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

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

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

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

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

Women are at increased risk of trauma exposure and of experiencing prolonged posttraumatic stress. Maternal trauma exposure and associated impairment may adversely impact mother–infant interaction quality, which may in turn be associated with infant temperament difficulties. More research is needed to identify which maternal trauma predictors are most robustly related to infant temperament outcomes. The present study aimed to address this gap by examining maternal sensitivity as a mediator of relations between maternal trauma and infant temperament in a longitudinal study of a rural cohort of mother–infant dyads. Mediation via maternal sensitivity was not supported in any of the primary analyses. Greater maternal trauma exposure was found to predict greater infant regulation behavior, a finding that was in opposition to expected results and which may be explained by protective factors found within the sample. The present sample was skewed toward married, educated women who reported high social support satisfaction and low trauma-associated impairment. The findings elucidate protective factors that may mitigate adverse outcomes for both mothers and infants. Future research models should include additional maternal trauma variables (e.g., recency, type, revictimization/polyvictimization), in utero maternal cortisol exposure, maternal insensitivity/ambiguous response patterns during caregiver tasks, and analysis of the IBQ-R subscales. [ABSTRACT FROM AUTHOR]

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

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

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

Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP. To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals. Case-control study. Laboratory. Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg). Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component. Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables. Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P <.001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P =.03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = −0.52, P <.01) and between the VAS score for worst pain in the past 24 hours and mental health (r = −0.46, P =.01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = −0.61, P <.01). Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP. [ABSTRACT FROM AUTHOR]

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

Background: Men with prostate cancer who undergo radical prostatectomy experience a decrease in quality of life, often related to sexual disfunction and urinary incontinence. Knowing and measuring the impact of radical prostatectomy on the individual's social, emotional, and family quality of life could help to plan and develop an appropriate, patient-centred therapeutic approach. Aim: In this study, we aimed to evaluate changes in quality of life of patients with prostate cancer before and after radical prostatectomy. Methods: A longitudinal, observational study of 114 participants was conducted using the method of test–retest. Quality of life before and after radical prostatectomy was measured through the following self-administered questionnaires: (1) The EORTC QLQ-C30 in its Spanish version was used to assess the generic quality of life the participants; (2) the EORTC QLQ-PR25 in its Spanish version was used to assess the specific, health-related quality of life of prostate cancer patients. Results: A total of 114 men took part in this study. The results from the QLQ-C30 questionnaire indicated an improvement in the dimensions of emotional role and cognitive function, as well as in the symptoms of fatigue, pain, nausea and vomiting, insomnia, and loss of appetite, after surgery. Patients scored lower in the dimensions of role functioning, social function, and economic impact after radical prostatectomy. According to the results from the QLQ-PR25 questionnaire, 61.40% of the participants experienced sexual impotence and 26.31% suffered urinary incontinence after surgery. There were significant differences in some postsurgical outcomes between patients who had neurovascular bundles preserved and those who had not. Conclusions: In-depth knowledge of, and measurement of changes in, quality of life after radical prostatectomy should allow for comprehensive, multidisciplinary, patient-centred care planning. Psychosocial assessment, both before and after surgery, is crucial in patients with prostate cancer. This study was prospectively registered with the CEIC-A on 2012-06-27, with registration number C.P.-C.I. PI12/0088 [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to evaluate the results of online group meetings for breast cancer patients in the active phase of treatment. The group therapy sessions took place weekly, synchronously, online, on Zoom, with a total of 12 meetings lasting about 2.5 h per session, between December 2021 and February 2022. We analyzed the topics of discussion chosen by the participants, the structure of the group, the results obtained at the main scales of evaluation/monitoring of quality of life and the motivation of patients to participate in the therapeutic group. All patients were in the active phase of treatment (chemotherapy, radiotherapy, hormone therapy, etc.). The main goal of the group therapy was to reduce the stress related to the disease. Material and methods: Systematic observations included ABS psychological tests, EQ-5D-5L, HADS—Hospital Anxiety and Depression Scale, and the Recurrence Fear Questionnaire; the questionnaires were administered at the beginning and at the end of the therapeutic intervention; the participation in the therapy and in the research of the patients began after signing the informed consent document; the intervention was evaluated at the end using a feedback questionnaire. The group was closed, and the participants signed an informed consent document and agreed to have the sessions recorded. Results: Comparing the initial with the final results of the psychological tests administered, there was an improvement in the quality of life of the participants in all areas, with a clinically significant decrease in the areas of pain and depression, along with an increase in perception of well-being, a decrease in FoP scores and an increase in the level of rationality about the disease. Conclusions: Group therapy for cancer patients was useful in improving the quality of life; the closed group, even online, provided a safe environment in which they could share feelings. A close correlation was noted between the scores obtained on the FoP-Q and HADS scales. It is evident that there is a strong relationship between FoP and depression. Results on these scales correlated well with results on the EQ-5D-5L quality of life questionnaire. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies aiming at relating exposure to phenols and phthalates with child social behavior characterized exposure using one or a few spot urine samples, resulting in substantial exposure misclassification. Moreover, early infancy exposure was rarely studied. OBJECTIVES: We aimed to examine the associations of phthalates and phenols with child social behavior in a cohort with improved exposure assessment and to a priori identify the chemicals supported by a higher weight of evidence. METHODS: Among 406 mother-child pairs from the French Assessment of Air Pollution exposure during Pregnancy and Effect on Health (SEPAGES) cohort, 25 phenols/phthalate metabolites were measured in within-subject pools of repeated urine samples collected at the second and third pregnancy trimesters (∼21 samples/trimester) and at 2 months and 1-year of age (∼7 samples/period). Social behavior was parent-reported at 3 years of age of the child using the Social Responsiveness Scale (SRS). A structured literature review of the animal and human evidence was performed to prioritize the measured phthalates/phenols based on their likelihood to affect social behavior. Both adjusted linear regression and Bayesian Weighted Quantile Sum (BWQS) regression models were fitted. False discovery rate (FDR) correction was applied only to nonprioritized chemicals. RESULTS: Prioritized compounds included bisphenol A, bisphenol S, triclosan (TCS), diethyl-hexyl phthalate (RDEHP), mono-ethyl phthalate (MEP), mono-n-butyl phthalate (MnBP), and mono-benzyl phthalate (MBzP). With the exception of bisphenols, which showed a mixed pattern of positive and negative associations in pregnant mothers and neonates, few prenatal associations were observed. Most associations were observed with prioritized chemicals measured in 1-y-old infants: Each doubling in urinary TCS (β=0.78; 95% CI: 0.00, 1.55) and MEP (β=0.92; 95% CI: -0.11, 1.96) concentrations were associated with worse total SRS scores, whereas MnBP and RDEHP were associated with worse Social Awareness (β=0.25; 95% CI: 0.01, 0.50) and Social Communication (β=0.43; 95% CI: -0.02, 0.89) scores, respectively. BWQS also suggested worse total SRS [Beta 1=1.38; 95% credible interval (CrI): -0.18, 2.97], Social Awareness (Beta 1=0.37; 95% CrI: 0.06, 0.70), and Social Communication (Beta 1=0.91; 95% CrI: 0.31, 1.53) scores per quartile increase in the mixture of prioritized compounds assessed in 1-y-old infants. The few associations observed with nonprioritized chemicals did not remain after FDR correction, with the exception of benzophenone-3 exposure in 1-y-old infants, which was suggestively associated with worse Social Communication scores (corrected 푝=0.07). DISCUSSION: The literature search allowed us to adapt our statistical analysis according to the weight of evidence and create a corpus of experimental and epidemiological knowledge to better interpret our findings. Early infancy appears to be a sensitive exposure window that should be further investigated. [ABSTRACT FROM AUTHOR]

