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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: 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]

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]

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]

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]

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]

Research has provided compelling evidence that employee referrals result in positive outcomes for organizations and job seekers, but it has been limited on how organizations can increase the likelihood of obtaining employee referrals. Using the theoretical lens of social exchange theory and tenets from expectancy theory, we tested two common assumptions of most employers: A referral bonus motivates employees to refer, and higher bonus amounts incite greater likelihood of referring. We theoretically developed and tested a model integrating the effects of perceived risk in referring and affective commitment and their interactions with the referral bonus to better explain the likelihood of referring. Results largely supported our predictions. Referral bonus presence, referral bonus amount, and affective commitment positively related to likelihood of referring, while perceived risk in referring negatively related to likelihood of referring. The findings also suggest that larger referral bonuses can help offset perceived risk in referring and low affective commitment levels. We contribute to the literature by developing theory, expanding the scope of the current referral literature, and offering a quantitative examination of previously theorized variables in the referring process. We conclude with suggestions to practicing managers on ways to improve the motivating potential of their employee referral programs. [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 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]

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 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]

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]

Background: Cardiovascular disease is the leading cause of death and disability in Egypt. An appropriate estimation of risk is important to improve cardiovascular outcomes and ensure efficient allocation of resources used to support disease prevention. Risk prediction charts have been developed to provide clinicians with a simple tool to estimate the absolute risk of developing coronary heart disease (CHD). Objectives: To test the accuracy of the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in predicting and identifying people at risk of developing CHD and to propose an alternative risk assessment instrument based on simple laboratory tests, routine examination, and reported personal and medical data. Methods: A cross-sectional screening survey was conducted at an emergency department of a health insurance hospital in Alexandria, Egypt. A total of 350 enrolled patients were evaluated clinically. We applied the WHO/ISH risk assessment chart for the Eastern Mediterranean region to test its accuracy in predicting CHD. Results: The validation statistics indicated that the WHO/ISH risk prediction charts identified cases with CHD with 60.0% sensitivity and 93.2% specificity. At least nine risk factors for developing CHD were detected in all patients in the study cohort. Hypertension was the strongest predictor of CHD [odds ratio (OR) (95% confidence interval (CI)): 20.8 (5.6–76.9)]. Silent cardiovascular risk factors were ascertained in about 30% of the studied population, a finding that did not differ significantly by sex. We propose a different risk assessment model for general practice that incorporates standard cardiovascular risk factors, with or without laboratory tests. Conclusions: Standard cardiovascular risk factors included in a simple risk prediction algorithm can predict multivariate CHD risk in apparently healthy individuals. Non-laboratory-based risk assessment models have no superior advantage over those employing laboratory investigations. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between static and dynamic postural stability and functional disability associated with chronic low back pain (CLBP). Methods: A total of 80 patients (age 44.64 ± 1.27 years) were recruited in this cross sectional study using convenience sampling. The One Leg Stand Test (OLST) was used to assess static balance with eyes open and eyes closed; Y Balance Test- Lower Quarter (YBT-LQ) was used to assess dynamic balance in the anterior, posterolateral and posteromedial directions; and functional disability was assessed using modified Oswestry Disability Index (mODI). Karl Pearson correlation coefficient was used to estimate the relationship between the variables. Results and Conclusion: mODI was negatively correlated to OLST with eyes closed (r= -0.721); YBTLQ composite score (r= -0.865); and reach distances in the posterolateral (r= -0.815) and posteromedial (r= -0.832) directions suggesting that control of postural stability was reduced with an increase in disability in patients with CLBP. [ABSTRACT FROM AUTHOR]

Aim: Breakfast plays an important role in the academic performance and mental health of adolescents. This study explored factors associated with breakfast skipping in high school students in South Korea. Methods: A cross‐sectional survey was completed by 1684 high school students. A logistic regression analysis was conducted to determine the factors associated with skipping breakfast, including sociodemographic factors, mental health problems (such as depression and anxiety), sleep and smartphone use patterns. Results: A total of 29.2% of the adolescents reported skipping breakfast and girls were significantly more likely to skip breakfast than boys (P <.001). The breakfast skipping group spent more time using a smartphone on weekdays [mean (SD) = 186.2 (180.0) min/d] than the breakfast eating group [mean (SD) = 110.2 (111.5) min/d] (P <.001). The Korean scale for smartphone addiction (S‐scale) score was higher in the breakfast skipping group (P =.006). Multivariate logistic regression analysis showed that female gender, poor academic performance (odds ratio (OR), 1.575; 95% CI, 1.166‐2.126, P =.003), depression (OR, 1.023; 95% CI, 1.002‐1.043, P =.031), time spent using a smartphone on weekdays (OR, 1.003; 95% CI, 1.002‐1.004, P <.001), and low parental monitoring of smartphone use were significantly associated with skipping breakfast. Conclusions: Findings indicate that unhealthy lifestyle including smartphone overuse negatively affects breakfast eating in adolescents. School‐based nutritional programs should be designed to assess and overcome various individual factors associated with breakfast skipping. [ABSTRACT FROM AUTHOR]

