35–0.71). Conclusion: Reduced frequency of stimulant use appears to be associated with meaningful improvement in various clinical indicators of recovery. Assessment of reduced use, in addition to abstinence, could broaden the scope of outcomes measured in randomized controlled trials of stimulant use disorders and facilitate the development of more diverse treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Dental caries (tooth decay) is the world's most prevalent noncommunicable disease and can lead to pain, infection, and edentulism. Many children with caries lack access to traditional dental services. School‐based caries prevention can increase access to care and reduce health inequities. Disruptions in school‐based care due to pandemic control policies may result in children losing access to their primary dental care option. Methods: The CariedAway project was a school‐based caries prevention program in operation from 2019 to 2023 in urban schools with a high proportion of low‐income, minority students. Program operations were suspended for 2 years due to the COVID‐19 pandemic. We estimated the prevalence of untreated decay, swelling, fistula, and pulpal involvement in participants at baseline and again after restrictions were lifted. Results: A total of 2998 children between the ages of 5 and 13 years were enrolled and received preventive care prior to pandemic shutdowns, and 1398 (47%) completed a follow‐up observation after 2 years. At baseline, approximately 30% had untreated caries on any dentition, 11% of children presented with evidence of dental sealants, and no participants had swelling, fistula, or pulpal involvement. After 24 months, 12% of participants had swelling fistula, or pulpal involvement that was not treated during the pandemic period. Conclusion: There are considerable unmet dental needs in high‐risk children that may be further exacerbated by a lack of access to care during disease outbreaks. [ABSTRACT FROM AUTHOR]

Objective: The tapering of biologic disease‐modifying antirheumatic drug (b‐DMARD) therapy for patients with rheumatoid arthritis (RA) in stable remission is frequently undertaken, but specific guidance on how to successfully taper is lacking. The objective of this study is to identify predictors of flare in patients in stable b‐DMARD–induced clinical remission, who did or did not follow structured b‐DMARD tapering. Methods: Patients with RA receiving b‐DMARD treatment who had achieved sustained remission according to a Disease Activity Score in 28 joints using the C‐reactive protein level (DAS28‐CRP) <2.6 for ≥6 months were offered tapering. Clinical, ultrasound (US) (total power Doppler [PD]/grayscale abnormalities), CD4+ T cell subsets, and patient‐reported outcomes (PROs) were collected at inclusion. The primary endpoint was the occurrence of flare (loss of DAS28‐CRP remission) over 12 months. Logistic regression analyses identified predictors of flare. Dichotomization into high/low‐risk groups was based on 80% specificity using the area under the receiving operator curve (AUROC). Results: Of 63 patients choosing tapering, 23 (37%) flared compared with 12 of 60 (20%) on stable treatment (P = 0.043). All patients who flared regained remission upon reinstating treatment. In the tapering group, flare was associated with lower regulatory T cell (Treg) (P < 0.0001) and higher CRP levels (P < 0.0001), erythrocyte sedimentation rate (P < 0.035), and inflammation‐related cells (IRCs) (P = 0.054); stepwise modeling selected Tregs (odds ratio [OR] = 0.350, P = 0.004), IRCs (OR = 1.871, P = 0.007), and CRP level (OR = 1.577, P = 0.004) with 81.7% accuracy and AUROC = 0.890. In the continued therapy group, modeling retained the tender joint count, total PD, and visual analog scale pain score, with 82.1% accuracy and AUROC = 0.899. Most patients in the study were considered low risk of flare (80 of 123 patients [65%]). Only 5 of 37 (13.5%) of the low‐risk patients who tapered flared, which was notable compared with the continued therapy group (20% flare). Conclusion: Flare on tapering b‐DMARDs was predicted by lower Tregs and elevated inflammation biomarkers (IRCs/CRP level); flare on continued b‐DMARDs was associated with raised pain parameters and US inflammation. Knowledge of these biomarkers should improve outcomes by targeted selection for tapering, and by increased monitoring of those on continued therapy predicted to flare. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is an autoimmune disorder with a varying range of organs involved leading to adverse outcomes. However, very little is known, with conflicting results about the association between RA and atrial fibrillation (AF). We aim to evaluate the association between RA and AF, and other clinical outcomes. We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until September 10, 2023. Primary clinical outcomes were AF. Secondary outcomes were acute coronary syndrome (ACS), stroke, and all-cause mortality (ACM). A total of 4 679 930 patients were included in the analysis, with 81 677 patients in the RA group and 4 493 993 patients in the nonrheumatoid arthritis (NRA) group. The mean age of the patients was 57.2 years. Pooled analysis of primary outcomes shows that RA groups of patients had a significantly higher risk of AF (odds ratios [OR], 1.53; 95% confidence interval [CI]: [1.16-2.03], p < .001) compared with NRA groups. Secondary Outcomes show that the RA group of patients had significantly higher odds of ACS (OR, 1.39; 95% CI: [1.26-1.52], p < .001), and ACM (OR, 1.19; 95% CI: [1.03-1.37], p = .02) compared with the NRA groups. However, the likelihood of stroke (OR, 1.02; 95% CI: [0.94-1.11], p = .61) was comparable between both groups of patients. Our study shows that RA groups of patients are at increased risk of having AF, ACS, and ACM. [ABSTRACT FROM AUTHOR]