Consumption of unhealthy commercial foods and beverages (UCFB) is common among infants and young children living in low- and middle-income countries. Such foods can displace other nutritious foods, however, there is limited evidence on how this consumption tracks across time. This study assessed and tracked UCFB consumption of children living in rural/peri-urban Cambodia during the complementary feeding period, identified UCFB consumption patterns of these children, and explored the association between UCFB consumption and growth. A 6-month longitudinal cohort study was implemented among 567 caregivers of children aged 10-14 months at recruitment. UCFB consumption was estimated each month via a telephone-administered 7-day food frequency questionnaire, and UCFB consumption patterns were identified based on changes in this frequency of consumption over time. The majority of children either maintained (45.7%, n = 246) or developed (43.5%, n = 234) an unhealthy consumption pattern and only 10.8% (n = 58) of children maintained/transitioned into a healthy consumption pattern. High consumers of UCFB at 10-14 months had a 4.7 (CI: 4.7 [3.1-7.2]) times odds of being high consumers of UCFB at 15-19 months (p < 0.001). There was a trend of lower length- for-age z-scores (LAZ) among children maintaining or developing an unhealthy consumption pattern (~-0. SD LAZ) compared to children maintaining/transitioning into a healthy consumption pattern, however, this association was not statistically significant. Findings indicate that high UCFB consumption begins during infancy and tracks into early childhood. National policies and programmes centred on early interventions addressing the use of UCFB for infant and young child feeding are needed. [ABSTRACT FROM AUTHOR]

Simple Summary: The number of pigmented moles is the most important risk factor for melanoma. This "real world" study conducted in 25 Australian childcare centers is the first to show it is possible to prevent a significant proportion of pigmented moles in young Caucasian children by dressing them in UPF 30-50+ clothing that covers at least half their body on a daily basis. Regularly wearing this clothing for 3.5 years was sufficient to prevent almost one-quarter of the pigmented moles that young children developed on their skin. This should, by implication, reduce their risk of developing melanoma in the future. Primary health care providers should stress the importance of garment coverage when recommending sun protection for children and should lobby for all sun-protective clothing standards to assess and report garment coverage, in addition to the transmission of ultraviolet radiation through the fabric (reported as UPF), on clothing labels and packaging for children's clothing, including school uniforms. Numerous pigmented moles are associated with sun exposure and melanomarisk. This cluster randomized controlled trial aimed to determine if sun-protective clothing could prevent a significant proportion of the moles developing in young children (ACTRN12617000621314; Australian New Zealand Clinical Trials Registry. Twenty-five childcare centers in Townsville (19.25° S), Australia, were matched on shade provision and socioeconomic status. One center from each pair was randomized to the intervention arm and the other to the control arm. Children at 13 intervention centers wore study garments and legionnaire hats at childcare and received sun-protective swimwear and hats for home use, while children at the 12 control centers did not. The 1–35-month-old children (334 intervention; 210 control) were examined for moles at baseline (1999–2002) and were re-examined annually for up to 4 years. Both groups were similar at baseline. Children at intervention centers acquired fewer new moles overall (median 12.5 versus 16, p = 0.02; 0.46 versus 0.68 moles/month, p = 0.001) and fewer new moles on clothing-protected skin (6 vs. 8; p = 0.021 adjusted for confounding and cluster sampling) than controls. Intervention children had 24.3% fewer new moles overall (26.5 versus 35) and 31.6% (13 versus 19) fewer moles on clothing-protected skin than controls after 3.5 years. Sunlight's influence on nevogenesis is mitigated when children regularly wear UPF 30-50+ clothing covering half their body, implying that increased clothing cover reduces melanoma risk. Sun-protective clothing standards should mandate reporting of the percentage of garment coverage for childrenswear. [ABSTRACT FROM AUTHOR]

The present study was designed to examine the direct and indirect contributions of parenting daily hassles and approaches to children's externalizing and internalizing behavior problems during the COVID-19 pandemic. The sample for this study was 338 preschool children (53.6% girls, Mage = 56.33 months, SD = 15.14) and their parents in Turkey. Parents reported their daily hassles, parenting approaches, and children's behavior problems. Findings from the structural equation model showed that higher levels of parenting daily hassles predicted higher levels of externalizing and internalizing behavior problems. In addition, we found an indirect effect of daily hassles on children's internalizing behaviors via positive parenting. Further, there was an indirect path from parenting daily hassles to children's externalizing behaviors through the negative parenting approach. Results are discussed in the context of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: to analyze the profile of nurses regarding integrative and complementary practices in health (ICPH) and understand how they are used in the care of people with arterial hypertension. Method: mixed-methods sequential explanatory design. The cross-sectional quantitative stage included 386 nurses who completed an online questionnaire addressing sociodemographic and professional information, training, and practice, with a descriptive and inferential analysis. The qualitative stage was performed via 18 online interviews with professionals who had ICPH training and implemented it in the care provided to individuals with hypertension, with a participatory analysis. Integration occurred through a connecting approach. Results: 36.8% had ICPH training; most were women, Caucasian, married, public servants, aged 37 (+ 9.4) on average; 14.2% incorporated ICPH into the care provided to people with hypertension; predominantly auriculotherapy (28.2%) and bloodletting in hypertensive crises. The results show that nurses integrally approached patients, and their approach was not limited to the vital sign altered at the time, but they also intervened in anxiety, stress, sleep, and rest. A potentiality observed concerns support treatment adherence. Conclusion: the profile of nurses with ICPH training is presented, and such practice has implications for lowering blood pressure. ICPH has been incorporated into the care of people with hypertension, but its use is still incipient, considering its potential in nursing care. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N -acetylcysteine (NAC). Study Design A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks. Study Results NAC did not significantly improve negative symptoms (P =.62), overall cognition (P =.71) or quality of life (Manchester quality of life: P =.11; Assessment of quality of life: P =.57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P =.26). Conclusions NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with "Australian and New Zealand Clinical Trials" on the 30 May, 2016 (Registration Number: ACTRN12615001273572). [ABSTRACT FROM AUTHOR]

