Search

Background: Reflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose laryngopharyngeal reflux disease(LPRD). However many patients do visit the outpatient department with minimal symptoms not sufficient to fit the criteria described by Belafsky et al. for diagnosing LPRD. Most of these patients are provisionally diagnosed and treated for LPRD. Reflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose(LPRD) (Belafsky PC et al., J Voice 16(2):274–7, 2002, Belafsky PC et al, Laryngoscope 111(8):1313–7, 2001). RSI has nine questions that the patient must grade from 0 to 5. An abnormal score is greater than 13. Laryngopharyngeal reflux (LPR) may or may not be diagnosed using the RSI and RFS especially when patients present with minimum symptoms not sufficient to score more than 13 and 7 respectively. These patients may miss the diagnosis and have to be treated empirically. Pepsin's presence in the saliva is indicative of reflux as pepsin is a gastric enzyme (NICE advice on Peptest for diagnosing gastro-oesophageal reflux, 2015, Wood JM et al., J Laryngol Otol 125(12):1218–24, 2011). Patients with minimum symptoms may be missed if diagnosis relies only on RSI AND RFS. The present study aims to see the correlation of pepsin-proven LPRD and RSI and RFS. Methods: This is a prospective study, 49 patients with symptoms suggestive of LPRD who tested positive for the pepsin test were further analysed for RSI and RFS. A cut-off value of > 25 ng/mL was considered diagnostic of LPRD (Dhillon VK et al., Curr Gastroenterol Rep 18(8):44, 2016). Result: The average RSI and RFS were respectively 10 and 4. The mean age of the patients in the study was 39 years and the mean weight was 60 kg. The association between RSI and PEPSIN detection is considered to be not statistically significant. Chi-squared equals 0.086 with 1 degree of freedom. The two-tailed P value equals 0.7698. Chi-squared equals 0.233 with 1 degree of freedom. The two-tailed P value equals 0.6295. The association between RFS and PEPSIN detection is considered to be not statistically significant. In terms of correlation analysis, neither the RSI nor the RFS had Pearson's correlation coefficient that was statistically significant. Conclusion: Since salivary pepsin detection and the RSI do not have any significant correlation, the RSI is not a valid diagnostic method for LPR and should not be used exclusively. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

The supplementary motor area (SMA) is involved in the functional deficits of chronic ankle instability (CAI), but the structural basis of its abnormalities remains unclear. To determine the differences in volume- and surface-based morphologic features of the SMA between patients with CAI and healthy controls and the relationship between these features and the clinical features of CAI. Cross-sectional study. Sports medicine laboratory. A total of 32 patients with CAI (10 women, 22 men; age = 32.46 ± 7.51 years) and 31 healthy controls (12 women, 19 men; age = 29.70 ± 8.07 years) participated. We performed T1-weighted structural magnetic resonance imaging of participants and calculated volume- and surface-based morphologic features of SMA subregions. These subregions included anterior and posterior subdivisions of the medial portion of Brodmann area 6 (6 ma and 6 mp, respectively) and supplementary and cingulate eye fields. Between-group comparisons and correlation analysis with clinical features of CAI were performed. Moderately thinner 6 mp (motor-output site; Cohen d = −0.61; 95% CI = −1.11, −0.10; P =.02) and moderately plainer 6 ma (motor-planning site; Cohen d = −0.70; 95% CI = −1.20, −0.19; P =.01) were observed in the CAI than the control group. A thinner 6 mp was correlated with lower Foot and Ankle Ability Measure Activities of Daily Living subscale scores before (r = 0.400, P =.02) and after (r = 0.449, P =.01) controlling for covariates. Patients with CAI had a thinner 6 mp and a plainer 6 ma in the SMA compared with controls. The thin motor-output site of the SMA was associated with ankle dysfunction in patients. This morphologic evidence of maladaptive neuroplasticity in the SMA might promote more targeted rehabilitation of CAI. [ABSTRACT FROM AUTHOR]

Background: Diabetes complications are prevalent in people with diabetes, causing considerable individual suffering and increased health costs. However, the relationships of multidimensional, modifiable, and nonmodifiable factors to diabetes complications and the role of diabetes distress have been rarely examined. Objective: The aims of this study were to examine the associations of age, sex, knowledge, self-efficacy, self-compassion, resilience, self-esteem, depressive symptoms, diabetes distress, social support, and body mass index with diabetes complications and to investigate the mediating role of diabetes distress. Methods: In this cross-sectional, correlational study, data on all study variables were collected from 148 people with diabetes through REDCap in 2023. Multiple regression analysis and the PROCESS macro for SPSS were used to address the aims. Results: Older age and higher levels of diabetes distress were associated with more diabetes complications. Depressive symptoms were associated with diabetes distress; and diabetes distress, but not depressive symptoms, was associated with diabetes complications, controlling for all other variables. Conclusions: Depressive symptoms and diabetes distress were directly or indirectly associated with diabetes complications, and diabetes distress was a mediator in the relationship between depressive symptoms and diabetes complications. Health care providers can target reduction of depressive symptoms and diabetes distress to reduce diabetes complications. [ABSTRACT FROM AUTHOR]

Background: Frailty is a multidimensional geriatric syndrome associated with physical, psychological and social changes. There is a paucity of research on frailty in Sub‐Saharan African (SSA) countries, especially Ethiopia. Objectives: To assess the initial correlations among frailty, nutritional status, depression and QOL (quality of life) in a group of older people in Ethiopia who are later enrolled in a study examining the effects of a nurse‐led community intervention on frailty and related health outcomes. Methods: Data from 68 community‐dwelling individuals 60 years of age, or over, were collected. Frailty was measured using the Amharic version of the Tilburg Frailty Indicator. The statistical analysis included Spearman's rank correlation coefficient for degrees of association, Mann–Whitney U‐test for variables with two categories and Kruskal–Wallis for variables with three or more categories. Results: The mean frailty score for participants was 7.3 (±1.9). Participants with higher frailty scores had lower nutritional status (rs = −0.46, p < 0.01). There was a statistically significant relationship (positive) between frailty scores and depression (rs = 0.39, p < 0.01). Depressed (Md = 9, n = 23) and non‐depressed frail older people (Md = 7, n = 45) showed a significant difference in their overall frailty score, U = 330.50, z = −2.49, p = 0.01, r = 0.30. There was an inverse significant association between the level of frailty across different domains in the QOL: physical (rs = −0.44, p < 0.01), psychological (rs = −0.45, p < 0.01), social relations (rs = −0.29, p < 0.05) and environmental (rs = −0.47, p < 0.01). Conclusion: The findings from this study were consistent with those from across middle‐income and high‐income countries. Implications for Practice: This research indicates that older people living in communities who are identified as frail often suffer from a poor nutritional status, depression and reduced QOL. It suggests that healthcare professionals in Sub‐Saharan countries would benefit from recognising the frailty in this population, and developing interventions aimed at enhancing nutrition, mental health and overall well‐being. [ABSTRACT FROM AUTHOR]

