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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: 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]

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]

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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: 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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

This study examined the moderating influences of active social networks (ASN), sedentary social networks (SSN) and ASN lost on the relationship between neighbourhood walkability and social activity in community-dwelling older adults aged 60 years or more in Accra, Ghana. A total of 863 individuals participated after G*Power 3.1 was utilized to calculate the minimum sample size. We analysed the data with Pearson's correlation test and hierarchical linear regression models. A sensitivity analysis was conducted to select the ultimate confounding variables. The study found a positive influence of neighbourhood walkability on social activity after the covariate adjustment (β = 0.18; t  =   5.2; p  = 0.000). The positive influence of neighbourhood walkability on social activity was significantly reduced by ASN lost and SSN. ASN did not have a significant moderating influence on the primary relationship. The study concludes that the positive influence of walkable neighbourhoods on social activity decreases as SSN and ASN lost increase. [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]

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]

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]

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]

Background: Impairments in squat depth have been reported in patients with femoroacetabular impingement syndrome (FAIS). However, little is known about single-leg squat (SLS) performance in these patients, despite this task being commonly used in the rehabilitation and training settings. Purpose/Hypothesis: The aims of this study were (1) to investigate whether patients with FAIS demonstrate differences in SLS performance compared with healthy controls and (2) to determine whether dynamic range of motion (ROM), muscle strength, hip morphologic measures, hip pain, and hip-specific function predict SLS performance in patients with FAIS. We hypothesized that patients with FAIS would demonstrate impaired SLS performance and that impaired hip biomechanics, muscle strength, and hip-specific function would predict squat performance in patients with FAIS. Study Design: Controlled laboratory study. Methods: Three-dimensional (3D) kinematic data were collected at 100 Hz using a 20-camera 3D motion capture system during 3 SLS trials in 34 patients with FAIS and 26 healthy controls. Isometric muscle strength was tested with a stationary handheld dynamometer in all participants. Squat performance was quantified by squat depth (in meters), and the biomechanical variables of dynamic ROM of the pelvis, the hip, the knee, and the ankle in all planes were calculated. In patients with FAIS, femoral and acetabular morphology were measured using radiographic alpha angles and lateral center-edge angles. Hip pain and hip-specific function were measured using the visual analog scale for pain and the Hip Outcome Score Activities of Daily Living subscale, respectively. Two-tailed independent-samples t tests were used to determine between-group differences for squat depth, dynamic ROM variables, and muscle strength. A hierarchical multiple linear regression (MLR) model was used to determine whether biomechanical variables, muscle strength, hip morphology measures, hip pain, and hip-specific function were predictors of squat depth. All statistical analyses were performed using SPSS Version 26. Results: There were no between-group differences in age (FAIS, 30.0 ± 7.0 years vs controls, 27.3 ± 7.0 years; P =.18) or body mass index (FAIS, 23.1 ± 2.8 vs controls, 22.6 ± 3.2; P =.51). Squat depth was less in patients with FAIS compared with healthy controls (FAIS, 0.24 ± 0.4 m vs controls, 0.29 ± 0.05 m; P <.001). In the sagittal plane, patients with FAIS demonstrated less dynamic ROM of the hip (FAIS, 67.8°± 12.4° vs controls, 79.2°± 12.5°; P =.001) and the knee (FAIS, 71.9°± 9.4° vs controls, 78.9°± 13.2°; P =.02) compared with controls. Patients with FAIS also demonstrated a less dynamic coronal plane pelvis ROM (FAIS, 11.3°± 5.0° vs controls, 14.4°± 6.7°; P =.044). Patients with FAIS had reduced hip muscle strength of the hip external rotator (FAIS, 1 ± 0.3 N/kg vs controls, 1.2 ± 0.3 N/kg; P =.034), hip internal rotator (FAIS, 0.8 ± 0.3 N/kg vs controls 1 ± 0.3 N/kg; P =.03), and hip flexor (FAIS, 4 ± 1.1 N/kg vs controls, 4.8 ± 1.2 N/kg; P =.013) muscle groups. The hierarchical MLR revealed that the dynamic ROM of the hip, the knee, and the pelvis, the hip external rotation muscle strength, and the femoral alpha angles were all significant predictors of squat performance, and the final MLR model explained 92.4% of the total variance in squat depth in patients with FAIS. Conclusion: Patients with FAIS demonstrate impaired SLS squat performance compared with healthy controls. This impaired squat performance is predominantly predicted by sagittal plane knee and hip biomechanics and hip external rotator strength, and less by frontal plane pelvic ROM and hip morphology in patients with FAIS. Clinical Relevance: Clinicians should focus treatment on improving dynamic ROM and hip external rotator muscle strength to improve squat performance; however, femoral morphology should also be considered in the treatment paradigm. [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]