Aim: This study aims to examine the relationship between older adults' health literacy and their psychological well‐being and the role of worry about future unmet needs for medical care in mediating this relationship. Methods: We adopted a sample of 965 older Chinese people aged 60+ (49.74% female) from the 2021 Chinese General Social Survey. A series of structural equation models (SEMs) were performed. Health literacy was measured by three items regarding older people's ability to understand medical professionals, ask them questions, and read medical instructions. A single‐item question was adopted to measure participants' worry about unmet needs for future medical care. Psychological well‐being was measured by three items regarding emotional problems and depressed or anxious mood in the past 4 weeks. Results: Worry about future unmet needs for medical care mediates the relationship between lack of health literacy and Chinese older people's psychological well‐being. The indirect effect accounts for 22.3% of the total effect. The SEM model has a satisfactory model fit (goodness of fit index = 1.000, comparative fit index = 0.999, Tucker‐Lewis index = 0.997, root mean square error of approximation = 0.009, standardized root mean square residual = 0.023, chi‐square test = 50.96, P = 0.321). Conclusions: The findings of this study underscore the importance of improving communication quality between healthcare providers and older adults. Clinical interventions that promote health literacy and address worries about unmet needs for medical services may benefit older adults. Geriatr Gerontol Int 2024; 24: 202–207. [ABSTRACT FROM AUTHOR]

Aim: To explore the mediating role of psychological capital between authentic leadership and innovative behaviour among Chinese nurses. Design: A cross‐sectional study. Methods: In December 2021, online surveys were delivered among nurses from 37 hospitals in Anhui Province by convenience sampling approach. The data was collected using the Chinese version of the Authentic Leadership Questionnaire, Nurse Psychological Capital Questionnaire and Nurse Innovative Behaviour Scale. The structural equation model and bootstrap test examined the mediating role of psychological capital between authentic leadership and innovative behaviour. Results: 3495 Chinese nurses from 37 Anhui Province hospitals participated in this study. The mean item score of authentic leadership was 3.25 (SD 0.83), psychological capital was 4.85 (SD 0.89), and innovative behaviour was 2.82 (SD 0.84). Authentic leadership perceived by nurses, psychological capital, and innovative behaviour were statistically significant and positively correlated with each other (r = 0.524 ~ 0.806, p < 0.01). Psychological capital significantly mediated the association between authentic leadership and innovative behaviour (β = 0.449, p < 0.001), and its mediating effect accounted for 76.75% of the total effect. Conclusion: Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' psychological capital and innovation behaviour. [ABSTRACT FROM AUTHOR]

Background: Transthoracic echocardiography (TTE) plays a key role in the initial work‐up of myocarditis where the identification of pathologic structural and functional changes may assist in its diagnosis and management. The aim of this systematic review was to appraise the evidence for the utility of echocardiographic parameters of cardiac structure and function in the diagnosis of myocarditis in adult populations. Methods: A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing TTE parameters in adult patients with myocarditis (1995–2020; English only; PROSPERO registration CRD42021243598). Data for a range of structural and functional TTE parameters were individually extracted and those with low heterogeneity were then meta‐analyzed using a random‐effects model for effect size, and assessed through standardized mean difference (SMD). Results: Available data from six studies (with a pooled total of 269 myocarditis patients and 240 controls) revealed that myocarditis can be reliably differentiated from healthy controls using echocardiographic measures of left ventricular (LV) size and systolic function, in particular LV end‐diastolic diameter, LV ejection fraction (LVEF) and LV global longitudinal strain (LV‐GLS) (p ≤.01 for all). LV‐GLS demonstrated the highest overall effect size, followed by LVEF and LVEDD (SMD: |0.46–1.98|). Two studies also demonstrated that impairment in LV‐GLS was associated with adverse cardiovascular outcomes in this population, irrespective of LVEF. Conclusions: LV‐GLS demonstrated the greatest overall effect size and therefore ability to differentiate myocarditis populations from healthy controls. GLS was also shown to be a predictor of adverse cardiovascular outcomes, in this population. Hightlights: What is already known on this subject? Myocarditis is a disease process that is often a diagnosis of exclusion, as it frequently mimics other acute cardiac pathologies.Transthoracic echocardiography is traditionally the initial imaging modality used for noninvasive structural assessment in populations with myocarditis. What might this study add? This study demonstrates that left ventricular (LV) global longitudinal strain, LV ejection fraction and LV end‐diastolic diameter can differentiate between myocarditis patients and healthy controls.LV‐GLS demonstrated the greatest overall effect size when comparing these two populations, in comparison to the other measures. How might this impact on clinical practice? This study demonstrates that assessment of myocardial deformation indices allows for sensitive discrimination between myocarditis patients from healthy controls.Routine assessment of LV‐GLS may serve as an important diagnostic tool in the acute care setting. [ABSTRACT FROM AUTHOR]