Nowadays pulmonary diseases are an increasingly important cause of morbidity and mortality. Diaphragmatic breathing is a controlled-breathing technique that aims to optimize thoracoabdominal movements. The aim of this study was to apply a respiratory and musculoskeletal physiotherapy program in institutionalized older adults and to assess the effects on their pulmonary function tests and oxygen saturation. A randomized double-blind clinical trial was conducted with thirty institutionalized older adults, randomly assigned to a control group (CG), who conducted musculoskeletal exercises; or an experimental group (EG) who, in addition, carried out diaphragmatic breathing, administered for eight weeks, three times/week. Outcomes were pulmonary function variables (forced vital capacity, FVC; forced expired volume at 1 s, FEV1; the FEV1/FVC ratio) and oxygen saturation (SpO2) before and after treatment. Normality of the distributions was tested with Saphiro-Wilk and the pre-post improvement was assessed with a two-sample Mann-Whitney test. Significance level was corrected for multiple comparisons using Benjamini-Hochberg correction (p < 0.04). There was a clinically significant improvement of FVC and FEV1 for the EG. Moreover, the EG showed a statistically significant increase of SpO2 (p = 0.028) after treatment when compared to CG. A physiotherapy program combining breathing and musculoskeletal exercises, improved respiratory parameters in institutionalized older adults. [ABSTRACT FROM AUTHOR]

Background: Global health care is moving toward function, quality of life, and occupation. Occupational therapy (OT) has been the only profession using "occupation" as core intervention since inception. With advancements in intervention techniques, occupational therapists (OTs) need to ensure the continued use of "occupation" as core intervention type. Previous surveys were conducted to analyze the use of specific intervention types: occupation-based interventions (OBIs), creative activities, acute-hospital-based rehabilitation, and different interventions used in pediatric OT practice. However, information on OT practices and types of interventions used by Indian OTs versus global OTs is unavailable. Objectives: The objective of this study was to analyze differences, if any, in the OT practices and types of interventions frequently used in daily practice by Indian versus global OTs. Study Design: This was an online, survey-based, cross-sectional study. Methods: The Google Forms questionnaire link was sent to OTs on E-mail with electronic written informed consent from May 2020 to March 2021 using convenient sampling. The questionnaire included participant's demographics, 17 clinical practice areas, and 9 intervention types and factors influencing OT practice. Total 201 (84 Indian OTs and 117 global OTs) fulfilled the selection criteria: OTs with at least bachelor's degree and minimum 3 years of work experience. Results: Indian OT workforce showed significantly more male OTs than global OTs (31 [36.9%] vs. 11 [9.4%]; 95% confidence interval [CI]: [0.0236-0.2964]; P = 0.0001) and OTs with master's degree (56 [66.7%] vs. 41 [35.04%]; 95% CI: [0.1852-0.4480]; P = 0.0001). Global OTs have more OTs with additional qualifications in non-OT fields (58 [49.57%] vs. 27 [32.10%]; 95% CI: [-0.3088--0.0406]; P = 0.013) and more OTDs (13 [11.11%] vs. 1 [1.23%]; 95% CI: [-0.1641--0.0335]; P = 0.006) than Indian OTs. Indian OTs practiced significantly more in the private sector: clinic and hospital (52 [61.90%] vs. 40 [35.80%]; 95% CI: [0.1273-0.3947]; P = 0.0001), whereas global OTs practiced significantly more in the government sector (46 [39.31%] vs. 19 [22.61%]; 95% CI: [-0.2930--0.0410); P = 0.0124). Among the organizational roles, Indian OTs work significantly more as consultants (50 [50.95%] vs. 35 [29.91%]; 95% CI: [0.0751-0.3457]; P = 0.0001) while global OTs work significantly more as managers (36 [30.76%] vs. 12 [14.28%]; 95% CI: [-0.2770--0.0526]; P = 0.0069). Among patient population treated, Indian OTs majorly (54.76%) treat children (up to 15 years) but significantly more in "all age groups" (35 [41.67%] vs. 18 [15.38%]; 95% CI: [0.1388-0.3870]; P = 0.0001) while global OTs treat significantly more adults (21-65 years) (61 [52.13%] vs. 25 [29.76%]; 95% CI: [-0.3569--0.0905]; P = 0.0015) and geriatric (>65 years) (50 [42.73%] vs. 17 [20.23%]; 95% CI: [-0.3492-0.1008]; P = 0.0008). Indian OTs practice significantly more in developmental disability rehabilitation (78 [92.85%] vs. 68 [58.11%]; 95% CI: [0.2424-0.4524]; P = 0.0001), ante- and postnatal women's care (15 [17.85%] vs. 3 [2.56%]; 95% CI: [0.0662-0.2396]; P = 0.00018), and hemophiliac rehabilitation (14 [16.67%] vs. 2 [1.70%]; 95% CI: [0.0666-0.2328]; P = 0.00012) areas of practice than global OTs. Indian OTs practice significantly more in clinic outpatient department (OPD) (62 [73.80%] vs. 55 [47%]; 95% CI: [0.1375-03985]; P = 0.0001), hospital OPD (40 [47.61%] vs. 27 [23.07%]; 95% CI: [0.1141-0.3767]; P = 0.0002), and inpatient (37 [44.04%] vs. 30 [25.64%]; 95% CI: [0.0516-0.3164]; P = 0.0006) while global OTs practice significantly more in natural environment settings (53 [45.29%] vs. 24 [28.57%]; 95% CI: [-0.2994--0.0350]; P = 0.016). Most preferred types of interventions among both groups are relatively the same: client education, counseling, and consultation and interview; therapeutic relationships; and therapeutic use of self. Besides these, Indian OTs prefer performance skills training and adaptive interventions, while global OTs prefer activities as therapeutic media and OBIs over other types. Preventive interventions and advocacy were the least preferred types of intervention among each group. Despite these relative preferences, significant differences were found between groups with regard to number of OTs practicing these 5 types of interventions: client education, counseling, and consultation (46 [54.76%] vs. 47 [40.17%]; 95% CI: [0.0073-0.2845]; P = 0.04]; performance skills training (41 [48.80%] vs. 34 [29.05%]; 95% CI: [0.0626-0.3324]; P = 0.004); preventive intervention and health promotion (29 [34.5%] vs. 24 [20.51%]; 95% CI: [0.0148-0.308]; P = 0.026]; adaptive interventions (39 [46.42%] vs. 23 [19.65%]; 95% CI: [0.1390-0.3964]; P = 0.001]; and preparatory interventions: (35 [41.67%] vs. 28 [23.93%]; 95% CI: [0.0467-0.3081]; P = 0.0075). Conclusion: The study provides the current stand for preferences and practices of therapeutic interventions by OTs in India versus globally, thus aiding in repositioning of OT practice, focusing on core OT domains as well as providing a baseline for monitoring practice trends over time. [ABSTRACT FROM AUTHOR]