Dolutegravir, an integrase strand inhibitor, has been linked to an increase in body mass index among adults. However, little is known about its effect on adolescents. The study assessed the effect of a dolutegravir-based regimen on adolescents' body weight and emphasized the gender-specific differences in weight gain, if any. This prospective cohort study was conducted among 182 treatment-experienced adolescents living with HIV at a tertiary hospital in Southeast Nigeria. The body mass index measurements were calculated before transitioning to dolutegravir and after six months of being on the dolutegravir regimen. A comparison of the difference in mean body mass index before and after dolutegravir-based therapy was determined using a paired t-test. At the end of the six-month follow-up, there was a significant increase in the respondents' overall body mass index z-score (t = −10.00, p < 0.001). There was a significant increase in the body mass index z-score of both genders (male; t = −7.49, p < 0.001, female; t = −6.91, p < 0.001). The dolutegravir-based therapy (β-coefficient = −0.17, t = − 2.09, p < 0.001) and baseline body mass index z-score (β-coefficient = 0.76, t = 15.86, p < 0.001) were significant predictors of body mass index z-score at six months. In adolescents living with HIV, the transition to dolutegravir is associated with increased body weight. Female adolescents tend to gain more weight compared to males. Therefore, there is a need for regular monitoring of body weight for early detection of obesity and prompt intervention. [ABSTRACT FROM AUTHOR]

Background: Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. Methods: Individuals with PTSD (n = 27), trauma-exposed individuals without PTSD (n = 27), and individuals without trauma exposure (n = 26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. Results: We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N -acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. Conclusion: In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo. [ABSTRACT FROM AUTHOR]

Aim: Digital platforms such as YouTube are popular sources of health-related information. Although there are studies evaluating the quality of different online medical content, studies focusing on the quality of dementia-related content are limited. This study aimed to investigate the quality of YouTube videos related to dementia patient care. Material and Methods: Using the term "Dementia care" on the YouTube platform, 100 English videos that met the inclusion criteria were identified and analyzed. In addition to video popularity measurements, to evaluate content quality, the global quality scale (GQS), modified DISCERN scale, Journal of the American Medical Association (JAMA) quality scale, and the patient education materials assessment tool for audio/visual materials (PEMAT-A/V) are used. Results: It was observed that most of the videos were uploaded by non-academic health institutions (36%) and health professionals (23%). When the content of the videos was evaluated, it was determined that general care strategies were the most common content with 52%. Scores indicating high levels of reliability and accuracy were determined on all applied content quality scales. Videos sourced from academic healthcare institutions were found to have the highest scores on content quality scales. In correlation analyses, video metrics such as duration, view ratio, number of comments, and video power index values were positively correlated with content quality scores. Conclusion: Videos about dementia patient care on YouTube generally exhibit high popularity and content quality. Individuals seeking information about dementia care on online platforms should be directed to videos uploaded by healthcare institutions. [ABSTRACT FROM AUTHOR]

Introduction: People with Parkinson's Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear. Methods: We analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson's Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods. Results: Freezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior-posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047). Conclusion: APA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk. [ABSTRACT FROM AUTHOR]

Background & Objective: The viruses are considered as one of the most prevalent factors that cause infertility because they represent a significant role in sexual transmission disease. The purpose of this study was to evaluate the correlations between viruses (HSV) viral load and semen parameters in groups of fertile and infertile Iraqi men. Materials & Methods: This study comprised fifty infertile males and fifty fertile healthy males. Seminal fluid analysis was conducted on all participants to detect the presence of HSV using the HSV1, 2 quantification kits. Results: There was a high significant correlation between sperm concentration and percentage of rapid linear progression motility (r= 0.478**) of infertile men. A strong meaningful connection was seen between the percentage of sperm concentration and both the percentage of sluggish linear or nonlinear motility (r = 0.681**) and the percentage of non-progressive motility (r = 0.604**). There was a strong negative connection (r = -0.725**) between the concentration of sperm and the number of immotile spermatozoa. On the others hand, there was a high significant correlation between rapid linear progression and slow linear or nonlinear (r =0 .413**) non-progressive motility (r = 0.704**) respectively, and high negative significant between rapid linear progression and immotile spermatozoa. The correlation between slow linear or nonlinear and non-progressive motility was highly significant (r= 0.555**) and negative significant between slow linear or nonlinear and immotile spermatozoa. Finally, A strong negative correlation (-0.813**) was observed between non-progressive motility and immotile spermatozoa. Conclusion: The study found that HSV infection had an effect on semen parameters and will cause male infertility. [ABSTRACT FROM AUTHOR]

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

Background: 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]

Context: Weight-bearing test (WBT) is a noninvasive quantitative test which has been used recently to determine loading capability of the individuals. The aim of this study was to strengthen the evidence for using the WBT test for measuring weight-bearing capacity of the upper-extremity with the specific objective of examining the internal and external responsiveness and concurrent validity of the test in patients with triangular fibrocartilage complex injury. Design: Single-group repeated measures. Methods: Internal responsiveness was assessed using effect size statistics. The correlation coefficient was used to examine external responsiveness by testing 5 hypotheses regarding predefined correlations between the changes in the measurements. Concurrent validity was evaluated by analyzing correlations between the WBT and other measurements. Thirty-one patients with triangular fibrocartilage complex injury were included for the analysis of the concurrent validity. Eighteen patients who completed all measurements at baseline and at 3-month follow-up enrolled for the responsiveness analysis. Measurements included the WBT, pain intensity, grip strength, and upper extremity functional level. Results: The WBT test was able to detect statistically significant changes in weight-bearing capacity between baseline and follow-up (P = .0001). The effect (size of the WBT was large. Three out of 5 hypotheses (60%) were confirmed, a good correlation was found between changes scores of the WBT and grip strength (r = .478; P < .05). There were significant correlations between the WBT and other measurements (r value range from -.401 to .742; P < .05). A higher con-elation was found between the WBT and grip strength (r = .742; P = .0001). Conclusions: The responsiveness and concurrent validity of the WBT test confirmed that it is able to measure change in weight-bearing capacity in patients with triangular fibrocartilage complex injury. [ABSTRACT FROM AUTHOR]