Introduction: Patients in emergency departments (EDs) constitute a diverse population with multiple health‐related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at‐risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample. Methods: Research assistants surveyed 1037 married, cohabiting, or partnered patients in face‐to‐face interviews (87% response rate) regarding IPV exposure, alcohol and drug use, psychological distress, ACEs, and other sociodemographic features. IPV was measured with the Revised Conflict Tactics Scale. Interaction effects were examined in multinomial and logistic models. Results: Results showed a significant interaction of gender and PTSD (odds ratio [OR] 3.06, 95% CI 1.21–7.23, p < 0.05) for mutual IPV. Regarding main effects, there were also statistically significant positive associations between mutual physical IPV and at‐risk drinking (OR 1.73, 95% CI 1.07–2.77, p < 0.05), having a hazardous drinker partner (OR 2.19, 95% CI 1.35–3.55, p < 0.01), illicit drug use (OR 2.09, 95% CI 1.18–3.71, p < 0.01), ACEs (OR 1.23, 95% CI 1.06–1.42, p < 0.01), days of cannabis use past in the 12 months (OR 1.003, 95% CI 1.002–1.005, p < 0.001), and impulsivity (OR 2.04, 95% CI 1.29–3.22, p < 0.01). Conclusions: IPV risk assessment in EDs will be more effective if implemented with attention to patients' gender and the presence of various and diverse other risk factors, especially PTSD. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of the coronavirus disease (COVID‐19) pandemic on Korean adolescents' oral health and identify the influential factors. Methods: The raw data from The Korea Youth Risk Behaviour Web‐based Survey before (2019) and after (2020) the outbreak of COVID‐19 were used in the study. Demographic characteristics and subjective general, mental, and oral health were analysed and compared between the 2 years. Further, the impact of changes in subjective mental health and the duration of indoor activity on oral health were analysed. Data were analysed using IBM SPSS Statistics, and all statistical significance was set at α = 0.05. The analysis was performed using the complex sample analysis module. Results: In 2020, compared with 2019, the proportion of adolescents who rated high on subjective academic performance, smoking, and drinking decreased (p < 0.001). However, there was no difference in the household economic status between 2020 and 2019 (p = 0.917), while subjective mental health improved. In addition, the risk of tooth fracture was 1.321 times higher after the pandemic. After the outbreak of COVID‐19, adolescents who were indoors for >24 h for non‐learning activities on weekends were 2.97 times more likely to have reported gingival pain and bleeding (p < 0.05). Conclusions: After the outbreak of COVID‐19, smoking and drinking decreased in Korean adolescents, while changes occurred in their learning patterns at home, and their mental health improved. Some oral symptoms increased or showed no change. [ABSTRACT FROM AUTHOR]

This study aimed to examine the perceived stress and body image in burn patients and the relationship between these two variables. This is a descriptive and cross‐sectional study. The study included total of 144 patients who had burn injuries, received treatment in a research and training hospital and were scheduled to be discharged. The data were collected prospectively by the researchers, using descriptive methods, Kruskal Wallis test, paired samples t test, and Pearson's correlation analysis. Of the patients, 59% were between the ages of 18 and 35 years, 68.1% were male, 65.3% had second‐degree burns, 77.1% had burn surfaces ranging between 10% and 20% of their body, and 54.9% had autograft surgery. The burn patients aged 51 years and over had higher perceived stress than younger patients, and the difference between them was statistically significant (P < 0.05). As the percentage of burn surface increased, the perceived stress increased, and the perceived body image weakened (P < 0.05). The burn patients with autograft surgery had lower perceived stress and higher perceived body image than those without autograft surgery, and the difference between them was statistically significant (P < 0.01). This study found an inverse relationship between perceived stress and body image in burn patients, which was affected by the percentage of burn surface and autograft surgery. Relevant interventions are suggested to increase perceived body image in burn patients and reduce their perceived stress. [ABSTRACT FROM AUTHOR]

Objectives: Veteran persons living with dementia (PLWDs) have high acute care utilization. We aim to understand why PLWDs seek care in the emergency department (ED) and how their utilization differs from older Veterans with no dementia diagnosis. We demonstrate the use of a novel national chief complaint data set in the Veteran Affairs Health Care System. Methods: This was a retrospective observational study of ED users 65 years or older as of FY2017. The primary outcome is presence of one or more ED visits in FYs 2017–2018 using a logistic regression model controlling for dementia and other variables. Secondary outcomes include counts of ED visits by disposition, Emergency Severity Index, chief complaints defined by a natural language processing program, and ED encounter diagnoses defined by primary International Statistical Classification of Diseases, Tenth Revision (ICD‐10‐CM) code. Results: Our cohort of Veterans comprised 3,115,263 patients. Of those, 255,372 (8.2%) had a diagnosis of dementia. Logistic regression modeling demonstrated that dementia is a significant predictor of ED use (p < 0.0001), with PLWDs more likely to have an ED visit (odds ratio 1.96, 95% confidence interval 1.94–1.98). PLWDs were admitted at higher rates when accounting for age and acuity. Chief complaints that were more common among PLWDs included falls (6.7% dementia vs. 3.3% without dementia), weakness (3.6% vs. 2.2%), and abnormal mental state (2.2% vs. 0.4%). ICD‐10‐CM codes were largely similar between the two groups. Conclusions: Our results reinforce that the ED is a common access point for Veterans with dementia. These patients require special consideration as they are more likely to visit the ED and be admitted. Our use of a novel national chief complaint data set suggests that they more commonly present with certain geriatric syndromes and nonspecific complaints. Further work is needed to determine whether these would warrant targeted interventions to improve quality of acute care. [ABSTRACT FROM AUTHOR]

Background: The majority of the US population have poor knowledge of cancers related to human papillomavirus (HPV). Identifying best sources for communicating this information can guide strategies to promote HPV vaccination. Objectives: To assess the relationship between sources of health information and individuals' knowledge of HPV‐related cervical and oropharyngeal cancer. Methods: This study conducts logistic regression on the most recent wave (2019) of the Health Information National Trends Survey. Dependent variables are indicators for self‐reported awareness that HPV causes (a) cervical cancer and (b) oropharyngeal cancer. The primary indicator is a variable for different sources of health information: The Internet, professional sources, print materials, friends/family and never looked for health information. Results: Being female, young, non‐Hispanic White and having college education is associated with higher odds of knowing about HPV‐related cervical cancer. Controlling for demographic factors, individuals using professionals and the Internet are more likely to know that HPV causes cervical cancer (aOR: 2.65, 95% CI: 1.66, 4.25; aOR: 2.47, 95% CI: 1.75, 3.50, respectively) compared to those who have never looked for health information. Similar results were found for HPV‐related oropharyngeal cancer. Conclusion: Findings provide implications for targeted messaging through effective channels to improve HPV vaccination uptake. [ABSTRACT FROM AUTHOR]