Background: The prevalence, indications, and preferred methods for gastrocnemius recession and tendo-Achilles lengthening—grouped as triceps surae lengthening (TSL) procedures—in foot and ankle trauma are supported by a scarcity of clinical evidence. We hypothesize that injury, practice environment, and training heritage are significantly associated with probability of performing adjunctive TSL in the operative management of foot and ankle trauma. Methods: A survey was distributed to members of the American Orthopaedic Foot & Ankle Society and the Orthopaedic Trauma Association. Participants rated how likely they would be to perform TSL at initial management, definitive fixation, and after weightbearing in the presence and absence of a positive Silfverskiöld test in 10 clinical scenarios of closed foot and ankle trauma. Results: A total of 258 surgeons with median 14 years' experience responded. Eighty-five percent reported foot and ankle fellowship training, 24% reported traumatology fellowship training, 13% both, and 4% no fellowship. Ninety-nine percent reported performing TSL with a median 25 TSL procedures per year, 72% open gastrocnemius recession, and 17% percutaneous tendo-Achilles lengthening). Across all scenarios, we observed low overall 8% probability with fair agreement (κ = 0.246) of performing TSL (range, 1% at initial management of an unstable Weber B bimalleolar ankle fracture with negative contralateral Silfverskiöld test to 29% at definitive fixation of tongue-type calcaneus fracture with positive contralateral Silfverskiöld test). Silfverskiöld testing significantly influenced TSL probability at all time points. University of Washington training (β = 1.5, P =.007) but not trauma vs foot fellowship training, years in practice, academic practice, urban setting, or facility trauma designation were significantly associated with likelihood of performing TSL. Conclusion: Orthopaedic traumatology and foot and ankle surgeons report similar indications, methods, and low perceived propensity to use TSL in the management of foot and ankle trauma. We found that graduates of 1 fellowship training site were more likely to perform TSL in the setting of acute trauma potentially indicating the need for better scientific data to support this practice. Level of Evidence: Level V, therapeutic. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship among caregiver burden, caregiving satisfaction, and health-related quality of life (HRQOL), and to identify caregiver- and child-related variables of caregiver burden and caregiving satisfaction. Designs and Methods: A cross-sectional study was conducted. Caregivers completed the Zarit Burden Interview, Caregiving Satisfaction Scale, and Health Survey Short Form. Socio-demographics of the caregivers and CMC were also collected. Results: Of 32 participants, 93.8% were female and the biological mother. A significant moderate, inverse relationship was found between caregiver burden and caregiving satisfaction. Caregiver burden had a significant strong, negative association with the mental health component of caregivers' HRQOL. Caregiving satisfaction had a significant moderate, positive association with the mental health component of caregivers' HRQOL. Education level of caregivers had a significant moderate, positive correlation with caregiver burden and a significant moderate, negative correlation with caregiving satisfaction. A significant moderate, positive association was found between family income and caregiver burden. White caregivers had significantly greater caregiver burden and significantly lower caregiving satisfaction compared to caregivers who were Black/African American and more than one race. Conclusions: Despite caregiver burden, caregivers of children with medical complexity have caregiving satisfaction. Regardless of the education level and family income of caregivers, caregiver burden and caregiving satisfaction should be recurrently assessed as caregivers provide long-term complex care for their child. Practice Implications: Associations of caregivers' mental HRQOL to caregiver burden and caregiving satisfaction highlight the importance of having nurses identify caregivers at risk of becoming overwhelmed with care. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the incidence and risk factors of cataract in people with diabetes mellitus (DM) using data from Ansan cohort of the Korean Genome and Epidemiology Study (KoGES). Methods: Data from a total of 329 patients with type 2 DM without cataract who participated in Ansan cohort of the KoGES from baseline survey (2001-2002) to fifth follow-up visit (2011-2012) were examined. The characteristics of the subjects were analyzed with frequency and percentage, and mean and standard deviation. Cataract incidence was measured as incidence proportion (%). For risk factors of cataract, hazard ratio (HR) and 95% confidence interval (CI) were obtained using the Cox proportional hazard model. Results: The cataract incidence over a 10-year follow-up period was 19.1% (15.1 in males and 25.8 in females), and mean age at the incidence of cataract was 63.48 years (61.58 years in males and 65.31 years in females). Age (HR=1.09, 95% CI=1.05-1.13) and HbA1c (HR=1.21, 95% CI=1.07-1.37) or the duration of DM (HR=1.05, 95% CI=1.00-1.09) were found to be independently associated with cataract development. Conclusion: Cataract development in people with DM is common, and its likelihood increases with age, HbA1c, and the duration of DM. Considering negative effect of cataract on their quality of life and economic burden, nurses should identify people with DM at a higher risk of cataract development, and plan individual eye examination programs to detect cataract development as early as possible. [ABSTRACT FROM AUTHOR]

Background and Objective: Hearing loss (HL) is one of the modifiable risk factors for Alzheimer's disease (AD). However, the underlying mechanism behind HL in AD remains elusive. A possible mechanism is cognitive load hypothesis, which postulates that over-processing of degraded auditory signals in the auditory cortex leads to deficits in other cognitive functions. Given mild cognitive impairment (MCI) is a prodromal stage of AD, untangling the association between HL and MCI might provide insights for potential mechanism behind HL. Methods: We included 85 cognitively normal (CN) subjects with no hearing loss (NHL), 24 CN with HL, 103 mild cognitive impairment (MCI) patients with NHL, and 23 MCI with HL from the ADNI database. All subjects underwent resting-state functional MRI and neuropsychological scale assessments. Fractional amplitude of low-frequency fluctuation (fALFF) was used to reflect spontaneous brain activity. The mixed-effects analysis was applied to explore the interactive effects between HL and cognitive status (GRF corrected, voxel p -value <0.005, cluster p -value < 0.05, two-tailed). Then, the FDG data was included to further reflect the regional neuronal abnormalities. Finally, Pearson correlation analysis was performed between imaging metrics and cognitive scores to explore the clinical significance (Bonferroni corrected, p < 0.05). Results: The interactive effects primarily located in the left superior temporal gyrus (STG) and bilateral inferior temporal gyrus (ITG). Post-hoc analysis showed that NC with HL had lower fALFF in bilateral ITG compared to NC with NHL. NC with HL had higher fALFF in the left STG and decreased fALFF in bilateral ITG compared to MCI with HL. In addition, NC with HL had lower fALFF in the right ITG compared to MCI with NHL. Correlation analysis revealed that fALFF was associated with MMSE and ADNI-VS, while SUVR was associated with MMSE, MoCA, ADNI-EF and ADNI-Lan. Conclusion: HL showed different effects on NC and MCI stages. NC had increased spontaneous brain activity in auditory cortex while decreased activity in the ITG. Such pattern altered with disease stage changing and manifested as decreased activity in auditory cortex along with increased activity in ITG in MCI. This suggested that the cognitive load hypothesis may be the underlying mechanism behind HL. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Coronavirus disease 2019 (COVID-19) struck the world by surprise by the rising numbers that required prompt governmental and hospital staff reaction to the ongoing crisis. A robust preparedness and personal protective equipment (PPE) were yet to be regarded as our best plan. Methods A survey study was conducted on 254 Egyptian house officers using an anonymous web-based questionnaire that was filled using Google Forms after obtaining online informed consent. Results The mean age of the participants was 25 years. Only 28.74% of the house officers were categorized as having a good preparedness, while 85.83% of them have a good PPE attitude. The preparedness and willingness were significantly associated with the overall worry related to the pandemic (P value = 0.012). Fear of contracting COVID-19 infection negatively affected their preparedness by 60% (odds ratio (OR) 0.40, 95% confidence interval (CI), 0.17–0.93, P value = 0.034). The House officers with family members at-risk for severe COVID-19 were less likely to be prepared and willing by 70% (OR 0.30, 95% CI 0.15–0.60, P value = 0.001). The house officers with good preparedness and willingness to deal with COVID-19 seemed to have a good PPE attitude (OR 11.48, 95% CI 2.43-54.34, P value = 0.002). Conclusion A significant number of house officers expressed low levels of preparedness, while most of them have a good PPE attitude. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence concerning the effects of greenness on childhood visual impairment is scarce. OBJECTIVES: We aimed to assess whether greenness surrounding schools was associated with visual impairment prevalence and visual acuity levels in Chinese schoolchildren and whether the associations might be explained by reduced air pollution. METHODS: In September 2013, we recruited 61,995 children and adolescents 6–18 years of age from 94 schools in seven provinces/municipalities in China. Greenness exposure was assessed using the normalized difference vegetation index (NDVI) and the soil-adjusted vegetation index (SAVI) from July to August 2013. Visual impairment was defined as at least one visual acuity level (dimensionless) lower than 4.9 (Snellen 5/6 equivalent). Three-year annual averages of particulate matter (PM) with an aerodynamic diameter of =1 lm (PM1) and nitrogen dioxide (NO2) at each school were assessed using machine learning methods. We used generalized linear mixed models to estimate the associations between greenness and prevalent visual impairment and visual acuity levels and used mediation analyses to explore the potential mediating role of air pollution. RESULTS: In the adjusted model, an interquartile range increase in NDVI500m was associated with lower odds of prevalent visual impairment [odds ratio (OR)=0.95; 95% confidence interval (CI): 0.93, 0.97]. The same increase in NDVI500m was also associated with 0.012 (95% CI: 0.008, 0.015) and 0.011 (95% CI: 0.007, 0.015) increases in visual acuity levels for left- and right-eye, respectively. Our results also suggested that PM1 and NO2 significantly mediated the association between NDVI500m and visual impairment. Similar effect estimates were observed for SAVI500m, and our estimates were generally robust in several sensitivity analyses. DISCUSSION: These findings suggest higher greenness surrounding schools might reduce the risk of visual impairment, possibly owing in part to lower PM1 and NO2 in vegetated areas. Further longitudinal studies with more precise greenness assessment are warranted to confirm these findings. https://doi.org/10.1289/EHP8429 [ABSTRACT FROM AUTHOR]