Aim: To measure nurses' turnover intention and identify associated factors in general hospitals in China. Background: Understanding nurses' turnover intention is important to retain nurses, but factors associated with turnover intention require elucidation. Method: A cross‐sectional survey was conducted across 23 hospitals in China to investigate nurses' (N = 12,291) turnover intention and its associated factors. Associated factors were explored by univariate and multilevel multiple logistic regression analysis. Results: The mean total score for nurses' turnover intention was 13.97 ± 3.63. High proactive personality score, a seriously ill family member, experience of negative workplace events, high work pressure and high work–family conflict increased the risk for turnover intention. A low turnover intention was associated with being a non‐local resident nurse, position title, high salary level, good person–organisation fit and person–group fit, and high family–work facilitation. Conclusion: Nurses with a proactive personality, heavy family care burden, experience of negative workplace events, no position title and a low salary may merit special consideration. Implications for Nursing Management: Nurses' personality traits should be further focused on, and it is important to build a nurse‐oriented organisation atmosphere, including protecting nurses from workplace violence, establishing friendly relationships with their families and expanding career paths. [ABSTRACT FROM AUTHOR]

Introduction: New immigrants underutilize health care because of multiple barriers. Although culturally competent health care improves access, it is typically assessed by providers, not newcomers whose perceptions matter most. Methodology: Surveys that included measures of cultural competence and health-related quality of life (QOL) were completed by 117 new immigrants in Windsor, Ontario, Canada. A series of stepwise linear regression analyses were conducted to identify independent predictors of QOL and its four domains: physical health, psychological, social relationships, and environment. Results: Our adjusted results suggest that experiences of discrimination was negatively associated with overall QOL (β = −.313; p <.001) and its psychological (β = −.318; p <.001), social (β = −.177; p =.048), and environmental (β = −.408; p <.001) domains. Discussion: Discrimination negatively influences new immigrant QOL. Provider cultural competency training should emphasize the influence of provider discrimination on immigrant health and explore learners' values and biases. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain. * DESIGN: Case-control. * METHODS: We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, systemdepression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression. * RESULTS: Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval ICI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR - 0.98; 95% Cl: 0.97,0.99), pain at multiple sites (pain at 1 other site : OR = 2.76 ; 95 % Cl : 1. 29, 591; pain at 4 or more other sites: OR = 10.45; 95% Cl: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91: 95% Cl: 1.33, 6.37: catastrophizer OR = 6.79; 95% Cl: 1.91,24.11) were independently associated with chronic plantar heel pair. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis) * CONCLUSION: Waist girth, ankle plantar flexor strength, multisite pain, and pain catasheel trophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. [ABSTRACT FROM AUTHOR]

This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries. A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey. Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden (β = −0.74, p = 0.008) and higher levels of patient physical health and function (β = −0.69, p = 0.003). Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes. After 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function. The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden. Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community. Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health. [ABSTRACT FROM AUTHOR]

The purpose was to examine knowledge, attitudes and preventive practices, as well as anxiety and stress of people living in a Gulf country with a diverse population toward the coronavirus disease 2019 (COVID‐19) pandemic. A descriptive cross‐sectional, exploratory design was used to meet the aims of this study. The target population was all individuals aged 18 years and older and who can read and write Arabic, English, or Hindi. The results showed that most individuals demonstrated a high level of knowledge regarding COVID‐19. Most individuals believed that COVID‐19 is not fatal and that countries can control the COVID‐19 virus. Despite the lower levels of anxiety and stress among this population, many individuals reported high levels of stress and anxiety. Higher levels of anxiety, higher levels of knowledge, and being married were associated with more preventive practices. This study showed that the level of knowledge is positively associated with compliance with preventive measures. Providing the public with accurate and consistent information regarding COVID‐19 may enhance their compliance with preventive measures. Using different risk communication strategies will ensure collaboration from the public and encourage them to be active members when facing contagious diseases [ABSTRACT FROM AUTHOR]