The abdominal skin is not a common area for keloid formation. The knowledge of laparoscopically induced keloids (LIK) remains little. This article aimed to review the case series of LIK and analyse the characteristics. A retrospective and descriptive study was conducted. Patients' clinical records in the database were collected, including the demographics, medical history, laparoscopic surgery information, keloid information, and the severity of LIKs recorded using the Patient and Observer Scar Assessment Scale. Twenty‐four LIK patients were enrolled. 18 patients were female and 10 had chronic diseases. 11 patients had non‐LIKs. 91.6% patients received laparoscopic cholecystectomy. LIKs were mainly located under the xiphoid process (N = 20), followed by the umbilicus (N = 16). 41.7% patients developed keloids at all trocha sites. The severity of the LIK was significantly negatively associated with the presence of the non‐LIK. Laparoscopic procedures could lead to the formation of keloids. Two types of LIKs were noticed: extended incisions induced long "spreading" type and trocha induced round bulging type. The presence of non‐LIKs could significantly reduce the severity of LIKs. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to examine the factors that impact vaccination uptake and additional protective behavior during the fourth wave of the pandemic in Israel, whereas the "pandemic fatigue" phenomenon has been identified as a hurdle to adherence to protective health behaviors against coronavirus disease 2019 (COVID‐19). Design A cross‐sectional, structured questionnaire was utilized for this investigation in September 2021, during the fourth wave of the pandemic. Methods: A sample of the adult (18+) Israeli population was employed for the study. Recruiting participants for the study was conducted through an online internet panel company that consists of over 100,000 members, representing all geographic and demographic sectors of the Israeli population. Results: Our findings indicate that pandemic fatigue has begun to have cascading effects on vaccination efforts. In particular, this study found that at this stage of the COVID‐19 pandemic, trust in authorities, and even threat perception components, such as concern and fear of contracting the disease, are incapable of predicting vaccination uptake. Instead, perception of the importance of the vaccine and its effectiveness are predictive of vaccination uptake. Conclusion: The findings indicate that at this stage of the pandemic, focusing on the robustness of the science behind the vaccine is more important than trying to regain public trust. The findings also suggest that risk communication employing fear tactics is losing its capacity to generate motivation for vaccination. Clinical Relevance: The findings of this study reveal lessons learned from the COVID‐19 global pandemic. Specifically, the study reveals how in times of prolonged crisis, we can currently and, in the future, prepare improved strategies for public communication in order to promote uptake of protective health behavior, such as vaccination. [ABSTRACT FROM AUTHOR]

Due to the COVID‐19 pandemic, many counselor training clinics rapidly transitioned in‐person (IP) services to videoconferencing psychotherapy (VCP). Because VCP is a relatively new technology, more research is needed to establish whether this delivery format is a safe and acceptable substitute for IP services in counselor training clinics. The purpose of this study is to explore questions related to how clients perceive VCP versus IP in terms of credibility and expectancy. Results from this investigation demonstrate that clients who participate in VCP, without first meeting their counselor in person, may initially question the credibility and effectiveness of VCP. However, results demonstrated improvement, in both groups, across the duration of therapy. These findings provide both initial support for the safety of VCP in counselor training clinics and justification for further research. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify prognostic autophagy‐related genes and lncRNAs to predict clinical outcomes in head and neck squamous cell carcinoma (HNSCC). Subjects and methods: Differentially expressed autophagy‐related genes and autophagy‐related lncRNAs were identified by comparing pare‐carcinoma and carcinoma samples of HNSCC. And then, we constructed an ARG and an AR‐lncRNA signature risk score. Receiver operating characteristic (ROC) curve analyses were performed to assess the prognostic prediction capacity. Gene Set Enrichment Analysis (GSEA) and Gene Ontology (GO) functional annotation were used to analysis the functions of ARGs and AR‐lncRNAs. Results: Six ARGs and thirteen AR‐lncRNAs were identified in the ARG and AR‐lncRNA signatures, and overall survival (OS) in the high‐risk group was significantly shorter than the low‐risk group. ROC analysis showed the ARG and AR‐lncRNA signatures have excellent ability of predicting the total OS of patients with HNSCC. What's more, GSEA and GO functional annotation proved that autophagy‐related pathways are mainly enriched in the high‐risk group. Conclusions: These findings indicated that our ARG signature and AR‐lncRNA signature could be considered to predict the prognosis of patients with HNSCC and provide a deep understanding of the biological mechanisms of autophagy in HNSCC. [ABSTRACT FROM AUTHOR]

Objectives: To assess (i) paediatric fever management practices among New Zealand ED doctors and nurses, including adherence to best practice guidelines; and (ii) the acceptability of a randomised controlled trial (RCT) of antipyretics for relief of discomfort in young children. Methods: A cross‐sectional survey of doctors and nurses across 11 New Zealand EDs. The primary outcome of adherence to paediatric fever management best practice guidelines was assessed with clinical vignettes and defined as single antipyretic use for the relief of fever‐related discomfort. Results: Out of 602 participants (243 doctors, 353 nurses and six unknown; response rate 47.5%), only 64 (10.6%, 95% confidence interval [CI] 8.3–13.4%) demonstrated adherence to best practice guidelines. In a febrile settled child with normal fluid intake, the percentage of participants that would use antipyretics doubled with abnormal vital signs (33.7% vs 72.9%, difference −39.2%, 95% CI –44.4% to −34.0%). Most participants would use antipyretics for reduced fluid intake (n = 494, 82.1%, 95% CI 78.8–85.0%) in a febrile settled child. Over half (n = 339, 57.1%, 95% CI 53.0–61.1%) would advise giving antipyretics to prevent febrile convulsions. Most (n = 467, 80.0%, 95% CI 76.5–83.1%) participants agreed that a RCT of antipyretics in febrile children <2 years of age with relief of discomfort as a primary outcome is needed. Conclusions: Just over 10% of New Zealand ED doctors and nurses demonstrated adherence to paediatric fever management best practice guidelines. A RCT of antipyretics in febrile children <2 years of age specifically addressing relief of discomfort as a primary outcome is strongly supported. [ABSTRACT FROM AUTHOR]