Reports have highlighted the role of supportive work environments in several nurse outcome measures, indicating a need for effective leadership styles that improve the nurse working environment. Authentic leadership is a relatively new concept in Arab work culture. The purpose of this study was to examine the relationship between authentic leadership demonstrated by nurse managers and work engagement among Jordanian registered nurses. A cross-sectional correlational design was employed. A sample of 238 registered nurses working in a public hospital in Jordan was collected. Data collection was performed by using the staff demographics questionnaire, the authentic leadership questionnaire (ALQ), and the Utrecht Work Engagement Scale (UWES)-17 items. Descriptive statistics, independent samples t-tests, one-way ANOVA, Pearson correlation, and hierarchical multiple regression analysis were employed to analyze the data. The results showed a statistically significant positive correlation between authentic leadership and work engagement in the hierarchical regression analysis (B = 0.34, t = 5.54, p < 0.001). After controlling demographic variables, authentic leadership accounted for 11% of the additional variance above and beyond the 5% accounted for age, educational level, and work experience (change of R 2 = 0.11, p < 0.01). Nurses whose managers demonstrate higher levels of authentic leadership report more work engagement (r = 0.37, p < 0.001). Considering the role of authentic leadership in promoting nurses' work engagement, it would be beneficial to develop authentic leadership behaviors for nurse managers. [ABSTRACT FROM AUTHOR]

The research aimed to find the relationship between Internet Vigilance, emotional creativity, and self-sufficiency. The current research sample consisted of (898) male and female students at Damietta University in the faculties of (Specific Education - Education - Physical Education - Applied Arts - Commerce - Science - Engineering - Literature – Computers and information) in the first and fourth academic year, with an average age of 20.09 and a standard deviation of 2.56 in the first university semester of the academic year 2022/2023. With the aim of revealing their levels in the Internet Vigilance variable, the level of the emotional creativity and self-efficacy variables, and the extent of the differences between them due to gender, academic stage, and specialization, and the nature of the relationship between each of the electronic alertness variable, the emotional creativity variable, and self-efficacy among male and female university students. Damietta, in the colleges of (Specific Education - Education - Physical Education - Applied Arts - Commerce - Science - Engineering - Literature - Computers and Information), Regarding the extent to which it is possible to predict each of the variables of emotional creativity and self-efficacy through the dimensions of the Internet Vigilance variable, the researcher here relied on two tools to measure the variable dimensions of Internet Vigilance, the (Reince et al., 2018) scale to measure the trait, and the (Johannes et al., 2020) scale to measure the situation, as the researcher Arabized it, codified it, and verified the extent of its psychometric properties, and two tools to measure the variables of emotional creativity and self-efficacy among male and female students at Damietta University in the faculties of (Specific Education - Education - Physical Education - Applied Arts - Commerce - Sciences - Engineering - Literature - Computers and Information) prepared by the researcher. To identify the results of the research, the following statistical treatments were used: T-test for independent samples, Cronbach's Alpha test, One-Way ANOVA, frequencies, arithmetic means, standard deviations, and correlation analysis. Pearson correlation coefficients, multiple regression analysis, and the bootstrap method to test confidence interval (CI) estimates, using version 23.0 of the statistical program SPSS. The research showed several results, the most important of which are: the existence of a significant correlation between Internet Vigilance and emotional creativity, and that the Internet Vigilance variable predicted emotional creativity, while The results related to self-efficacy showed its mediation in the relationship between each of the variables (Internet Vigilance and emotional creativity).The results also showed that the effect of self-efficacy on Internet Vigilance among university students varies according to the students’ academic stage. The results also showed that there are statistically significant differences in the relationship between self-efficacy and emotional creativity among university students depending on the variable of type (sex), as well as specialization (scientific/ literary). [ABSTRACT FROM AUTHOR]

In Pakistan, like other developing countries, utilization of family planning methods is a serious public health concern among married women. Researchers in the study focused on utilization of family planning methods among married women and their exposure to media messages. The researchers used retrospective analysis of secondary data of 3334 married women. Our research findings reveal that married women have a very limited access to media service messages promoting utilization of family planning methods. It is discussed that women with exposure to media messages about the utilization of family planning significantly utilized birth control behavior than women who had not heard and seen any media message. The authors concluded that married women in the country particularly in rural areas have a very limited access to media messages promoting family planning which causes non-utilization of family planning methods. It is recommended that different programs and awareness messages on media should be started to promote family planning and married women's access to media programs should be ensured. [ABSTRACT FROM AUTHOR]

Background: Alexithymia is the inability to identify and describe one's own emotions. Adolescents who suffer from Restrictive Eating Disorders (REDs) show a higher prevalence of alexithymia than the general population. Methods: The study explored the correlation between levels of alexithymia in mothers, fathers, and adolescents affected by REDs and patients' ability to recognize their emotions. The study also aimed to evaluate if patients' emotional distress can significantly impact the severity of their disorder and functioning measured by the Clinical Global Impression Scale - Severity (CGI-S) and the Children's Global Assessment Scale (CGAS). We enrolled 67 families of adolescents affected by REDs. Parents and patients' levels of alexithymia were assessed through the Toronto Alexithymia Scale (TAS-20). Spearman's correlation shows a statistically significant correlation between mothers and patients' levels of alexithymia. Results: Our findings also suggest that fathers and mothers' TAS scores correlate with each other. However, there is no statistically significant relationship between the influence of the TAS scores of fathers and sons/daughters. Conclusions: In conclusion, mothers' level of alexithymia could influence both fathers and patients' difficulty in identifying and describing their own emotions. This relationship can be investigated further when considering externally oriented thinking. However, the severity of the disease and overall functioning do not appear to be affected by patients' levels of alexithymia. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID‐19, and if moral distress faced by nurses is a moderating factor. Background: Resilience can help nurses maintain their personal health during COVID‐19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear. Method: A cross‐sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor‐Davidson Resilience Scale (CD‐RISC), Moral Distress Scale‐Revised (MDS‐R), and Hospital Ethical Climate Scale (HECS). Results: Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress. Discussion: This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID‐19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate. Implications for nursing and health policy: This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate. [ABSTRACT FROM AUTHOR]

Aim: The aims of the present study are to describe the status of selfmanagement behaviors and illness perception, and explore the relationship between illness perception and self-management behaviors among Chinese diabetic foot patients. Methods: A cross-sectional study was conducted at the endocrinology department of a comprehensive tertiary hospital in Guangzhou, China. Data were collected on illness perception, self-management behaviors, and demographic and clinical characteristics over 9 months among 156 subjects. Data were analyzed using Pearson correlation analysis, univariate analysis and multiple linear regression analysis. Results: Only 3.2% of participants maintained excellent self-management behaviors. Additionally, the participants perceived diabetic foot as chronic and could be well controlled through treatment. Multiple linear regression analysis revealed that illness perception was associated with self-management behaviors. Conclusions: Patient illness perception is an important factor influencing self-management behaviors. It may be helpful to improve self-management behaviors by tailoring the content of the intervention to fit the patients' illness perceptions. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association 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: Aims: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC). Methods & Procedures: Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono‐, bi‐ and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate. Outcomes & Results: The DDK rates increased throughout childhood, but the oldest children, 9‐year‐olds in the current study, did not achieve adult‐like rates for all mono‐ and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate. Conclusions & Implications: This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills. WHAT THIS PAPER ADDS: What is already known on the subject: Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge: The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean‐speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work?: This study provided normative data of young Korean‐speaking children aged 3–9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone. [ABSTRACT FROM AUTHOR]