Background The ongoing COVID-19 pandemic has resulted in a sharp rise in demand for healthcare workers worldwide. This has been coupled with reduced numbers of available medical professionals due to confirmed or suspected infections with SARS-CoV-2. To counteract these shortages, governments of several countries have considered the enrolment of medical students into the workforce in order to help to tackle the ongoing crisis. Methods Questionnaire-based study assessing the perceived role of medical students in assisting in the COVID-19 pandemic. The primary aim was to determine factors contributing to the willingness of medical students to actively assist in the pandemic. The secondary aim was to evaluate their perspectives regarding the associated changes in medical education. Results Out of 760 responses, 71.18% of medical students were willing to assist the medical workforce during the pandemic. Clinical year students were more likely to help in a medical capacity than pre-clinical students (OR = 0.384, 95%CI [0.167, 0.883, P  < 0.05)]. Respondents concerned about their own well-being were less likely to engage in clinical work (OR = 0.680, 95%CI [0.491, 0.941], P  < 0.020). Students who agreed that online lectures will negatively impact their education were inclined to think that the academic year should be extended (95%CI [0.065, 0.271], P  = 0.001). Conclusions Most students are willing to help in both a medical and non-medical capacity. Their primary concerns when working in a medical setting are the risk of infecting their relatives and patients, lack of protective equipment and necessary knowledge as well as legal uncertainty whilst working without a medical qualification. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, nursing students have had a key role in supporting the healthcare sector. They can join healthcare professionals in clinical practice or provide information to increase citizens' levels of knowledge and their compliance with the restriction measures. The study aimed to develop and validate a tool to measure knowledge of and attitudes toward COVID-19 among nursing students in Greece. Methods: A questionnaire was developed through theoretical research and expert consultation. A cross-sectional study was conducted among 348 undergraduate nursing students of the Department of Nursing, Hellenic Mediterranean University, recruited by convenient sampling. Validity and reliability were analyzed. Results: The Kaiser–Meyer–Olkin measure was 0.84, indicating that the sample size was adequate for factor analysis. In addition, the p-value for Bartlett's test of sphericity was <0.001, denoting that the correlation matrix was suitable for factor analysis. The construct validity of the questionnaire was determined through exploratory factor analysis (EFA), which revealed that 16 items lead to four factors: knowledge, attitude toward restriction measures, compliance with them, and volunteering. One of the key findings of this study was that participants preferred to receive information from valid sources rather than social media during the crucial period of the "infodemic". Conclusions: The questionnaire was shown to have satisfying psychometric properties and, therefore, can be used as a tool in future research in the area of nursing students' knowledge, attitudes, compliance, and volunteering during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

To assess the vitamin D status in healthy 6‐month‐old infants, as well as vitamin D supplementation and feeding patterns in Guangzhou, China, serum 25‐hydroxyvitamin D (25OHD) concentrations of 202 infants were measured at birth (cord blood) and at 6 months of age in Guangzhou, China. Questionnaires acquiring demographic characteristics, maternal and infantile vitamin D supplementation during pregnancy and first 6 months after birth, and feeding patterns during the first 6 months were completed by participating mothers. Physical examinations and blood sampling were carried out among infants at 6 months of age. The majority of infants (93.6%) were supplemented with vitamin D during the first 6 months of life on a voluntary basis. The M ± SD of cord serum 25OHD concentration was 46.2 ± 16.4 nmol/L, whereas the M ± SD of 25OHD concentration at 6 months was 82.9 ± 24.9 nmol/L. Serum 25OHD concentrations <30 nmol/L were seen in 34 (16.8%) infants at birth but only one (0.5%) at 6 months. Only 11 (5.4%) infants had concentrations >75 nmol/L at birth, whereas the majority of infants (n = 131, 64.9%) had concentrations >75 nmol/L at 6 months. The main predictors of 25OHD levels at 6 months included season, vitamin D supplementation, parental education level, and feeding patterns. To conclude, serum 25OHD concentrations were low at birth in a southern Chinese population, and infantile supplementation is an effective way to improve 25OHD status. Exclusively breastfed infants might need greater vitamin D supplementation, and individualized vitamin D supplementation plans might be needed. [ABSTRACT FROM AUTHOR]

The article discusses a study on the association between health providers' (HP) postpartum copper intrauterine device (PPIUD) service experience and the discontinuation and expulsion of IUD in Nepal. Results include the high likelihood of IUD expulsion after a vaginal birth, the difference between deliberate discontinuation and expulsion, and the characteristics of women that were associated with IUD discontinuation including age and ethnicity.