Background: The body index [body mass, body mass index (BMI), waist circumference and waist–height ratio] and functional fitness (aerobic capacity, muscular strength, balance, flexibility and functional ability) of people with Down syndrome (DS) are substantially lower than those in the general population, as DS has an overall negative impact on health. Aims: This study explored the effect of a 24‐week basketball training programme on the body composition and functional fitness of adults with DS. Methods and procedure outcomes: Twenty‐two adults with DS (24 ± 6 years; 25 ± 4 kg/m2) were randomly allocated to the experimental (n = 11, 67.04 kg) and control groups (n = 11, 69.36 kg). The experimental group performed 24 weeks of basketball programme training (3 times per week, 60 min per session), while the control group maintained their daily activities without any special physical training. Body composition and functional fitness parameters were measured before and after the intervention. To evaluate the differences between groups, an analysis of covariance (ANCOVA) was used while controlling for differences at baseline. Results: Hip circumference and waist–height ratio were statistically different at baseline between the intervention and control groups. After the 24‐week basketball training programme, the results showed significant differences between the exercise and control groups for hip circumference, body mass, BMI, waist circumference, hip circumference, waist–height ratio, flexibility, aerobic capacity, static and dynamic balance, balance and basketball functional ability (P < 0.05). The exercise group showed significant improvements in all variables of body composition and functional fitness (P < 0.05) except for the waist–hip ratio. There was no statistical significance between all physical composition and functional health variables in the control group except for the standing long jump (P > 0.05), with effect sizes ranging from small to large. Conclusions and implications: The basketball training programme improved body composition and functional fitness of adults with DS. [ABSTRACT FROM AUTHOR]

Background: The safety of waterbirth is contested because of the lack of evidence from randomized trials and conflicting results. This research assessed the feasibility of a prospective study of waterbirth (trial or cohort). Methods: We conducted a prospective cohort study at an Australian maternity hospital. Eligible women with uncomplicated pregnancies at 36 weeks of gestation were recruited and surveyed about their willingness for randomization. The primary midwife assessed waterbirth eligibility and intention on admission in labor, and onset of second stage. Primary outcomes measured feasibility. Intention‐to‐treat analysis, and per‐protocol analysis, compared clinical outcomes of women and their babies who intended waterbirth and nonwaterbirth at onset of second stage. Results: 1260 participants were recruited; 15% (n = 188) agreed to randomization in a future trial. 550 women were analyzed by intention‐to‐treat analysis: 351 (waterbirth) and 199 (nonwaterbirth). In per‐protocol analysis, 14% (n = 48) were excluded. Women in the waterbirth group were less likely to have amniotomy and more likely to have water immersion and physiological third stage. There were no differences in other measures of maternal morbidity. There were no significant differences between groups for serious neonatal morbidity; four cord avulsions occurred in the waterbirth group with none in the landbirth group. An RCT would need approximately 6000 women to be approached at onset of second stage. Conclusions: A randomized trial of waterbirth compared with nonwaterbirth, powered to detect a difference in serious neonatal morbidity, is unlikely to be feasible. A powered prospective study with intention‐to‐treat analysis at onset of second stage is feasible. [ABSTRACT FROM AUTHOR]

Background: The longitudinal associations of sleep timing and time in bed (TIB) with dementia and cognitive decline in older adults are unclear. Methods: This population‐based cohort study used data from 1982 participants who were aged ≥60 years, free of dementia, and living in rural communities in western Shandong, China. At the baseline (2014) and follow‐up (2018) examinations, sleep parameters were assessed using standard questionnaires. Cognitive function was measured using the Mini‐Mental State Examination (MMSE). Dementia was diagnosed following the DSM‐IV criteria, and the NIA‐AA criteria for Alzheimer disease (AD). Data were analyzed using restricted cubic splines, Cox proportional‐hazards models, and general linear models. Results: During the mean follow‐up of 3.7 years, dementia was diagnosed in 97 participants (68 with AD). Restricted cubic spline curves showed J‐shaped associations of sleep duration, TIB, and rise time with dementia risk, and a reverse J‐shaped association with mid‐sleep time. When sleep parameters were categorized into tertiles, the multivariable‐adjusted hazard ratio (HR) of incident dementia was 1.69 (95%CI 1.01–2.83) for baseline sleep duration >8 hours (vs. 7–8 h), 2.17 (1.22–3.87) for bedtime before 9 p.m. (vs. 10 p.m. or later), and 2.00 (1.23–3.24) for mid‐sleep time before 1 a.m. (vs. 1–1.5 a.m.). Early bedtime and mid‐sleep time were significantly associated with incident AD (HR range: 2.25–2.51; p < 0.05). Among individuals who were free of dementia at follow‐up, baseline long TIB, early bedtime and mid‐sleep time, early and late rise time, and prolonged TIB and advanced bedtime and mid‐sleep time from baseline to follow‐up were associated with a greater decline in MMSE score (p < 0.05). These associations with cognitive decline were statistically evident mainly among men or participants who were aged 60–74 years. Conclusions: Long TIB and early sleep timing are associated with an increased risk of dementia, and the associations with greater cognitive decline are evident only among older people aged 60–74 years and men. [ABSTRACT FROM AUTHOR]