Introduction.: Hispanic/Latino students often underachieve in higher education programs in the health professions and have shown lower first-time pass rates on the National Physical Therapy Examination than their White peers. A plausible explanation for this difference is the lack of English proficiency. The purpose of this study was to determine predictive academic variables for passing licensure examination on the first attempt for Hispanic/Latino Doctor of Physical Therapy (DPT) students. Review of the Literature.: Numerous studies have been conducted to determine the factors that predict success on the National Physical Therapy Examination; however, there is a scarcity of literature on the predictors of success for Hispanic/Latino DPT students, particularly on the influence of English proficiency. Subjects.: A nonprobability convenience sample of 67 Hispanic students from a single DPT program was used. Methods.: A retrospective, predictive, correlational study was conducted. Data collection was performed by secondary analysis of student academic profiles. Predictor variables included proficiency in the English language; undergraduate grade point average; verbal, quantitative, and written skills; and first-year and third-year grade point average while enrolled in the physical therapist education program. Results.: The first-time pass rate was 59.7% (n = 40). Results showed that students who passed and those who did not pass on their first attempt differed in first-year and third-year program grade point average with large effect sizes of d = 1.13 and d = 1.48, respectively; however, third-year grade point average was the only significant independent predictor of success. English proficiency and preadmission variables did not predict first-time success. Discussion and Conclusion.: The results suggest first-year and third-year grade point average may be used to identify at-risk students. Use of these variables is encouraged to monitor the progression of students. The study highlighted the need to identify additional predictors of performance. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus (DM) is a main, highly prevalent, and challenging public health issue. Suboptimal self-care for type II diabetes can lead to poor glycemic control, complications, and even death. Objective: This study investigated the incidence of distress and its link with self-care habits of patients with diabetes type II. Methods: A correlational, cross-sectional design with a convenient sample of 200 patients was used to conduct this study. Three questionnaires were administered: (A) the demographic and medical data questionnaire; (B) diabetes self-care activities in brief; and (C) the diabetes distress scale in Arabic language. Results: The patients' mean age was 51.78 ± 11.34; 80% of patients practiced lower levels of diabetes self-care, and 37% of them had a high level of diabetes distress. Self-care is associated with diabetes distress (R = −0.152, p -value =.032). Conclusion: Self-care activities can help in the early detection and management of diabetes distress. Sustained self-care education is promising to minimize diabetes distress. The potential advantages of association between diabetes distress and self-care can offer self-care programs that enhance diabetes distress management. [ABSTRACT FROM AUTHOR]

Objective The role of inspiratory muscle performance in functional performance in patients with coronavirus disease 2019 (COVID-19) is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. Methods Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer, which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. Results The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] vs 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (β = 0.308; odds ratio = 1.36) at HD. Conclusion A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. Impact This study shows that inspiratory muscle training may be an important adjunct after COVID-19. [ABSTRACT FROM AUTHOR]

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

The argument for a female advantage in word list learning is often based on partial observations that focus on a single component of the task. Using a large sample (N = 4403) of individuals 13–97 years of age from the general population, we investigated whether this advantage is consistently reflected in learning, recall, and recognition and how other cognitive abilities differentially support word list learning. A robust female advantage was found in all subcomponents of the task. Semantic clustering mediated the effects of short-term and working memory on long-delayed recall and recognition, and serial clustering on short-delayed recall. These indirect effects were moderated by sex, with men benefiting more from reliance on each clustering strategy than women. Auditory attention span mediated the effect of pattern separation on true positives in word recognition, and this effect was stronger in men than in women. Men had better short-term and working memory scores, but lower auditory attention span and were more vulnerable to interference both in delayed recall and recognition. Thus, our data suggest that auditory attention span and interference control (inhibition), rather than short-term or working memory scores, semantic and/or serial clustering on their own, underlie better performance on word list learning in women. [ABSTRACT FROM AUTHOR]

Background Intrinsic foot muscle (IFM) weakness can result in reduced foot function, making it crucial for clinicians to track IFM strength changes accurately. However, assessing IFM strength can be challenging for clinicians, as there is no clinically applicable direct measure of IFM strength that has been shown to be reliable and valid with the foot on the ground. Purpose The purpose was to investigate the intra-rater and inter-rater reliability of a novel, budget-friendly IFM dynamometer and determine its agreement with a handheld dynamometer (HHD). The researchers also examined correlations of foot morphology and activity level to IFM strength. Study design Descriptive Laboratory Study Methods Two assessors measured IFM strength of 34 healthy volunteers (4 male, 30 female; age=21.14±2.57, height=164.66 ±7.62 cm, mass=64.45±11.93 kg) on two occasions 6.62±0.78 days apart with the novel dynamometer to assess intra- and inter-rater reliability. The HHD was used to measure IFM in the first session in order to assess validity. Results For the novel dynamometer, intra- and inter-rater reliability was moderate-to-excellent (ICC = 0.73 - 0.95), and the majority of the strength tests were within the 95% limits of agreement with the HHD. Wider foot morphology and a higher number of days walking over the prior seven days had small but significant correlations with IFM strength (dominant foot r = 0.34, non-dominant foot r = 0.39; r = -0.33, -0.39 respectively). Conclusion This novel IFM dynamometer is a budget-friendly ($75) tool that was shown to be reliable and valid in a healthy population. Levels of evidence Level 3 [ABSTRACT FROM AUTHOR]

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

Background: Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue. Objectives: This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU. Methods: The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline. Results: The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7. Conclusions: Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care. [ABSTRACT FROM AUTHOR]