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To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures – highlighting significant complaints of subjective feeling of dizziness – were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. The implementation of posturography – including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements. Uncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation. Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations. Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the knowledge, attitudes, practices and barriers faced by dental health care professionals (DHCP) regarding the Centers for Disease Control and Prevention (CDC) infection control guidelines in dental settings and summary (2003, 2016) prior to onset of the SARS-CoV-2 (COVID-19) pandemic. Methods: A descriptive, cross-sectional study design was used to create a 42-item electronic survey. A convenience sample of dental assistants registered dental hygienists, and dentists (n=397) was recruited through professional dental social media groups, face-to-face recruitment, and snowball sampling. Descriptive statistics were used to analyze the data. Results: The completion rate was 66.7% (n=265). The mean knowledge score for the CDC infection control guidelines was 58%. Less than half (39%) of the respondents were able to correctly identify hand hygiene as the most important measure in preventing the spread of infections among patients and DHCP. One third (33%) of the respondents were unaware of the CDC guidelines regarding respiratory hygiene/cough etiquette measures in dental settings. Participants indicated that the greatest barrier in following infection control guidelines was a heavy workload (37%), followed by time restraints (25%), and expense (15%). Conclusion: Although DHCPs reported familiarity (perceived knowledge) with 2003/2016 CDC infection control guidelines in dentistry, their knowledge and practices were inadequate. This information may serve as a baseline for future consideration of infection control continuing education as a requirement for licensure, particularly given the impact of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

To verify the association between Human Activity Profile and functional capacity, functional class and systolic function of the patients with Chagas heart disease (CHD). Sixty-two patients with CHD were evaluated by echocardiography, maximal exercise testing and Human Activity Profile questionnaire. The sample was stratified, according to the values of peak oxygen uptake (low or normal), functional class (symptomatic or asymptomatic), and left ventricular ejection fraction (preserved or systolic dysfunction). Linear regression and two-group comparisons analyses were used. Receiver-operating characteristic analysis was used to determine different cutoff values of the Human Activity Profile for low peak oxygen uptake prediction. Peak oxygen uptake was an independent predictor of Human Activity Profile (R2-adjusted = 0.27). Patients with low peak oxygen uptake had lower scores in Human Activity Profile [difference of 6.9 (95%CI 2.5–11.4)] than those with normal peak oxygen uptake. Symptomatic patients also showed lower scores when compared to the asymptomatic [difference of 6.2 (95%CI 1.7–10.8)]. There was no difference between left ventricular ejection fraction classes. The Human Activity Profile score of 76.5 was the optimal cut point value in predicting low peak oxygen uptake (sensitivity = 66.0% and specificity = 71.8%). The Human Activity Profile questionnaire is associated with functional capacity of patients with CHD and is able to identify individuals with low peak oxygen uptake. Functional impairment is one of the most common clinical findings in all stages and is an important predictor of poor prognosis of the Chagas heart disease; A patient-derived measure of functional capacity is potentially useful in the setting of the Chagas heart disease; The Human Activity Profile questionnaire is effective in the identification of patients with Chagas heart disease with functional impairment and may be a valid method for functional evaluation. [ABSTRACT FROM AUTHOR]

Objectives: Community, school, family, and individual factors protect against mental illness in general samples of adolescents. How these assets apply to Somali youth resettled to the United States (U.S.), a group with significant trauma exposure, remains unclear. We aimed to quantify which protective factors are associated with lower prevalence of depressive symptoms, suicidality, and self-injury among Somali youth in the U.S. compared with their non-Hispanic white peers. Design: Participants consisted of 8th, 9th, and 11th grade respondents to the 2016 Minnesota Student Survey, an anonymous school-administered statewide survey with 85.5% school district participation, who identified as Somali ethnicity (n = 1552) or as non-Hispanic white (n = 80,583). Multivariable logistic regression assessed odds of depressive symptoms, suicidal ideation and attempts, and self-harm, using eight protective factors (i.e. internal developmental assets, school engagement, empowerment, and family and teacher connectedness, caring adults and after-school activity frequency and quality) as independent variables. Models were run separately for Somali and white youth. Results: Somali youth reported similar rates of depressive symptoms, but lower levels of suicidal ideation or attempts and self-harm behaviors than their white peers (p < 0.001). All eight protective factors were associated with outcomes in the expected direction for white youth. For Somali youth, internal developmental assets (aOR 0.79, 95% CI: 0.65–0.97), empowerment (aOR 0.58, 95% CI: 0.45–0.73), family connectedness (aOR 0.60, 95% CI: 0.51–0.71), perception of caring adults in the community (aOR: 0.84, 95% CI: 0.76–0.92), and quality of after-school activities (aOR: 0.72, 95% CI: 0.61–0.86) were protective against depressive symptoms, with similar patterns for other outcomes. Other school factors protected Somali youth less consistently. Conclusions: Previously established protective factors against mental illness, particularly school factors, do not universally apply to Somali youth. Interventions that strengthen individual, family, or community factors, or that increase the relevance of school factors, should be explored for these youth. [ABSTRACT FROM AUTHOR]