Background: Although T factor is defined as the size of invasive area rather than total tumor size in the eighth edition of the TNM classification, whether the pathological invasive area to tumor ratio (ITR) is a prognostic factor has not yet been evaluated. Methods: In total, 432 lung adenocarcinoma patients were analyzed, among which 266 patients with pathological stage IA were used to perform a subanalysis. Results: Smoking status (odds ratio [OR]: 0.43, p = 0.01), neutrophil‐to‐lymphocyte ratio (NLR) (OR: 1.97, p = 0.03), maximum standardized uptake value (SUVmax) (OR: 3.62, p < 0.01), and ITR (OR: 6.76, p < 0.01) were significantly different in univariate analysis. Smoking status (OR: 0.34, p < 0.01), SUVmax (OR: 3.05, p < 0.01), and ITR (OR: 5.44, p < 0.01) were risk factors for recurrence in multivariate analysis. In patients with pathological stage IA disease, smoking status (OR: 0.34, p = 0.03), NLR (OR: 2.30, p = 0.04), SUVmax (OR: 3.63, p < 0.01), pathological invasive area (OR: 4.00, p < 0.01), and ITR (OR: 6.03, p < 0.01) were significantly different in univariate analysis. Smoking status (OR: 0.27, p = 0.02), SUVmax (OR: 3.93, p < 0.01), and ITR (OR: 4.38, p < 0.01) were significant risk factors for recurrence in multivariate analysis. Conclusions: SUVmax and ITR are risk factors for recurrence. These results suggest that SUVmax is important for deciding the indication for limited resection or adjuvant chemotherapy, and ITR is an adaptation criterion for adjuvant chemotherapy for early‐stage lung adenocarcinoma patients. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance is common in patients with heart failure. The aims of this study were to assess the prevalence of sleep disturbance in patients with heart failure, and to examine the serial multiple mediation effects of psychological distress and sleep hygiene practices on the relationship between symptom burden and sleep quality. Methods: We recruited eligible heart failure patients in a large, university‐affiliated hospital in Shandong Province, China, from November 2018 to June 2019. The Pittsburgh Sleep Quality Index, Heart Failure Somatic Perception Scale, Hospital Anxiety and Depression Scale, and Sleep Hygiene Practice Scale were used to assess patients' sleep quality, symptom burden, psychological distress, and sleep hygiene practices. The mediation effects were analyzed using the PROCESS tool in SPSS. Results: Two hundred and thirty seven heart failure patients were included in the final analyses. Among these patients, 189 patients (67.1%) had a sleep disturbance (Pittsburgh Sleep Quality Index score of >5). Higher symptom burden, higher level of psychological distress, and poorer sleep hygiene practices were associated with patients' poorer sleep quality. The psychological distress and sleep hygiene practices had mediation effects on the relationship between symptom burden and sleep quality in patients with heart failure. Conclusions: Patients' symptom burden could affect their sleep quality through psychological distress and sleep hygiene practices besides a direct effect. Thus, psychological distress and sleep hygiene practices should be fully considered in the development of interventions to improve patients' sleep quality, apart from alleviating patients' symptom burden. [ABSTRACT FROM AUTHOR]

Introduction: Current research evidence suggests that people with schizophrenia have sensory processing difficulties. Sensory modulation has growing evidence for use in this population. This study aimed to evaluate the extent to which health, social, cognitive, and occupational functioning outcomes were impacted by sensory modulation interventions for people with schizophrenia. Methods: A prospective observational cohort study using a waitlist control design was used in two large hospital and health services in Queensland, Australia. The study recruited patients who used sensory modulation (n = 30) across the two hospitals and those who did not use sensory modulation interventions as a control (n = 11). Results were analysed using a series of planned comparisons including independent and paired t‐tests, and mixed ANOVA was used whenever statistically indicated. The analysed measures were pre‐ and post‐intervention scores. Results: This study found no statically significant differences between the control and intervention groups at both pre‐ and post‐intervention. However, analysis of results from within the intervention group showed statistically significant improvements between pre‐ and post‐test scores on distress, occupational functioning, and health and social functioning but not on sensory processing and global cognitive processing. Further analysis of results from this study, compared with those from an earlier study on the general population showed significant differences in Low Registration and Sensation Avoiding, as measured by the Adult/Adolescent Sensory Profile, between participants with schizophrenia and those without schizophrenia. Conclusion: This study provides evidence to suggest that sensory modulation interventions can be complementary to standard care when utilised appropriately in clinical settings. Findings also suggest that the sensory profile of people with schizophrenia is different to that of the general population and this may have clinical implications. Further longitudinal research is needed with larger and randomised samples, using more targeted measures to better explore effectiveness of sensory modulation interventions. [ABSTRACT FROM AUTHOR]