Despite several strategies in place in South Africa and globally to prevent maternal mortality and morbidity, maternal deaths remain high, especially in sub-Saharan Africa and lower to middle-income countries. The aim of the study was to identify the challenges that lead to pregnant women's delays in seeking antenatal care (ANC) early and to find strategies to prevent such delays, contributing to a reduction of maternal deaths in South Africa. The study was conducted in two phases. Phase one analysed data on maternal deaths collected by the District Health Information System (DHIS) of the KwaZulu-Natal Department of Health from all 11 districts over a 10-year period (2009-2019). The data on maternal deaths revealed that there was a very high maternal mortality rate; between 800 and 1 780 per 100 000 live births. This correlated with very low antenatal visits; between 695-895 per 100 000 live births. In phase two, a literature review was conducted using several computer-assisted databases, bibliographies and websites to identify and source current policies. The literature review presents causes of delay in seeking ANC and strategies to prevent maternal deaths. Recommendations were made to consider strengthening education and awareness related to family planning; women empowerment through community health programmes and change in healthcare providers' behaviours and attitudes; ensuring availability of maternal health resources; and developing strategies to ensure that the ANC services delivered are in line with the South African Department of Health Guidelines. [ABSTRACT FROM AUTHOR]

The Intelligibility in Context Scale (ICS) is a parent-report screening tool used to measure parents' perceptions of children's functional intelligibility. This tool has been translated into over 60 languages and found to have a good reliability and validity. The purpose of the current study was to translate the ICS into Sinhala (the ICS-SIN), the main language spoken by the Sinhalese people in Sri Lanka, and to validate it with both typically developing (TD) children and children with repaired cleft lip and/or palate (CLP). The translation process followed the forward-backward-forward method. A total of 88 parents of TD children and children with CLP aged 12–15 years old (TD n = 50, CLP n = 38) completed the ICS-SIN questionnaire. Parents of TD and CLP children reported their children's speech as most intelligible to parents and least intelligible to strangers. The ICS-SIN had high internal consistency for both groups (TD α = 0.87, p < 0.05, CLP α = 0.97, p < 0.05). The ICS-SIN total scores and item scores showed significant correlations, indicating a good construct validity. TD participant group's ICS-SIN average mean scores (M = 4.88, SD = 0.29) were significantly higher compared to the CLP ICS-SIN average mean scores (M = 4.64, SD = 0.67) and varied according to gender in both groups, suggesting good discriminant validity. The ICS-SIN has overall good psychometric properties. Therefore, this tool has the potential to be used as a valid parent-rating screening tool for clinical and research purposes in Sri Lanka. [ABSTRACT FROM AUTHOR]

Trauma anesthesia care can be among the most challenging situations anesthesia providers may encounter. The challenges encountered are helped by providing anesthesia providers on forward-deployed surgical teams with the best equipment available that meets the limitations of light weight, easily movable, and not reliant on electrical supply. This study assesses three questions derived out of the recent formation and equipping of the U.S. Army's Forward Resuscitative and Surgical Detachment. The highly advanced field transport ventilator, the Hamilton-T1 is being used by the detachments' anesthetists with the Universal Portable Anesthesia, Complete (UPAC) draw-over vaporizer. However, no literature supports best use practices regarding use in a push- or pull-through configuration, adding supplemental oxygen, and the impact on the ventilator from contamination with inhaled anesthetics. Utilizing a human patient simulator, these questions were examined in a quasiexperimental and descriptive manner, using the Hamilton-T1 and UPAC vaporizer in multiple configurations. The findings support the efficacy of both push- and pull-through configurations, offer options for the most efficacious use of oxygen, and appear to show no adverse effects from anesthetic vapor entering the ventilator's compression mechanism. [ABSTRACT FROM AUTHOR]

Aim: Little is known about attitudes toward advance directives and factors associated with them among emergency and palliative care nurses who often or daily face end‐of‐life circumstances. Thus, we aimed to compare the levels of attitudes toward advance directives, communication skills, knowledge about end‐of‐life care (knowledge), and awareness of the concept of a good death (good death awareness) between emergency and palliative care nurses, and to examine factors associated with attitudes toward advance directives in the total sample. Methods: In this cross‐sectional, correlational study, data were collected from 153 nurses (59 emergency and 94 palliative care nurses) at three tertiary hospitals using online or offline surveys and were analyzed using t‐tests and multiple linear regression analysis. Results: The levels of attitudes, communication skills, knowledge, and good death awareness were moderate in both groups. Attitudes in emergency compared to palliative care nurses were less positive (46.78 vs. 48.38; p =.044), and knowledge was significantly lower (13.64 vs. 15.00; p =.004). Communication skills and good death awareness between the two groups were similar. In the total sample, emergency practice (B = –1.59, p =.024), and lower levels of good death awareness (B = 0.30, p <.001), communication skills (B = 0.18, p =.001), and education (B = –2.84, p =.015) were associated with less positive attitudes (F = 9.52, p <.001; R2 = 0.35). Conclusions: The findings demonstrate the need for improvements in attitudes, knowledge, communication skills, and good death awareness in both groups, especially emergency nurses. Two modifiable targets of interventions to improve nurses' attitudes were also noted. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impact of in situ simulation (ISS) with scripting on nursing staff's knowledge and confidence to initiate rapid response teams (RRTs) immediately after identifying patient condition deterioration. Background/Significance: Failure to rescue (FTR) related to delays in activation of RRT is on the rise, leading to poor patient outcomes. Lack of confidence, knowledge, and empowerment are associated with delayed activation of RRTs. As such, the nursing staff's confidence is integral in activating RRTs and FTR prevention. In situ simulation may help nurses increase their confidence, thus empowering timely RRT initiation. Methods: This quantitative pretest-posttest study used a convenience sample of nurses and nursing assistants. First, participants completed the Rapid Response Team Survey (RRTS) pretest. Then, they participated in the ISS scenario. Lastly, they completed debriefing and the RRTS posttest. Results: Pearson's correlation results showed no significant relationships between the variables. Dependent t-test results showed statistically significant increases between the pretest and posttest means (Part l, t = -5.51, p < .001, MD = 1.32; Part 2, t = -1.04, p < .01, MD = 3.1). These results suggest that ISS with scripting increased participants' knowledge and confidence in early activation of RRTs. Additionally, staff reported feeling more confident and empowered regarding future RRT decision-making and communication with other healthcare colleagues. Discussion: Early activation of RRTs prevents FTR. The results of this study suggest ISS with scripting increases staff's knowledge, confidence, and empowerment to activate RRTs. We recommend that hospital organizations adopt ISS with scripting to empower nurses to activate RRTs to prevent FTR. [ABSTRACT FROM AUTHOR]