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. People with low back pain (LBP) may display an altered lumbar movement pattern of early lumbar motion compared to people with healthy backs. Modifying this movement pattern during a clinical test decreases pain. It is unknown whether similar effects would be seen during a functional activity. Objective. The objective of this study was to examine the lumbar movement patterns before and after motor skill training, effects on pain, and characteristics that influenced the ability to modify movement patterns. Design. The design consisted of a repeated-measures study examining early-phase lumbar excursion in people with LBP during a functional activity test. Methods. Twenty-six people with chronic LBP received motor skill training, and 16 people with healthy backs were recruited as a reference standard. Twenty minutes of motor skill training to decrease early-phase lumbar excursion during the performance of a functional activity were used as a treatment intervention. Early-phase lumbar excursion was measured before and after training. Participants verbally reported increased pain, decreased pain, or no change in pain during performance of the functional activity test movement in relation to their baseline pain. The characteristics of people with LBP that influenced the ability to decrease early-phase lumbar excursion were examined. Results. People with LBP displayed greater early-phase lumbar excursion before training than people with healthy backs (LBP: mean = 11.2°, 95% CI = 9.3°-13.1°; healthy backs: mean = 7.1°, 95% CI = 5.8°--8.4°). Following training, the LBP group showed a decrease in the amount of early-phase lumbar excursion (mean change = 4.1°, 95% CI = 2.4°-5.8°); 91% of people with LBP reported that their pain decreased from baseline following training. The longer the duration of LBP (β = - 0.22) and the more early-phase lumbar excursion before training (β = - 0.82), the greater the change in early-phase lumbar excursion following training. Limitations. The long-term implications of modifying the movement pattern and whether the decrease in pain attained was clinically significant are unknown. Conclusions. People with LBP were able to modify their lumbar movement pattern and decrease their pain with the movement pattern within a single session of motor skill training. [ABSTRACT FROM AUTHOR]

Background: Polyunsaturated fatty acids (PUFAs) are associated with a lower risk of multiple diseases. Fatty acid desaturase 1 gene (FADSl) polymorphisms and dietary PUFA intake are both established determinants of circulating PUFA proportions. Objective: We explored the joint effects of FADSl polymorphisms and dietary PUFA intake on circulating PUFA proportions. Design: We studied 2288 participants from a nested case-control study of coronary artery disease among participants who provided blood samples in the Nurses' Health Study and the Health Professionals Follow-Up Study. Dietary PUFA intake was obtained from semiquantitative food-frequency questionnaires. FADSl rs174546 was genotyped by using the Affymetrix 6.0 platform, and circulating PUFA proportions were measured with gas-liquid chromatography. Linear regression models were used to examine the associations between rs174546 and circulating proportions of each fatty acid. Gene-diet interactions were tested by including a cross-product term of dietary intake of each PUFA by rs174546 genotype in the linear regression models. Results: After adjustment for sex and ancestry, each copy of the C allele of rs174546 was associated with higher circulating pro-portions of arachidonic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) and lower proportions of linoleic acid and a-linolenic acid. The magnitude of positive association between higher consumption of dietary EPA or DHA and circulating pro-portions of EPA increased with each copy of the rs174546_T allele (P-interaction = 0.01 and 0.007, respectively). Each 1-SD increment in EPA intake was associated with an average 3.7% increase in circulating EPA proportions among participants with the rs174546_CC genotype and an average 7.8% increase among participants with the TT genotype. Conclusions: Carriers of the T allele at FADSl rs174546 may need higher doses of dietary EPA and DHA to achieve the same circulating proportions of EPA as carriers of the C allele. The implications of these findings on disease risk and dietary guidelines require further study. [ABSTRACT FROM AUTHOR]

Context: Recent employment data from collegiate athletic training settings have demonstrated departure trends among men and women. These trends have been hypothesized to be related to work-life balance. However, work-life balance is only 1 aspect of a myriad of factors. Due to the complex nature of the work-life interface, a multilevel examination is needed to better understand the precipitators of departure. Objective: To quantitatively examine factors that may influence collegiate athletic trainers' (ATs') job satisfaction and career intentions via a multilevel examination of the work-life interface. Design: Cross-sectional study. Setting: Web-based questionnaire. Patients or Other Participants: Athletic trainers employed in National Collegiate Athletic Association Division I, II, or III or National Association of Intercollegiate Athletics colleges or universities (N =299: 56.5% female, 43.5% male). The average age of participants was 33.6±8.3 years, and their average experience was 10.3±7.6 years. Data Collection and Analysis: Participants responded to an online questionnaire consisting of demographic questions, 9 Likert-scale surveys, and open-ended questions. Job-satisfaction Scores (JSSs) and intention-to-leave scores (ITLSs) served as the dependent variables and factors from individual, organizational, and sociocultural levels were the independent variables. Hierarchical regression analysis was run to determine the predictability of factors. Results: No sex differences in ITLS or JSS were found in our sample. Independent variables explained 68.5% of the variance in JSS and 28.8% of the variance in ITLS. Additions of factor levels increased the percentage of explained variance in both scores. Conclusions: A combination of individual-, organizational-, and sociocultural-level factors was able to best predict JSS and ITLS among collegiate ATs. [ABSTRACT FROM AUTHOR]

Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey ( n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context. [ABSTRACT FROM AUTHOR]

Vitamin B6 is important in fetal development, but little is known of the vitamin B6 status of pregnant women and newborns in North America and potential modifying factors. This prospective study determined maternal and cord plasma concentrations of pyridoxal 5′ phosphate (PLP; an indicator of vitamin B6 status) in a convenience sample of 368 Canadian pregnant women and their newborns. The association of maternal intake of vitamin B6 and fetal genetic variants with cord plasma PLP and homocysteine concentrations was also examined. Dietary and supplemental intakes of vitamin B6 were assessed in early and mid to late pregnancy. PLP concentrations were measured in maternal plasma in early pregnancy and at delivery, and in cord plasma. Six fetal variants of the MTHFR and CβS genes were assessed for their association with cord plasma PLP and homocysteine concentrations. Geometric mean (95% CI) PLP concentrations were 107 (98, 116) nmol/L in early pregnancy and 58 (53, 62) nmol/L at delivery, respectively, and 296 (275, 319) nmol/L in cord blood ( p < .0001). During early pregnancy and at delivery, 3.6% and 5.5% of women had plasma PLP concentrations <20 nmol/L, respectively. Ninety eight percent of the women with supplemental B6 intake of at least the recommended dietary allowance had PLP concentrations >20 nmol/L. Fetal genetic variants were not associated with cord PLP and homocysteine concentrations. Vitamin B6 deficiency is uncommon in a cohort of Canadian pregnant women due largely to prevalent vitamin B6 supplement use. [ABSTRACT FROM AUTHOR]

Aim: In our research we wanted to propose a holistic model of palliative care from the perspective of nurses. Additionally, we compared the presence of specific aspects of palliative care (psychological, physical, social and spiritual) in hospitals and the community/home environment. Design: A quantitative cross-sectional study was used. Methods: The sample consisted of 127 nurses (92 hospital nurses, 35 community nurses). The proposed model was tested using a specific method of structural equation modeling (SEM) known as partial least squares (PLS). Results: Our research confirmed that physical aspects are influenced both by psychological and spiritual aspects, whereas social aspects have only an indirect influence. We detected a statistically significant difference between the hospital and the community environment regarding the impact of psychological aspects on social aspects, and of psychological aspects on physical aspects. Conclusion: Our research highlighted the professional shortcomings of the holistic approach in palliative care as it stands, especially in the community care setting, where it is necessary to ensure in-depth knowledge and skills, and practice within each holistic domain to provide quality treatment to palliative patients. [ABSTRACT FROM AUTHOR]