Objective: Mentalisation‐based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co‐morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two‐fold—to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design. Method: Thirty‐two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM‐5 criteria for BPD. On admission patients were categorised as very underweight (BMI 15.0–16.4 kg/m2), underweight (BMI 16.5–18.4 kg/m2) or healthy weight range (BMI ≥ 18.5–24.9 kg/m2). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m2) or non‐weight restored (BMI < 18.5 kg/m2). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ‐8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)‐21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA). Results: Both groups experienced improvements in eating disorder symptoms and measures of psychological well‐being. Participants within the MBT group exhibited greater improvements in reflective capacity as defined by the RFQ‐8 however these benefits appeared to be limited to patients who achieved weight restoration at discharge. The eligibility criteria—which excluded comorbid BPD—led to challenges in recruitment which limited the power of the study analysis. As participants with a range of different eating disorder diagnoses were included this led to complexities in estimating the treatment effect within a defined cohort. Conclusions: Although the small sample size must be noted as a limitation—the finding that weight restoration appears to be associated with improvements in reflective capacity in MBT would be worth exploring in a subsequent larger study. Modification of eligibility criteria and recruitment from a defined cohort may increase the efficiency of a future study. Highlights: This pilot study highlights important challenges to conducting a full‐scale trial comparing MBT with treatment as usual in a cohort of eating disorder patientsMBT aims to develop skills in reflective capacity and has been shown to lead to positive outcomes in patients with borderline personality disorder and eating disorders who often have concrete 'black and white' thinking stylesOverall the study displayed MBT to be an acceptable and potentially valuable therapeutic modality for this patient group while highlighting potential challenges for patient recruitmentThe novel finding, that benefits of MBT may not extend to those patients who remain non‐weight restored, is consistent with the concept of the "starved brain" and suggests weight restoration is central to therapeutic gains [ABSTRACT FROM AUTHOR]

This study used the Japanese Adverse Drug Event Report database to investigate whether steroid use decreases the risk of nephropathy in patients who were administered a proton pump inhibitor (PPI). Disproportionality of kidney injury was observed between patients who did and those who did not use steroids while taking lansoprazole (reporting odds ratio, 0.78; 95% confidence interval [CI], 0.65‐0.93; P =.002) or rabeprazole (reporting odds ratio, 0.69; 95%CI, 0.53‐0.89; P =.005). Multiple logistic regression analysis revealed a significantly negative association of kidney injury with steroid use (odds ratio [OR], 0.85; 95%CI, 0.75‐0.96; P =.011) and a significantly positive association with the presence of chronic kidney disease (OR, 1.66; 95%CI, 1.44‐1.90; P <.001), the presence of comorbidities that relate to nephropathy (OR, 1.43; 95%CI, 1.29‐1.59; P <.001), male sex (OR, 1.25; 95%CI, 1.13‐1.39; P <.001), and age ≥80 years (OR, 1.21; 95%CI, 1.07‐1.37; P =.002). These findings suggest that steroid use may decrease the risk of proton pump inhibitor–induced nephropathy. [ABSTRACT FROM AUTHOR]

Aims and objectives: Pressure ulcers (PUs) are a serious health problem. They can be considered as an indicator of the quality of health care and are associated with considerable cost increases for the health care system. The prevention of PUs is a major concern in hospital care. The aim of the study was to reveal the current PU prevention‐related processes and structures with a specific focus on the Accident and Emergency (A&E) Department. Method: In late 2018/early 2019, all German hospitals were invited to participate in a nationwide cross‐sectional survey. One standardized questionnaire was assigned to a representative of each hospital. The representative was asked to state what PU‐related structures and processes are implemented in their hospital, in general and specific to the A&E department. Besides mostly descriptive analysis, PU‐related processes were analysed on PU incidence in a multivariate linear regression model. Results: Two hundred seventy‐six hospitals participated in the survey. 63.4% (n = 175) of the participating hospitals had at least one PU manager. Skin inspection was the most frequently performed procedure. Although not recommended, 1.3% (2.1%) of the facilities still use sheepskins quite often (very often). In the regression model on PU incidence, only the process 'mobilization in bed' was statistically significantly associated. Although the risk of developing a PU in the emergency department is high, more than half of the facilities had no PU guidelines. Conclusion: Even if recommended procedures (skin inspection, 30° positioning) have been used frequently, regular training could help to bring new scientific findings such as the use of local skin protection dressings into clinical practice. Prevention guidelines should be established in all areas of care even for A&E as well as when patients are transferred inside or out of the hospital, where the risk of PU development was considered low. [ABSTRACT FROM AUTHOR]

Background: Patient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes. Design: Cross‐sectional study. Setting and participants: Patients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK. Outcome measures: Patient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia. Results: 743 patients were included (eGFR: 32.3 (SD17.1) mL/min/1.73 m2, age 67.8 (SD13.9) years, 68% male). The mean PAM score was 55.1 (SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P =.004), greater number of comorbidities (P =.026) and lower haemoglobin (P =.025). Patients with low activation had a 17% greater number of CVD risk factors (P <.001). Risk factors in those with low activation were being older (P <.001) and having diabetes (P <.001). Conclusion: This study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation. Patient or Public Contribution: Patients were involved in the design of main study. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a risk factor for atrial fibrillation (AF). The effect of antidiabetic medications on AF or the outcomes of catheter ablation (CA) has not been well described. We sought to determine whether metformin treatment is associated with a lower risk of atrial arrhythmias after CA in patients with DM and AF. Methods and Results: A first CA was performed in 271 consecutive patients with DM and AF (age: 65 ± 9 years, women: 34%; and paroxysmal AF: 51%). At a median of 13 months after CA (interquartile range: 6–30), 100/182 patients (55%) treated with metformin remained in sinus rhythm without antiarrhythmic drug therapy, compared with 36/89 patients (40%) not receiving metformin (p =.03). There was a significant association between metformin therapy and freedom from recurrent atrial arrhythmias after CA in multivariable Cox hazards models (hazard ratio [HR]: 0.66; ±95% confidence interval [CI]: 0.44–0.98; p =.04) that adjusted for age, sex, body mass index, AF type (paroxysmal vs. nonparoxysmal), antiarrhythmic medication, obstructive sleep apnea, chronic kidney disease, coronary artery disease, left ventricular ejection fraction, and left atrial diameter. A Cox model that also incorporated other antidiabetic agents and fasting blood glucose demonstrated a similar reduction in the risk of recurrent atrial arrhythmias with metformin treatment (HR: 0.63; ±95% CI: 0.42–0.96; p =.03). Conclusions: In patients with DM, treatment with metformin appears to be independently associated with a significant reduction in the risk of recurrent atrial arrhythmias after CA for AF. Whether this effect is due to glycemic control or pleiotropic effects on electroanatomical mechanisms of AF remains to be determined. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. Methods: Systematic review and meta‐analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. Results: Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta‐analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare‐related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. Conclusions: This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area. [ABSTRACT FROM AUTHOR]