PURPOSE Patients' values and priorities in their lives should be appreciated from an early phase of incurable diseases such as advanced cancer. However, studies examining these characteristics have been lacking. This study attempted to determine what patients with advanced lung cancer valued most, once they had been diagnosed, and any associated factors. METHODS Patients with newly diagnosed advanced lung cancer (N = 248) were enrolled in a questionnaire survey conducted at 16 hospitals in Japan. Their priorities were assessed using a free-text response to the question what is the most important thing to you now? at the time of diagnosis and 3 months after diagnosis. The free-text responses were classified into 10 categories for quantification. The clinical characteristics associated with the category describing daily life were further examined. RESULTS Free-text comments were obtained from 103 (44.0%) and 66 (42.6%) patients at the time of diagnosis and at 3 months, respectively. Themost frequent categories were family (at diagnosis: 50.5%; at 3months: 50.0%) and daily life (at diagnosis: 33.0%; at 3 months: 36.4%), followed by health (at diagnosis: 32.0%; at 3 months: 27.3%) at both time points. The patients mentioning daily life, the issues related to how to spend daily life, showed significantly higher total scores and functional well-being subscale scores on the Functional Assessment of Cancer Therapy-Lung scale at both time points and lower depression scores at diagnosis and lower anxiety scores at 3 months on the Hospital Anxiety and Depression Scale. CONCLUSION Family and daily life were highly valued by patients with advanced lung cancer at diagnosis. A better quality of life and better mood were associated with mentioning daily life, which should be taken into account in care planning to maintain patients' involvement in daily life even with incurable diseases. [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]

A simulation study was conducted to investigate the heuristics of the SIBTEST procedure and how it compares with ETS classification guidelines used with the Mantel–Haenszel procedure. Prior heuristics have been used for nearly 25 years, but they are based on a simulation study that was restricted due to computer limitations and that modeled item parameters from estimates of ACT and ASVAB tests from 1987 and 1984, respectively. Further, suggested heuristics for data fitting a two-parameter logistic model (2PL) have essentially went unused since their original presentation. This simulation study incorporates a wide range of data conditions to recommend heuristics for both 2PL and three-parameter logistic (3PL) data that correspond with ETS's Mantel–Haenszel heuristics. Levels of agreement between the new SIBTEST heuristics and Mantel–Haenszel heuristics were similar for 2PL data and higher than prior SIBTEST heuristics for 3PL data. The new recommendations provide higher true-positive rates for 2PL data. Conversely, they displayed decreased true-positive rates for 3PL data. False-positive rates, overall, remained below the level of significance for the new heuristics. Unequal group sizes resulted in slightly larger false-positive rates than balanced designs for both prior and new SIBTEST heuristics, with rates less than alpha levels for equal ability distributions and unbalanced designs versus false-positive rates slightly higher than alpha with unequal ability distributions and unbalanced designs. [ABSTRACT FROM AUTHOR]

PURPOSE End-of-life care for women with ovarian cancer is persistently aggressive, but factors associated with overuse are not well understood. We evaluated physician-level variation in receipt of aggressive end-of-life care and examined physician-level factors contributing to this variation in the SEER-Medicare data set. METHODS Medicare beneficiaries with ovarian cancer who died between 2000 and 2016 were included if they were diagnosed after age 66 years, had complete Medicare coverage between diagnosis and death, and had outpatient physician evaluation and management for their ovarian cancer. Using multilevel logistic regression, we examined physician variation in no hospice enrollment, late hospice enrollment (# 3 days), . 1 emergency department visit, an intensive care unit stay, terminal hospitalization, . 1 hospitalization, receiving a lifeextending or invasive procedure, and chemotherapy (in the last 2 weeks). RESULTS In this sample of 6,288 women, 51% of women received at least one form of aggressive end-of-life care. Most common were no hospice enrollment (28.9%), an intensive care unit stay (18.6%), and receipt of an invasive procedure (20.7%). For not enrolling in hospice, 9.9% of variation was accounted for by physician clustering (P, .01). Chemotherapy had the highest physician variation (12.4%), with no meaningful portion of the variation explained by physician specialty, volume, region, or patient characteristics. CONCLUSION In this study, a meaningful amount of variation in aggressive end-of-life care among women dying of ovarian cancer was at the physician level, suggesting that efforts to improve the quality of this care should include interventions aimed at physician practices and decision making in end-of-life care. [ABSTRACT FROM AUTHOR]

Survivors of interpersonal violence are at increased risk of negative mental health outcomes; however, scant research has explored the relationship between violence exposure and mental health symptoms among formerly incarcerated individuals. This cross-sectional survey study investigates the demographic characteristics and mental health symptoms (i.e., psychological distress and suicidal ideation) associated with interpersonal violence exposure, including physical and sexual intimate partner violence, non-partner sexual violence, and sexual violence perpetrated by prison employees in a sample of formerly incarcerated men and women, with the aim that the findings both deepen the understanding of the effects of sexual violence exposure and help inform prison and jail policies. Surveys were administered to English-speaking adults ages 18 and older to recruit a sample of adults who were formerly incarcerated (N = 201). Questions on the survey included questions regarding demographic details, sexual violence exposure, mental health symptoms, and time incarcerated. Findings show that higher levels of sexual violence exposure were significantly associated with higher levels of psychological distress and reporting of suicidal ideation. Results also suggest that higher levels of income and education and younger age were significantly associated with sexual violence perpetrated by prison employees. In addition, most forms of interpersonal violence were independently associated with psychological distress and suicidal ideation in this population. The findings make recommendations for prison and jail policies to include targeted treatment for individuals with sexual victimization histories, to mitigate the risk of revictimization and appropriately treat adverse mental health outcomes from sexual victimization within and outside the confines of incarceration. [ABSTRACT FROM AUTHOR]

Purpose: Augmentative and Alternative Communication (AAC) provides an alternative means of communication for individuals who are unable to effectively communicate using spoken language. The present study seeks to investigate the role of proximity in facilitating AAC (specifically Speech Generating Devices; SGD) use in a homogeneous population: ambulatory school-aged children with autism spectrum disorder (ASD). Method: Twelve school-age children with ASD who use an SGD as their primary mode of communication participated in the study. The percentage of time the child was within the proximity of their device was calculated over nine videotaped sessions and data logging provided information regarding device use over an 18-week period. Result: Children were in proximity to their device 65% of the time. There was a significant positive correlation between percentage of time in proximity to device and the average minutes of device use on the day video recorded. Exploratory analyses revealed that communicative abilities may be more connected to proximity than school context. Conclusion: These results support the importance of developing a program for assuring device proximity in order to encourage consistent device use in minimally verbal ambulatory school-age children with ASD. [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]