Background: Ageist and helping attitudes among undergraduate homecare students are a concern for educators, healthcare professionals and home care workers due to their potential to increase the marginalisation of older people and negatively impact quality of care. Objectives: The current study evaluated the effect of extended contact with community‐dwelling older adults on the ageist and helping attitudes of home care students. Methods: Fifty‐five students attending a public university in Turkey were randomly assigned to the intervention group (n = 27) or control group (n = 28). The intervention group received positive theoretical education and had extended contact with community‐dwelling older adults, while the control group only received positive theoretical education. Before and after the intervention, the students' ageist attitudes were evaluated with Kogan's Attitudes towards Old People scale (KAOP) and helping attitudes were evaluated with the Helping Attitude Scale (HAS). Results: There were statistically significant differences between pre‐ and post‐test mean KAOP total, positive ageism and negative ageism subscale scores in the intervention group (p < 0.05) and in KAOP negative ageism score in the control group (p < 0.05). HAS scores showed no significant post‐intervention change in helping attitudes in either group. Conclusion: Extended contact with community‐dwelling older adults had a favourable influence on undergraduate health students' ageism attitudes. These results suggest that contact with older adults may be an effective strategy to reduce ageism but may not increase helping behaviours. Implications for practice: Positive contact experiences with community‐dwelling older adults can be used to reduce ageism in home care students. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic resuscitation of organ donors and the attenuation of oxidative stress incurred by organs following brain death and transplantation have the potential to improve organ yield and allograft function. Thiamine (vitamin B1) is a vital coenzyme in both energy metabolism and the production of antioxidants that has not been studied in the donor population. Research Aim: To determine the frequency of subclinical thiamine deficiency in brain-dead organ donors and its correlation with demographics, length of hospitalization, donor management, lactic acidosis, and the requirement for vasoactive support. Design: Prospective cohort study of brain-dead donors managed at a single organ procurement organization's organ recovery facility. Results: A total 64 donors were enrolled; 24 donors had thiamine levels drawn upon arrival and 40 donors had levels drawn at the time of organ procurement. Whole blood thiamine levels were inversely correlated with the time from death (P =.007) and 20% (8/40) of donors had levels below the normal range at the time of organ procurement. Demographic features of the donor were not associated with thiamine levels although longer hospital stays prior to death were associated with lower levels (P <.05). The presence and resolution of lactic acidosis was not associated with whole blood thiamine level. Higher thiamine levels were associated with earlier discontinuation of vasoactive support (P =.04). Discussion: Whole blood thiamine deficiency was not uncommon at the time of organ procurement. Thiamine may be associated with the requirement for hemodynamic support. [ABSTRACT FROM AUTHOR]

Purpose: To examine the determinants of radiation safety culture among radiologic technologists in the United States. The specific aims were to report descriptive statistics related to radiation safety culture determinants and examine relationships between specific determinants of radiation safety culture and overall perception of radiation safety (OPRS). Methods: Radiologic technologists working in radiography, mammography, and computed tomography were identified using the American Society of Radiologic Technologists membership database. The researcher implemented a quantitative cross-sectional design using the Radiation Actions and Dimensions of Radiation Safety (RADS) survey instrument, which contained the study's determinants and OPRS variable, to guide hypotheses testing. Descriptive statistics were used to report RADS survey item outcomes, and Pearson correlation and multiple linear regression tests were conducted to analyze the hypothesis. Results: A total of 425 radiologic technologists completed the survey. Ten variables significantly correlated with OPRS. The variables of leadership actions (β = .402; P < .001), teamwork across imaging stakeholders (β = .304; P = .011), organizational learning (β = .121; P = .007), and questioning attitude (β = .110; P = .001) predicted OPRS, with leadership actions being most important in the model. Discussion: The correlation between OPRS scores and the 10 determinants suggests that each variable is a relevant determinant of radiation safety culture among radiologic technologists in the United States. The outcomes establish key priorities and provide an actionable foundation to facilitate a positive radiation safety culture in medical imaging. Conclusion: The study presented a unique examination of OPRS determinants among American radiologic technologists. Findings can be used to support clinically-oriented interventions in improving radiation safety culture. [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]

Objectives: This study investigated associations between weather conditions, physical activity, and sedentary time in primary school-aged children in Australia and Canada. Methods: Cross-sectional data on 9-11-year-old children from the Australian (n = 491 ) and Canadian (n = 524) sites of the International Study of Childhood Obesity, Lifestyle and the Environment were used. Minutes of daily moderate-to-vigorous-physical-activity (MVPA) and sedentary time were determined from 7-day, 24-h accelerometry (Actigraph GT3X+ triaxial accelerometer). Day-matched weather data (temperature, rainfall, snowfall, relative humidity, wind speed) were obtained from the closest weather station to participants' schools. Covariates included parental highest education level, day type, sex, and BMI z-scores. Generalized mixed model analyses allowing for clustering of participants within schools were completed. Scatterplots with Loess curves were created for maximum temperature, MVPA, and sedentary time. Results: Daily maximum temperature was significantly associated with MVPA and sedentary time in Australia (MVPA p = .05, sedentary p = .01) and Canada (p < .001, p = .001). Rainfall was negatively associated with MVPA in Australia (p < .001) and positively associated with sedentary time in Canada (p = .02). Conclusions: MVPA and sedentary time appear to be optimal when the maximum temperature ranges between 20°C and 25°C in both countries. The findings have implications for study design and interpretation for surveillance and intervention studies. [ABSTRACT FROM AUTHOR]

This study examines the effects of the perceived congruity of recruitment advertisements and organizational image on organizational attractiveness. Based on Mandler's schema congruity theory (1982) and on recruitment research, we developed hypotheses and tested them on a sample of 1,091 individuals. The results show that recruitment advertisements that conform to the organization's image show a higher degree of attractiveness to applicants, particularly because these advertisements have higher resulting credibility than advertisements with low congruity. Furthermore, applicants' level of familiarity with the organization moderates the relationship between congruity and organizational attractiveness, as congruent recruitment advertisements lead to more positive effects for well-known organizations. This suggests that highly recognizable organizations should use congruent advertisements to unleash the full potential of their recruitment efforts. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate a communication skills program based on nonviolent communication targeted on inpatient alcoholics at the alcoholics specialized ward. Design and Methods: The sample for this mixed methods quasi‐experimental study comprised 47 patients who were hospitalized in the alcoholic wards of two psychiatric hospitals in South Korea. Findings: The program effectively improved participants' empathy, anger expression, communication competence, and alcohol abstinence self‐efficacy (p <.001). Practice implications: This program could be implemented in community‐based alcoholic care with the aim of preventing relapse and serve as the basis for developing similar programs for family members. [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]