Background: Youth baseball players who experience elbow pain during the season frequently exhibit radiographic elbow abnormalities. However, it is unknown whether asymptomatic elbow abnormalities are risk factors for in-season elbow injuries. Purpose: To determine whether the preseason presence of asymptomatic medial epicondyle apophysitis is a risk factor for inseason elbow injuries in youth baseball players. Study Design: Cohort study; Level of evidence, 2. Methods: Youth baseball players (N ¼ 210; age range, 7-12 years) with no pain or history of injury in their throwing arms underwent preseason evaluations that included shoulder and elbow range of motion measurements, shoulder muscle strength testing, and ultrasound elbow scans with a multifrequency 13-MHz linear array transducer. Over 1 year of play, the players and their parents maintained daily elbow pain diaries. Elbow injuries were defined as medial elbow symptoms that prevented ball throwing for 8 days. Results: The preseason ultrasound evaluation revealed medial epicondyle apophysitis in 59 players. In the year following, elbow injuries occurred in 17 (28.8%) players with preseason medial epicondyle apophysitis and 18 (11.9%) players without apophysitis. Independent predictors of elbow injuries were preseason medial epicondyle apophysitis (odds ratio [OR], 2.488; 95% confidence interval [CI], 1.152-5.376; P ¼ .02) and deficits of abduction (ABD) and external rotation of the dominant shoulder (OR, 0.963; 95% CI, 0.936-0.992; P ¼ .012). Conclusion: Asymptomatic medial epicondyle apophysitis and ABD and external rotation deficits in the dominant shoulder were risk factors for elbow injuries in 7- to 12-year-old youth baseball players. These findings may aid in the design of programs to prevent elbow injuries in this population. [ABSTRACT FROM AUTHOR]

The Star Excursion Balance Test (SEBT) has frequently been used to measure motor control and residual functional deficits at different stages of recovery from lateral ankle sprain (LAS) in various populations. However, the validity of the measure used to characterize performance-the maximal reach distance (MRD) measured by visual estimation-is still unknown. Objectives: To evaluate the concurrent validity of the MRD in the SEBT estimated visually vs the MRD measured with a 3D motion-capture system and evaluate and compare the discriminant validity of 2 MRD-normalization methods (by height or by lower-limb length) in participants with or without LAS (n = 10 per group). Results: There is a high concurrent validity and a good degree of accuracy between the visual estimation measurement and the MRD gold-standard measurement for both groups and under all conditions. The Cohen d ratios between groups and MANOVA products were higher when computed from MRD data normalized by height. Conclusion: The results support the concurrent validity of visual estimation of the MRD and the use of the SEBT to evaluate motor control. Moreover, normalization of MRD data by height appears to increase the discriminant validity of this test. [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]

BACKGROUND: Some patients with acute heart failure (AHF) who are treated initially with noninvasive ventilation (NIV) will require endotracheal intubation, which indicates NIV failure. The incidence and prognosis of NIV failure in patients with AHF are not well characterized. METHODS: Using the National In-Patient Sample (NIS), we conducted a retrospective cohort study of subjects hospitalized with AHF between 2008 and 2014 who were treated with NIV within 24 h of hospital admission. We determined predictors of NIV failure and determined the association between NIV failure and in-hospital mortality using Cox proportional hazard models. RESULTS: Of 279,534 subjects hospitalized with AHF and treated with NIV, 4,257 (1.52%) failed NIV and required intubation. Cardiogenic shock (odds ratio 8.79, 95% CI 6.89-11.2) and in-hospital arrest (odds ratio 24.9, 95% CI 18.71-33.14) were associated with NIV failure. In-hospital mortality was 26.5% for NIV failure compared to 5.6% for those without NIV (P < .001). After adjustment for demographics, comorbidities, cardiogenic shock, and in-hospital arrest, NIV failure was associated with nearly a 2-fold risk of inhospital mortality (odds ratio 1.95, 95% CI 1.59-2.40). CONCLUSIONS: Intubation after initial NIV treatment was required in 1.5% of subjects hospitalized with AHF and treated with NIV, and was associated with high in-hospital mortality. These findings can guide future prospective interventional trials and quality improvement ventures. [ABSTRACT FROM AUTHOR]