BACKGROUND: Falls among older adults are the most common cause of hospital admissions. A Matter of Balance may reduce these falls by improving balance, flexibility, gait speed, and agility. OBJECTIVE: The study aimed to measure functional reach and gait speed among adults older than 65 years following A Matter of Balance. It was hypothesized that functional reach scores would increase and gait speed scores would decrease. METHODS: This was an interventional study with the primary outcomes of functional reach (measured by the Functional Reach test) and gait speed (measured by the Timed Up and Go test). A one-tailed paired t test was used to compare pre- and postprogram functional reach mean differences. A one-tailed Wilcoxon signed-rank test was used for comparing median differences of pre- and postprogram gait speed. Characteristics of participants who improved scores were compared with those who did not improve, using two-tailed independent-samples t tests and two-tailed Pearson's χ2. Effect sizes were computed for tests significant beyond p <.05. RESULTS: Mean functional reach increased by 0.6 inches (SD = 2.21, p =.002; d = 0.2). Median gait speed decreased by 1.25 s (interquartile range = 2.39, p <.001; r =.76). Improvement was not attributable to differences of age, sex, health status, preexisting conditions, or delivery site. CONCLUSIONS: Following A Matter of Balance, functional reach and gait speed improved. Adults older than 65 years should be encouraged to participate in the program, as it may reduce their fall risk. [ABSTRACT FROM AUTHOR]

Little is known about the prevalence of young adult refugees' primary care use following resettlement in Colorado. Among a sample of Bhutanese and Burmese young adult refugees resettled in Colorado, proportions with a primary care provider (PCP), physical exam in the last 12 months, and knowledge to make an appointment were calculated across 4 years and compared within the refugee population by demographics using Pearson's Chi-Squared tests and compared to older refugees and to the general population using two-tailed tests of proportions. Greater than 70% of young adult refugees reported a physical exam in the last 12 months during the 4 years after arrival. Disparities were identified within young adult refugees by sex, marital status and country of origin. Young adult refugees were significantly different than both refugees over 55 and the general population in terms of their primary care use. Young adult refugees need support to identify PCPs earlier in resettlement and maintain primary care use years after resettlement. [ABSTRACT FROM AUTHOR]

Purpose: Speech-in-noise tests and suprathreshold auditory evoked potentials are promising biomarkers to diagnose cochlear synaptopathy (CS) in humans. This study investigated whether these biomarkers changed after recreational noise exposure. Method: The baseline auditory status of 19 normal-hearing young adults was analyzed using questionnaires, pure-tone audiometry, speech audiometry, and auditory evoked potentials. Nineteen subjects attended a music festival and completed the same tests again at Day 1, Day 3, and Day 5 after the music festival. Results: No significant relations were found between lifetime noise-exposure history and the hearing tests. Changes in biomarkers from the first session to the follow-up sessions were nonsignificant, except for speech audiometry, which showed a significant learning effect (performance improvement). Conclusions: Despite the individual variability in prefestival biomarkers, we did not observe changes related to the noise-exposure dose caused by the attended event. This can indicate the absence of noise exposure-driven CS in the study cohort, or reflect that biomarkers were not sensitive enough to detect mild CS. Future research should include a more diverse study cohort, dosimetry, and results from test-retest reliability studies to provide more insight into the relationship between recreational noise exposure and CS. Supplemental Material: https://doi.org/10.23641/asha.16821283 [ABSTRACT FROM AUTHOR]

Due to the coronavirus pandemic, online food purchases have increased. Nutrition labels and ingredients lists are important to assist individuals in making healthy food choices, but their provision is not mandatory for online stores in Hong Kong. This study aimed to investigate the prevalence of missing nutrition labels and ingredients list information on the e‐shops of major chain supermarkets in Hong Kong. Data from the e‐shops of four major chain supermarkets were collected using a bespoke web scraper program, which extracted the product page link, product name, brand, package size, ingredient list in text and product image links of every edible product available. A total of 22 365 products which were required by law to carry a food label on their packaging were included in the analysis. Prevalence of missing nutrition label or ingredients list on the respective product page was determined. Pearson's χ2 tests were used to test for differences in the prevalence between retailers. A two‐tailed p < 0.05 was considered statistically significant. Two e‐shops provided nutrition labels and ingredients list for none or only a negligible number of products. Overall, the prevalence of missing information was higher for nutrition labels than for ingredients lists (80.5% vs. 70.2%; p < 0.001). Provision of information varied greatly between stores and food categories. We found a high prevalence of missing nutrition labels and ingredients lists on e‐shops of major supermarkets in Hong Kong. Regulations on nutrition labelling should be extended to cover pre‐packaged food and beverages sold online. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) dramatically increases the risk of both substance use disorder (SUD) and suicide in veterans. Military-related trauma, however, may not be the only or most significant trauma experienced by veterans. Trauma exposure is high among those joining the military. This study sought to identify the prevalence of five types of childhood trauma (emotional, physical, and sexual abuse and emotional and physical neglect) and three adult trauma symptom clusters (intrusive thoughts, avoidance, and hyperarousal) among veterans seeking SUD treatment and to clarify the associations between types of trauma and specific symptom clusters. Veterans at three Veterans Affairs (VA) SUD treatment facilities in the Midwest completed surveys at treatment entry (n 1 = 195) and at 6-month follow-up (n 2 = 138). Measures included the Childhood Trauma Questionnaire-Short Form and the PTSD Checklist, either a military or a civilian version, depending on whether the most traumatic event occurred in or out of the military. The prevalence of childhood trauma was high, ranging from 40.5% experiencing physical abuse down to 22.8% experiencing sexual abuse. At baseline, 60.2% of the military trauma group met criteria for PTSD, compared with 33.9% of the civilian trauma group, a significant difference, χ2(1, N = 195) = 14.46, p <.01. Childhood emotional and physical abuse were moderately associated with intrusion and hyperarousal in the military trauma group, but in the civilian trauma group a broader spectrum of childhood traumas were associated with a broader array of symptom clusters, including avoidance. At follow-up, symptoms improved and were less associated with childhood trauma. These findings illuminate the persistence of effects of childhood trauma and recommend more targeted PTSD treatments. [ABSTRACT FROM AUTHOR]

Introduction. Physical therapists (PTs) from various educational and clinical backgrounds are being hired to address the faculty shortage issue. Little is known about how junior PT faculty feel about their experiences in academia. the purpose of this study was to 1) explore current demographic and self-perceived experiences of junior faculty in PT education programs across the United States, 2) compare beliefs and experiences based on the highest academic degree held and the type of faculty line held, and 3) explore the relationships between job satisfaction and experiences in academia with the likelihood to remain in academia. Full-time junior faculty employed 5 years or less at accredited PT education programs. Methods: Descriptive correlational study using a 63-item, self-report, electronic, job satisfaction survey was sent to faculty employed at 223 accredited PT education programs in the United States. Results: Two hundred twenty-four fulltime junior faculty completed the survey. Respondents with clinical degrees were more satisfied in their position and more likely to stay in academia than those with terminal academic degrees. Similarly, respondents in nontenure-track positions were more satisfied and more likely to stay in academia than those in tenure-track positions. Social support, teaching, and scholarly activity mentorship were found to contribute to job satisfaction. Also, an association was found between job satisfaction and intention to remain in academia for all cohorts (rs ≥ 0.72; P = .001). Discussion and Conclusions: Junior PT faculty who received support and mentorship were more satisfied with their jobs and more likely to remain in academia. PT education programs should consider new or expanded mentorship programs for junior faculty, regardless of academic background, to promote professional progress, positive role-modeling, and faculty retention. [ABSTRACT FROM AUTHOR]