Background. For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. Objective. The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. Design. This was a retrospective and observational study. Methods. An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. Results. Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. Limitations. Self-report, clinician memory, and convenience sampling are limitations of this type of survey research. Conclusions. The extremely high prevalence of IPSB among physical therapist professionals warrants practitioner and student education as well as clear workplace policy and support. [ABSTRACT FROM AUTHOR]

Background: The organization of health care in Norway poses a number of challenges in terms of assessment, treatment and follow-up. The introduction of care pathways in oncology has increased the focus on systematic improvement of care processes as a means of quality improvement. However, it is unclear how well the existing care processes are currently organized. Objective: To assess health care personnel's perceptions of the organization of care processes in the specialist health service in Norway. Method: The Care Process Self-Evaluation Tool (CPSET) assesses five dimensions of the organization of care processes: Patient-focused organization, Coordination of the care process, Communication with patients and family, Collaboration with primary care, and Monitoring and follow-up of the care process. Employees (N = 503) in 27 selected care processes in the Western Norway Regional Health Authority (Helse Vest) were asked to complete the CPSET. Analyses were based on responses from 239 employees in 22 valid care processes (48 per cent response rate). Results: The CPSET average score of 6.9 (standard deviation 1.80) in the sample was higher than comparable international figures. However, Norwegian employees considered the follow-up of the care process and the collaboration with primary care to be poorer than other dimensions of care organization. Care processes with a written clinical procedure were better organized than processes without such standardization. Conclusion: The specialist health service should improve the systematic follow-up of care pathways as well as the collaboration with primary care. [ABSTRACT FROM AUTHOR]

Context: Concussions in student-athletes are a serious problem. Most states have enacted legislation mandating concussion education for student-athletes, under the assumption that education leads to better self-reporting of concussions and improved knowledge of symptoms. Objectives: (1) To determine the effect of state-based concussion legislation on the proportion of student-athletes receiving concussion education and to assess the moderation of this effect by gender and sport and (2) to assess the effect of concussion education on student-athletes' knowledge of concussion symptoms and likelihood of seeking treatment after a concussion. Design: Cross-sectional study. Setting: Private university. Patients or Other Participants: A total of 249 National Association of Intercollegiate Athletics collegiate athletes attending St Xavier University; 160 were surveyed prelegislation and 89 were surveyed postlegislation. Main Outcome Measure(s): Participants completed an anonymous survey that assessed previous involvement in concussion-education programs, degree of self-reporting after a concussion, and ability to enumerate symptoms. Results: The number of athletes who reported having received education increased after the implementation of concussion legislation; however, almost 25% still reported not having received education. Athletes who played football were more likely to report having received education than those who played volleyball. The student-athletes' ability to name a diversity of concussion symptoms or to report seeking medical attention after a concussion did not improve in the postlegislation period relative to the prelegislation period. Conclusions: Legislation has been passed in all 50 states to address concussions in student-athletes; however, improvements are still needed. Concussion education must be delivered in a uniform, effective manner to all student-athletes across sports and genders. Concussion education should emphasize the diversity of symptoms, especially cognitive and behavioral symptoms. We must develop and disseminate evidence-based educational programs that are clinically proven to be effective in improving athletes' knowledge and behaviors. [ABSTRACT FROM AUTHOR]

Only a few studies have focused on the association between overall diet, rather than intakes of individual nutrients or foods, and depressive symptoms in Japanese. This cross-sectional study examined associations between a diet quality score and depressive symptoms in 3963 young (age 18 years) and 3833 middle-aged (mean age 47·9 (sd 4·2) years) Japanese women. Dietary information was collected using a diet history questionnaire. A previously developed diet quality score was computed mainly based on the Japanese Food Guide Spinning Top. The prevalence of depressive symptoms was 22·0 % for young women and 16·8 % for middle-aged women, assessed as a Center for Epidemiologic Studies Depression (CES-D) score ≥23 and ≥19, respectively. As expected, the diet quality score was associated positively with intakes of ‘grain dishes’, ‘vegetable dishes’, ‘fish and meat dishes’, ‘milk’ and ‘fruits’ and inversely with intakes of energy from ‘snacks, confection and beverages’ and Na from seasonings. After adjustment for potential confounders, OR for depressive symptoms in the highest v. lowest quintiles of the diet quality score was 0·65 (95 % CI 0·50, 0·84) in young women (Pfor trend=0·0005). In middle-aged women, the corresponding value was 0·59 (95 % CI 0·45, 0·78) (Pfor trend<0·0001). Analyses where the diet quality and CES-D scores were treated as continuous variables also showed inverse associations. In conclusion, this cross-sectional study showed that a higher diet quality score was associated with a lower prevalence of depressive symptoms in young and middle-aged Japanese women. Prospective studies are needed to confirm a public health relevance of this finding. [ABSTRACT FROM AUTHOR]

Background: Statistical analysis plans increase the transparency of decisions made in the analysis of clinical trial results. The purpose of this paper is to detail the planned analyses for the PREVENT trial, a randomized, placebo-controlled trial of patient education for acute low back pain. Results: We report the pre-specified principles, methods, and procedures to be adhered to in the main analysis of the PREVENT trial data. The primary outcome analysis will be based on Mixed Models for Repeated Measures (MMRM), which can test treatment effects at specific time points, and the assumptions of this analysis are outlined. We also outline the treatment of secondary outcomes and planned sensitivity analyses. We provide decisions regarding the treatment of missing data, handling of descriptive and process measure data, and blinded review procedures. Conclusions: Making public the pre-specified statistical analysis plan for the PREVENT trial minimizes the potential for bias in the analysis of trial data, and in the interpretation and reporting of trial results. [ABSTRACT FROM AUTHOR]

Background: Hand hygiene at key moments during patient care is considered an important infection prevention and control measure to reduce healthcare-associated infections. While there is extensive research in Western settings, there is little in the United Arab Emirates where particular cultural and religious customs are thought to influence hand hygiene behaviour. Aim: To examine the hand hygiene knowledge and beliefs of health professionals at a tertiary care hospital in the United Arab Emirates. Methods: A mixed methods design employed a survey followed by focus groups with nurses and doctors. Findings: A total of 109 participants (13.6%) completed the survey: 96 nurses (88%) and 13 doctors (12%). Doctors’ hand hygiene knowledge was slightly higher than that of nurses (78.5% versus 73.5%). There was no significant difference in scores on the hand hygiene beliefs scale between nurses (M = 103.06; SD = 8.0) and doctors (M = 99.00; SD = 10.53; t (80) = 1.55; p = 0.13, two-tailed). Seven categories emerged following transcript analysis. Discussion: Hand hygiene knowledge scores suggest further hand hygiene education is required, especially on alcohol-based hand rub use. Addressing doctors’ beliefs is particularly important given the leadership roles that doctors play in healthcare settings. [ABSTRACT FROM AUTHOR]