Background: Different cultural context results in variability in health professionals' attitude toward family presence in the emergency department (ED) during resuscitation. Knowledge about emergency department health professionals' (EDHPs') attitude toward family presence during resuscitation (FPDR) in Greece can contribute to the understanding of cultural and value-related obstacles and opportunities to implement this practice. It would be useful for Greek health professionals when they have to care for citizens from other countries in which guidelines for FPDR exist to understand their difference in behavior and reaction and be more tolerant. Objectives: To explore Greek EDHPs' experiences, concerns, and benefits regarding FPDR and determine the contributing factors that are associated with their positive or negative attitude about the process. Methods: A convenience sample of 305 health professionals working in the ED of 9 general hospitals of the National Healthcare System in northern Greece participated in a cross-sectional study (response rate, 87.6%). Results: Positive experience of FPDR was encountered in 65.9% of EDHPs. Only 2.3% reported that they work in EDs where FPDR is allowed. Hospital regional location, previous positive experience of FPDR, and competency in supporting family members during FPDR were independently associated with a positive attitude toward FPDR. Conclusions: Greek EDHPs are not ready to accept FPDR practice. The establishment of formal policy similarly to resuscitation guidelines and family-centered training courses are needed to mitigate negative beliefs. Attempts to enhance positive attitude should include educational interventions providing knowledge on the benefits of FPDR. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders (MSDs) are the leading cause of pain and disability among nurses and are frequently accompanied by depression. However, the association between the comorbidity of MSDs and depression and working conditions has not been studied, which was the aim of this study. Methods : In 2015, all nurses (n = 1,102) employed at a community hospital in the Northeast United States were invited to participate in this cross-sectional study. A survey was distributed in which participants were asked to report on MSDs, depressive symptoms, as well as subjective working conditions assessed including physical demands, psychological demands, decision authority, social support, and work–family conflict. Findings : 397 nurses responded (36%), and the prevalence of the comorbidity of MSDs and depression was 14.5%. Poisson regression (PR) models suggested that work–family conflict was associated with increased risk of the comorbidity (PR = 2.18; 95% confidence interval [CI] = 1.33–3.58), as was 8-hour night shift (PR = 2.77; 95% CI = [1.22, 6.31]) or 12-hour day shift (PR = 2.20; 95% CI = [1.07, 4.50]). Other working conditions were not directly associated with the comorbidity. Conclusions/Application to Practice : The comorbidity of MSDs and depression is prevalent among hospital nurses, and work–family conflict and working night shift or longer shifts were significantly associated with this. Effective workplace programs are needed to address nurses' working conditions to reduce their work–family conflict, thereby improving their musculoskeletal and mental health. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to translate and culturally adapt The Pelvic Girdle Questionnaire to Swedish, and to evaluate the construct and discriminative validity. Materials and methods: A translation and cultural adaptation process was performed according to international guidelines. Pilot tests were conducted among 16 women during pregnancy and post-partum. Analysis of the construct and discriminative validity of the Swedish version of the Pelvic Girdle Questionnaire was performed in a sample of 177 pregnant women suffering from pain in the lumbo-pelvic area. Participants completed the Pelvic Girdle Questionnaire along with Oswestry Disability Index, numeric rating scales for pain intensity and for pelvic girdle pain concerns. Results: The Swedish version of the Pelvic Girdle Questionnaire showed high internal consistency with Cronbach's alphas between 0.82 and 0.96, good convergent validity with high correlations with the Oswestry Disability Index and the pain intensity numeric rating scale, whereas moderate correlation was shown between the concerns numeric rating scale and the other instruments as hypothesized. Receiver operating characteristic curves showed good discriminatory capacity for women in need of treatment. Conclusions: The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability. It has good construct and discriminative validity for measurements of consequences of pregnancy-related pelvic girdle pain among Swedish speaking women. Pregnancy-related pelvic girdle pain may be disabling and long-lasting, however treatable when identified. The Pelvic Girdle Questionnaire is the only condition-specific, reliability tested and validated questionnaire for pelvic girdle pain. The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability, good construct validity for pelvic girdle pain among Swedish speaking women, and shows good discriminative capacity for women in need of treatment. [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]