Background The OnBaseU screen was developed to evaluate a baseball pitcher's ability to perform movement patterns key to pitching. However, due to lack of validation, it is unclear what application is ideal for this screen. Purpose To compare four OnBaseU tests to relevant pitching mechanics measured using 3D motion capture to evaluate if the OnBaseU screen can be used to assess pitching mechanics. The secondary purpose was to compare OnBaseU and 3D motion capture seated trunk rotation test results to determine the validity of the OnBaseU test. Methods OnBaseU screening and 3D motion capture pitching evaluations were completed for 103 adolescent pitchers (age = 15.2 ± 1.29 years; height = 1.80 ± 0.0866 m; weight = 76.2 ± 13.8 kg). A motion capture seated trunk rotation test was also conducted on 80 of the 103 youth players (age = 15.2 ± 1.32 years; height = 1.80 ± 0.0889 m; weight = 75.7 ± 13.9 kg). Results Stride length and OnBaseU side step walkout test data were moderately correlated, and all other comparisons were not correlated or were minorly correlated. No significant differences were found between kinematics from players who obtained different OnBaseU scores, except for stride lengths during pitching of players who scored a 1 or 3 on the OnBaseU side step walkout test (p<0.01). Further, OnBaseU and motion capture seated trunk rotation tests were not correlated (r = 0.003) and not found to be statistically associated (p = 0.83). Conclusion Results from this study indicate that the OnBaseU clinical assessment screen may not have use in assessing pitching mechanics and that visual grading criteria used in the OnBaseU seated trunk rotation test may not be accurate. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

This study examined public perceptions of sentencing severity for males convicted of domestic violence assault compared with non-domestic violence assault. Over the years, surveys have reported changes in community attitudes toward seeing domestic violence as a more serious issue and an increased understanding of what acts constitute a domestic violence offense (Carlson & Worden, 2005). This study aimed to (a) examine whether public perceptions of sentencing severity differ between domestic and non-domestic violence assault offenses committed under similar circumstances; and (b) whether these perceptions remain after adjusting for personal attitudes, victimization experiences, and sociodemographic factors. After reading vignette scenarios depicting domestic and non-domestic assault, 284 undergraduate students responded to a survey about their perceptions of appropriate sentence outcomes and length. Results found that regardless of participants' punitiveness (and other factors), the manipulation of the victim–offender relationship was a significant predictor for judgments of sentencing severity. Notably, the results highlighted a leniency effect in the perceptions of participants toward perpetrators of domestic violence when compared with those who received the non-domestic violence scenario. These findings imply that undergraduate students judge domestic violence as less serious and hence not warranting as severe sentencing as non-domestic violence assault perpetrators. The study indicates that public perceptions of sentencing severity for domestic violence perpetrators are not consistent with the reported shift in public perceptions toward seeing domestic violence as a serious public issue. These findings highlight the importance of continued community education about domestic violence as well as the need to take care when considering engaging public opinion in sentencing practices for domestic violence perpetrators. [ABSTRACT FROM AUTHOR]

Aims: To explore the codevelopment between loneliness and depression in older adults, and to identify its potential baseline individual, family and extrafamilial correlates. Background: The number of older adults around the world has steadily increased over the last decades. Later life is a particularly vulnerable life stage due to multiple unfavourable conditions, and mental health in this stage appears to become an inescapable issue. Previous research has found the cross‐sectional association between loneliness and depression, but their codevelopment has been understudied. Therefore, exploring the codevelopment and its correlates has significant implications for prevention and healthcare professionals. Design: A longitudinal follow‐up study. Methods: The study used nationally representative data over a 14‐year follow‐up period from the Taiwan Longitudinal Study on Ageing focused on Taiwanese aged 60 years and above (n = 4049). Group‐based trajectory modelling, group‐based dual‐trajectory modelling and multinomial logistic regression were the primary analytical methods. Results: We identified three distinct dual trajectories of loneliness and depression: longitudinal low‐frequency lonely depressed (29.3%), longitudinal moderate‐frequency lonely depressed (59.4%) and longitudinal high‐frequency lonely depressed (11.3%). After considering several demographic and background characteristics, difficulty in physical functioning, number of physical symptoms and diseases, sleep quality and number of child deaths were found to be significantly associated. Conclusion: Across the three identified dual‐trajectory groups, they all showed a stable loneliness frequency pattern over time; however, the moderate‐frequency group and high‐frequency group both had a trajectory of increasing depression. It seems that depression tends to change over time in a worsening direction, especially for those with a certain frequency of loneliness. Furthermore, differences in individual and family correlates were found across the groups. Implications for practice: Interventions focusing on the specific factors may help hinder coexisting loneliness and depression, and have implications for developing health promotion strategies and chronic disease care plans. [ABSTRACT FROM AUTHOR]

Insecure attachment orientations are disproportionately frequent in child sexual abuse (CSA) survivors and have been found to mediate some of the effects of CSA on adult interpersonal and romantic difficulties, including sexual revictimization (SR). A sense of relational entitlement (SRE) has received growing attention in psychological discourse and research in recent years. It reflects both adaptive (assertive) and pathological (restricted or inflated) attitudes to the assertion of needs and rights and has not been studied in adult CSA survivors. The purpose of this study was to examine associations between CSA, attachment orientations, SR, and SRE. Sixty-seven Israeli women aged 25 ± 3.95 years (30 adult CSA survivors and 37 healthy female controls with no history of CSA) completed a demographic questionnaire and self-reported measures of adult attachment orientations, sense of entitlement in romantic relationships, and adult SR. CSA survivors reported greater attachment anxiety and attachment avoidance, more restricted SRE, and higher revictimization rates than control women. No difference was found between the groups in inflated SRE. In the CSA but not the control group, anxious and avoidant attachment orientations were significantly and negatively associated with assertive SRE. Insecure (anxious and avoidant) attachment fully mediated the association between CSA and restricted SRE. Our findings suggest that the interplay between insecure attachment and CSA is related to a sense of impaired assertive entitlement and elevated restricted entitlement in adult CSA survivors. This entitlement pattern can be destructive to survivors' romantic relationships and should be addressed in therapy. [ABSTRACT FROM AUTHOR]