Objective Coronary artery disease (CAD) in the general population is characterized by an increased frequency of particular susceptibility single-nucleotide polymorphisms (SNPs). Because the frequency of CAD is increased among patients with rheumatoid arthritis (RA), we sought to determine whether the frequency of these SNPs is increased in RA patients with CAD, hypothesizing that RA could enhance CAD risk by acting through established genetic pathways predisposing to CAD. Methods Coronary artery calcification (CAC) as detected by computed tomography was used as a measure of CAD in 561 patients with RA. One hundred SNPs associated with CAD in the general population were genotyped or imputed, and their relationship to CAC was established through multiple regression analysis for individual SNPs and a genetic risk score representing their cumulative effect. Results Ninety-one CAD-related SNPs were genotyped successfully; of these, 81 exhibited no association with CAC (Agatston units) or different CAC categorizations, either individually or collectively, in the genetic risk score. Only rs579459 ( ABO) and rs17676451 ( HAL) had a consistent positive association between genotype and CAC, with a significant increase in the frequency of the effect allele in both homozygous and heterozygous genotype distributions. Five were variably negatively associated. Furthermore, a positive association between the Disease Activity Score in 28 joints and CAC was observed, and after adjustment for traditional cardiovascular risk factors, it was not modified by correcting for the CAD-related SNP genetic risk score. Conclusion The increased risk of CAC in patients with RA does not appear to operate primarily through established genetically regulated atherogenic mechanisms that are preponderant in the general population. [ABSTRACT FROM AUTHOR]

Background: Findings on the relation between fruit consumption and the risk of type 2 diabetes mellitus (T2DM) have been inconsistent. Objectives: We examined whether the consumption of total, temperate, subtropical, and tropical fruit is associated with T2DM risk and whether differences in the carbohydrate quality of fruit influence T2DM risk in Asians. Design: We included 45,411 participants in the Singapore Chinese Health Study who were 45-74 y old and had no diabetes, cancer, or cardiovascular disease at recruitment (1993-1998). Fruit intake was assessed with the use of a validated food-frequency questionnaire. Physician-diagnosed incident T2DM cases were reported at followup 1 (1999-2004) and follow-up 2 (2006-2010) interviews. Cox proportional hazards regression was used to estimate HRs and 95% CIs of diabetes risk. Results: In 494,741 person-years of follow-up, 5207 participants developed T2DM. After adjustment for lifestyle and dietary risk factors, high total fruit consumption was not consistently associated with lower T2DM risk [men: HR of 1.33 (95% CI: 1.04, 1.71) for ≥3 servings/d compared with <1 serving/wk (P-trend = 0.17); women: HR of 0.88 (95% CI: 0.71, 1.11) (P-trend = 0.008); P-interaction = 0.003]. The direct association in men was observed for higher-glycemic index (GI) fruit [HR: 1.51 (95% CI: 1.22, 1.86) for ≥1 serving/d compared with rarely consumed; P-trend = 0.001] but not for lower or moderate GI fruit. In women, the consumption of temperate fruit, but not of subtropical or tropical fruit, was associated with lower T2DM risk [HR: 0.79 (95% CI: 0.67, 0.92) for ≥1 serving/d compared with rarely; P-trend = 0.006]. Conclusions: The consumption of temperate fruit, such as apples, was associated with a lower risk of T2DM in women, whereas the consumption of higher-GI fruit, such as bananas, was associated with higher risk in men. The impact of fruit consumption on the risk of diabetes may differ by the type of fruit, which may reflect differences in the glycemic impact or phytochemical content. [ABSTRACT FROM AUTHOR]

Background: Despite increasing levels of education and income in the Swiss population over time and greater food diversity due to globalization, adherence to dietary guidelines has remained persistently low. This may be because of barriers to healthy eating hampering adherence, but whether these barriers have evolved in prevalence over time has never been assessed, to our knowledge. Objective: We assessed 15-y trends in the prevalence of selfreported barriers to healthy eating in Switzerland overall and according to sex, age, education, and income. Design: We used data from 4 national Swiss Health Surveys conducted between 1997 and 2012 (52,238 participants aged ≥18 y, 55% women), applying multivariable-adjusted logistic regression models to assess trends in prevalence of 6 barriers to healthy eating (taste, price, daily habits, time, lack of willpower, and limited options). Results: The prevalence of 3 barriers exhibited an increasing trend until 2007, followed by a decrease in 2012 (from 44% in 1997 to 50% in 2007 and then to 44% in 2012 for taste, from 40% to 52% and then to 39% for price, and from 29% to 34% and then to 32% for time; quadratic P-trend < 0.0001). Limited options decreased slightly until 2007 (35-33%) and then sharply by 2012 (18%) (linear P-trend < 0.0001). Daily habits remained relatively stable across time from 42% in 1997 to 38% in 2012 (linear P-trend < 0.0001). Conversely, lack of willpower decreased steadily over time from 26% in 1997 to 21% in 2012 (linear P-trend < 0.0001). Trends were similar for all barriers irrespective of sex, age, education, and income. Conclusion: Between 1997 and 2012, barriers to healthy eating remained highly prevalent (≥20%) in the Swiss population and evolved similarly irrespective of age, sex, education, and income. [ABSTRACT FROM AUTHOR]

Background: Although dietary flavonoid intake has been associated with less weight gain, there are limited data on its impact on fat mass, and to our knowledge, the contribution of genetic factors to this relation has not previously been assessed. Objective: We examined the associations between flavonoid intakes and fat mass. Design: In a study of 2734 healthy, female twins aged 18-83 y from the TwinsUK registry, intakes of total flavonoids and 7 subclasses (flavanones, anthocyanins, flavan-3-ols, flavonols, flavones, polymers, and proanthocyanidins) were calculated with the use of food-frequency questionnaires. Measures of dual-energy X-ray absorptiometry-derived fat mass included the limb-to-trunk fat mass ratio (FMR), fat mass index, and central fat mass index. Results: In cross-sectional multivariable analyses, higher intake of anthocyanins, flavonols, and proanthocyanidins were associated with a lower FMR with mean ± SE differences between extreme quintiles of 20.036 0.02 (P-trend = 0.02),20.03 ± 0.02 (P-trend = 0.03), and 20.05 ± 0.02 (P-trend < 0.01), respectively. These associations were not markedly changed after further adjustment for fiber and total fruit and vegetable intakes. In monozygotic, intakediscordant twin pairs, twins with higher intakes of flavan-3-ols (n = 154, P = 0.03), flavonols (n = 173, P = 0.03), and proanthocyanidins (n = 172, P < 0.01) had a significantly lower FMR than that of their co-twins with within-pair differences of 3-4%. Furthermore, in confirmatory food-based analyses, twins with higher intakes of flavonolrich foods (onions, tea, and pears; P = 0.01) and proanthocyanidin-rich foods (apples and cocoa drinks; P = 0.04) and, in younger participants (aged <50 y) only, of anthocyanin-rich foods (berries, pears, grapes, and wine; P = 0.01) had a 3-9% lower FMR than that of their co-twins. Conclusions: These data suggest that higher habitual intake of a number of flavonoids, including anthocyanins, flavan-3-ols, flavonols, and proanthocyanidins, are associated with lower fat mass independent of shared genetic and common environmental factors. Intervention trials are needed to further examine the effect of flavonoid-rich foods on body composition. [ABSTRACT FROM AUTHOR]