Background: A culture of patient safety is one of the cornerstones of good-quality healthcare, and its provision is one of the significant challenges in healthcare environments. Aim: The purpose of this study was to evaluate the effect of a surgical safety educational programme on the attitudes of nurses to patient safety in operating rooms (OR). Design: An interventional one-group pre-/post-test design, which sought to measure changes in OR nurses' attitudes toward patient safety culture. Methods: A simple random sampling technique was used to recruit 66 OR nurses working at six Royal Medical Service hospitals in Amman, Jordan. All participants took part in a 4-hour educational workshop. Pre-tests and post-tests were done. Results: The results of this study showed that OR nurses' attitudes towards a culture of patient safety was originally negative; significant improvement after attending the programme was found (3.3 ± 0.20 versus 3.8 ± 0.30). There was a negative correlation between years of experience and nurses' attitudes towards patient safety. Conclusions: Incorporating courses about safety culture into continuing education programmes may improve nurses' attitudes towards patient safety. Nurses should be qualified to play an important role in creating a culture of patient safety. [ABSTRACT FROM AUTHOR]

This study evaluates the effects of a short-term Cardio Tai Chi program on the cardiorespiratory fitness and hemodynamic parameters in sedentary adults. Thirty-one sedentary participants (age: 58 ± 9 years, body mass: 63 ± 12 kg) were subjected to an exercise program during 10 sessions over a 10-day period within 2 weeks. The Cardio Tai Chi program consisted in a series of three to five intervals lasting 90 s each at ∼70% maximal heart rate separated by 2-min of low-intensity recovery. Primary outcome measures were cardiorespiratory fitness (peak oxygen uptake, V ˙ O 2 p e a k ) assessed by the Rockport walking test and resting hemodynamic parameters (systolic, diastolic, mean, and pulse pressures). We observed a significant difference of means on post-pre V ˙ O 2 p e a k [4.5 ml/kg/min, 95% confidence interval (CI): 3.1 to 5.8, p = 0.004], systolic blood pressure (-5.5 mmHg, 95% CI:-7.3 to -3.8, p = 0.010) and pulse pressure (-3.7 mmHg, 95% CI: -5.2 to -2.3, p = 0.028). No significant differences were observed for diastolic pressure (−1.8 mmHg, 95% CI: -2.6 to -1.0, p = 0.226), mean blood pressure (2.5 mmHg, 95% CI: 1.4 to 3.6, p = 0.302), or resting heart rate (-0.9 beat/min, 95% CI: -2.0 to 0.1, p = 0.631). Our findings suggest that engaging in a short-term Cardio Tai Chi program can improve cardiorespiratory fitness and hemodynamic parameters in sedentary adults. [ABSTRACT FROM AUTHOR]

Exhaustive exercise induces various disturbances of homeostasis, with impaired bioenergetics often associated with strenuous muscular work. However, no study so far validated serum biomarkers of creatine metabolism vs. traditional markers of exhaustive exercise and fatigue. Here, we investigated how well changes in serum guanidinoacetic acid (GAA), creatine and creatinine correlate with responses in blood lactate, creatine kinase, interleukin-6 and cortisol in 11 young active men (age 23.2 ± 3.7 years; VO2max 49.5 ± 5.4 ml/kg/min) exposed to exhaustive exercise. All participants were subjected to running at individual running speed at anaerobic threshold until exhaustion, with venous blood drawn at baseline and during an exercise session at 5-min intervals. Running-to-exhaustion markedly affected serum GAA and creatine levels, with circulating GAA increased for 5.3 ± 8.5%(95% CI, −0.4 to 11.0), and serum creatine elevated by 33.9 ± 21.8% (95% CI, 19.3 to 48.6) compared to baseline levels (P ≤ 0.05). In addition, moderate-to-strong positive linear correlations were found between exhaustive exercise-induced changes in serum cortisol and GAA levels (r = 0.79; P = 0.03), and cortisol and creatine concentrations (r = 0.81; P = 0.03). This suggests a link between cortisol and heavy exercise-induced impaired bioenergetics, with future studies needed to evaluate a cause-and-effect interconnection between cortisol and GAA-creatine axis. [ABSTRACT FROM AUTHOR]

Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes. [ABSTRACT FROM AUTHOR]