Background: An intensive care unit (ICU) delirium prediction tool, PREdiction of DELIRium in ICu patients (PRE‐DELIRIC), has been developed and calibrated in a multinational project. However, there is a lack of evidence regarding the predictive ability of the PRE‐DELIRIC among Chinese ICU patients. Aim: To evaluate the predictive validity (discrimination and calibration) of PRE‐DELIRIC. Design: This is a retrospective cohort study. Methods: A retrospective cohort study was conducted. Consecutive participants (a) admitted to the ICU for ≥24 hours, (b) aged ≥18 years, and (c) admitted to the ICU for the first time were included. Ten predictors (age, APACHE‐II, urgent and admission category, urea level, metabolic acidosis, infection, coma, sedation, and morphine use) assessed within 24 hours upon ICU admission were assessed. Delirium was assessed using the Confusion Assessment Method for ICU. Outcomes included ICU length of stay and mortality. Discrimination and calibration were determined by the areas under the receiver operating characteristic curve (AUROC), box plot, and calibration plot. Results: A total of 375 ICU patients were included, with 44.0% of patients being delirious. Delirium was significantly associated with age, PRE‐DELIRIC score, ICU length of stay, and mortality. The AUROC was 0.81 (95% confidence interval, 0.77‐0.86). The optimal cut‐off point identified by max Youden index was 49%. The calibration plot of pooled data demonstrated a calibration slope of 0.894 and an intercept of −0.178. Conclusions: The PRE‐DELIRIC has high predictive value and is suggested to be adopted in ICUs for early initiation of preventive interventions against delirium among high‐risk patients. Relevance to clinical practice: Clinicians can adopt the PRE‐DELIRIC among ICU patients to screen patients at high risk of developing delirium. Early initiative interventions could be implemented to reduce the negative impacts of ICU delirium. [ABSTRACT FROM AUTHOR]

Background: Portopulmonary hypertension (PoPH) is a rare condition with poorer survival compared to idiopathic/familial pulmonary arterial hypertension (IPAH/FPAH). Aims: To compare the characteristics, survival, prognostic factors and management of PoPH and IPAH/FPAH patients and to assess the impact of treatment on survival of PoPH patients. Methods: Analysis of data of prevalent and incident PoPH patients enrolled in the Spanish registry of PAH (REHAP) from January 1998 to December 2017 and comparison with IPAH/FPAH patients. Variables analysed: patient and disease (PAH and liver) characteristics, first‐line PAH‐targeted therapy, causes of death, prognostic factors and survival (according to aetiology and treatment in PoPH patients). Results: Compared to IPAH/FPAH patients (n = 678), patients with PoPH (n = 237) were predominantly men, older and had better functional class and higher prevalence of ascites. Haemodynamics were better. Biomarkers for heart failure were worse. Age‐ and sex‐adjusted 5‐year survival rate from diagnosis was 49.3% for PoPH patients and 68.7% for IPAH patients (P < 0.001). Treated PoPH had better survival than non‐treated. PAH‐ and liver‐related causes accounted for 30.2% and 24.7% of deaths in PoPH patients. PoPH patients were less likely to receive first‐line PAH‐targeted therapy and this was associated with greater mortality. Increasing age, worse exercise capacity and ascites were independent prognostic factors of poorer survival; first‐line oral monotherapy was associated with improved survival. Eight (3.4%) PoPH patients underwent liver transplantation. Conclusions: PoPH patients are undertreated and show poorer survival than IPAH/FPAH patients. First‐line treatment with PAH‐targeted therapy was associated with better survival. Presence of ascites was a predictor of mortality. [ABSTRACT FROM AUTHOR]

Objective: To investigate the factors that are associated with medical student interest in remote and very remote practice in Australia. Design: Aggregated data of an annual cross‐sectional survey from 2013 to 2017. Setting: Australia. Participants: Medical students from 17 medical schools, at the point of finishing one year of clinical training in a rural or remote location in Australia. Main outcome measures: Intention for working in a remote or very remote location as a doctor. Results: Responses were analysed from 3328 medical students. From this cohort, 37.6%, 54.0% and 7.0% of students reported future career intent in capital or major cities; regional Australia; and remote or very remote Australia respectively. Multivariable analysis indicated students interested in remote and very remote practice compared to those interested in regional practice were more likely to be from a rural background, have prior generalist intentions, felt as though their rural clinical school (RCS) experience increased interest in remote and very remote practice, and had higher rural practice self‐efficacy. Odds ratios were larger for these factors when students interested in remote or very remote practice were compared with students interested in practicing in capital or major cities. Conclusions: Rural background, prior generalist intentions, rural practice self‐efficacy and the overall influence of the RCS experience are associated with interest in remote and very remote practice. [ABSTRACT FROM AUTHOR]