Context: It has been postulated that subjects with weak hip abductors and external rotators may demonstrate increased knee valgus, which may in turn raise risk of injury to the lower extremity. Recent studies have explored the potential link between hip strength and knee kinematics, but there has not yet been a review of this literature. Objective: To conduct a systematic review assessing the potential link between hip-abductor or external-rotator strength and knee-valgus kinematics during dynamic activities in asymptomatic subjects. Evidence Acquisition: An online computer search was conducted in early February 2011. Databases included Medline, EMBASE, CINAHL, SPORTDiscus, and Google Scholar. Inclusion criteria were English language, asymptomatic subjects, dynamometric hip-strength assessment, single or multicamera kinematic analysis, and statistical analysis of the link between hip strength and knee valgus via correlations or tests of differences. Data were extracted concerning subject characteristics, study design, strength measures, kinematic measures, subject tasks, and findings with regard to correlations or group differences. Evidence Synthesis: Eleven studies were selected for review, 4 of which found evidence that subjects with weak hip abductors or external rotators demonstrated increased knee valgus, and 1 study found a correlation to the contrary. Conclusions: There is a small amount of evidence that healthy subjects with weak hip abductors and perhaps weak external rotators demonstrate increased knee valgus. However, due to the variation in methodology and lack of agreement between studies, it is not possible to make any definitive conclusions or clinical recommendations based on the results of this review. Further research is needed. [ABSTRACT FROM AUTHOR]

Context: Chronic midportion Achilles tendinopathy is a common and hard-to-treat disorder characterized by degenerative changes of the tendon matrix. Ultrasonographic tissue characterization (UTC) was successfully used to quantify structural human Achilles tendon changes. This novel and reliable technique could be used in follow-up studies to relate tendon structure to symptoms. Objective: To quantify structural tendon changes and assess clinical change in patients with tendinopathy. Design: Prospective observational study. Setting: Orthopedic department in a university medical center. Patients: 23 patients with chronic midportion Achilles tendinopathy. Intervention: The patients performed a 16-wk home-based eccentric exercise program. An experienced researcher performed the ultrasonographic data collection with the UTC procedure. These data were assessed by a blinded observer. The severity of symptoms was established with the validated Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Main Outcome Measures: UTC was performed to quantify tendon structure through measuring the proportion of 4 echo types. Echo types I and II represent more or less organized tendon bundles, and echo types III and IV represent disintegrated tendon structure. On the VISA-A, the total possible score is divided by 100 for a percentage score, with a perfect score of 100. Follow-up was at 2, 8, 16, and 24 wk. Results: The mean percentage of echo types I and II changed by 0.3% after 24 wk (P = .92, 95% CI -5.8 to 5.3). The mean VISA-A score increased slightly but significantly by 11.3 points after 24 wk (P = .01, 95% CI 2.6-20.0). An increased VISA-A score was not correlated with an increased percentage of echo types I and II (P = .94, r = -.02), and the baseline percentage of echo types I and II did not correlate with an increased VISA-A score (P = .74, r = .07). Conclusions: There is no short-term increase in organized tendon structure after eccentric exercises. Tendon structure is not related to symptom severity and cannot be used as a predictor of clinical outcome. [ABSTRACT FROM AUTHOR]

Purpose: To determine the change in stability of three different implant systems using resonance frequency analysis (RFA) and to correlate RFA measurements with factors related to implant design, length, and diameter, patient gender, and dental arch. Clinical and radiologic evaluations were performed up to 1 year after loading. Materials and Methods: Three different types of implants from three different manufacturers were inserted in the posterior maxilla and mandible. RFA measurements were performed at implant placement and weekly up to 8 weeks postoperatively and were compared with respect to implant type, length, and diameter and dental arch. The implants were loaded after 8 weeks. All implants were examined radiographically at baseline and at 6 and 12 months. Plaque Index, Sulcus Bleeding Index, peri-implant probing depths, and marginal bone loss were recorded. Repeated-measurements analysis of variance, two-tailed mixed-model analysis of variance, the Least Significant Differences and Mann-Whitney U tests were used for statistical analyses. Results: All the groups showed high stability values at all time points (above 71). There were statistically significant differences between groups at all time points except 1 and 2 weeks. Mandibular implants showed statistically higher stability values than maxillary implants. Wide implants showed statistically higher stability values than narrow implants. Mean marginal bone loss was 0.22 ± 0.47 mm after 1 year. Conclusions: All three implant systems showed clinically acceptable stability values prior to early loading. The success rates and bone loss were similar to the values reported in the literature. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bisphenol A (BPA) is an endocrine disruptor that affects fetal growth in experimental studies. Bisphenol F (BPF) and bisphenol S (BPS), which have been substituted for BPA in some consumer products, have also shown endocrine-disrupting effects in experimental models. However, the effects of BPF and BPS on fetal growth in humans are unknown OBJECTIVES: Our goal was to investigate trimester-specific associations of urinary concentrations of BPA, BPF, and BPS with size at birth METHODS: The present study included 845 pregnant women from Wuhan, China (2013–2015), who provided one urine sample in each of the first, second, and third trimesters. Linear regressions with generalized estimating equations were applied to estimate trimester-specific associations of urinary bisphenol concentrations with birth weight, birth length, and ponderal index. Linear mixed-effects models were used to identify potential critical windows of susceptibility to bisphenols by comparing the exposure patterns of newborns in the 10th percentile of each birth anthropometric measurement to that of those in the 90th percentile. RESULTS: Medians (25th–75th percentiles) of urinary concentrations of BPA, BPF, and BPS were 1.40 (0.19–3.85), 0.65 (0.34–1.39), and 0.38 (0.13– 1.11) ng/mL, respectively. Urinary BPA concentrations in different trimesters were inversely, but not significantly, associated with birth weight and ponderal index. Urinary concentrations of BPF and BPS during some trimesters were associated with significantly lower birth weight, birth length, or ponderal index, with significant trend p-values (p,trend < 0.05) across quartiles of BPF and BPS concentrations. The observed associations were unchanged after additionally adjusting for other bisphenols. In addition, newborns in the 10th percentile of each birth anthropometry measure had higher BPF and BPS exposures during pregnancy than newborns in the 90th percentile of each outcome. CONCLUSIONS: Prenatal exposure to BPF and BPS was inversely associated with size at birth in this cohort. Replication in other populations is needed. [ABSTRACT FROM AUTHOR]

The article discusses a mobility program that could be hardwired on the medical-surgical unit to improve patient quality of care and shorten hospital length of stay. Topics mentioned include complications occurring during hospitalizations at the project site due to immobility and deconditioning, the effects of mobilization on hospital-acquired conditions, and the comparison of implementing set ambulation protocols using a mobility plan versus standard care.

Purpose: To investigate psychological distress among parents of children with autism spectrum disorder and the associated sociodemographic factors influencing parents' distress. Design and Methods: A cross‐sectional design with a sample of 123 Jordanian parents providing care to children with autism spectrum disorder was used. A sociodemographic questionnaire, the Oberst Caregiving Burden Scale, the Bakas Caregiving Outcomes Scale, and the Hospital Anxiety and Depression Scale were utilized for data collection. Findings: Parents reported moderate levels of burden, negative life changes, and borderline depression and anxiety. The perceived burden related to caregiving task difficulty positively correlated with that related to time spent on tasks and negatively correlated with caregivers' caregiving‐related outcomes. The perceived burden of caregiving tasks was negatively correlated with depression and anxiety and anxiety levels were positively correlated with depression (P < 0.001). Practice Implication: Healthcare providers, advanced practice nurses, and policy makers should be aware of the burden, anxiety, and depression experienced by caregivers of children with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background: Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design: Cross‐sectional, multicentre, survey‐based study. Methods: An online short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results: Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than 5 years of experience were more likely to rate a patient spending 50%–74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia. Conclusions: When surveyed on various aspects of glycaemic control, ICU nurses and physicians often agreed, although there were certain areas of disagreement, in which their profession and level of experience seemed to play a role. Relevance to clinical practice: Differing views on glycaemic control amongst professionals may affect their practice and, thus, could lead to health inequalities. Clinical leads and the multidisciplinary ICU team should assess and, if necessary, address these differing opinions. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery. Methods: This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound images of the placenta obtained at the 18–21-week fetal anatomy screen. The relationship between placental thickness and neonatal birthweight was assessed using Pearson's correlation coefficient (r) with 95% confidence interval (CI). Logistic regression was used to assess the association between placental thickness and secondary binary outcomes of neonatal intensive care unit (NICU) admission and poor Apgar scores. Two-sample t-tests, or exact Wilcoxon rank-sum test for non-normally distributed data, were used to assess for differences attributable to medical comorbidities (pre-gestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, preeclampsia and eclampsia). Results: Placental thickness had a positive correlation with neonatal birthweight [r=0.18, 95% CI=(0.05, 0.32)]. The mean placental thickness measured 34.2±9.7 mm. The strength of the correlation remained similar when adjusting for gestational age (r=0.20) or excluding medical comorbidities (r=0.19). There was no association between placental thickness and NICU admission, Apgar scores <7 or medical comorbidities. Conclusion: Our study demonstrated a positive correlation between sonographic placental thickness and birthweight. Future prospective studies are warranted in order to further investigate whether a clinically significant correlation exists while adjusting for more covariates. [ABSTRACT FROM AUTHOR]