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Background: Screen-based simulation is a cost-effective educational modality that allows nursing students to comfortably acquire new skills as they become accustomed to digital environments. The aim of this study is to evaluate the effectiveness of a screen-based simulation tool in enhancing knowledge and skills related to medication administration and dosage calculation in nursing students. Methods: This multicenter, single-blind, stratified, randomized controlled trial initially enrolled 480 nursing students. The 351 students eligibles were randomly allocated to two groups. Using a screen-based simulation tool (SIMDOSE®), the intervention group was trained in drug administration and dosage calculation through four perfusion clinical cases. The control group underwent the same training content using the paper-and-pencil method. knowledge and skills acquisition, Students' satisfaction, self-confidence and anxiety were analyzed using Jamovi software (version 2.3.18). Results: 4 out of 5 main variables examined were significantly different, specifically in dosage calculation, where the simulation group excelled both in the knowledge post-test (post – pre = 1.00 (20%); p = 0.004) and in the objective structured clinical examination (p = 0.013). The intervention group reported higher levels of satisfaction and self-confidence than the control group (p < 0.001). Their moderate anxiety levels didn't differ significantly (0.161). Conclusion: The SIMDOSE® platform can be used as a supplementary teaching method of dosage calculation for nursing students. Screen-based simulation has benefits that nurse educators should be aware of, such as being a key to more satisfied and confident students. Trial registration: This Moroccan clinical trial was prospectively registered (16/05/2023) in the Pan African Clinical Trial Registry (pactr.samrc.ac.za) with trial registration number PACTR202305505743210. [ABSTRACT FROM AUTHOR]

Background: The social culture, gender stereotypes, and social status of nursing in China impact the professional commitment of male nursing students. Increasing the professional commitment of male nursing students is critical for alleviating the shortage of nurses and addressing the gender gap. The outbreak of the COVID-19 pandemic has caused widespread public concern about the nursing profession and may have changed people's perception of the profession, which in turn may have a positive impact on the professional commitment of male nursing students in China. Objective: This research aimed to assess how the COVID-19 pandemic affected the professional commitment of male nursing students in China and to analyze the impact of the COVID-19 pandemic on potential factors that might affect their professional commitment. Methods: A descriptive comparative study was conducted. This study involved total 368 male nursing students from five 4-year universities in Henan Province, China. 190 male nursing students were included before the COVID-19 pandemic (October to November 2019) and 178 were included after the COVID-19 pandemic (April to May 2023). The data, such as the sociodemographic characteristics and professional commitment of the two samples, were collected using a paper-and-pencil questionnaire. The research instruments used included the Professional Commitment Scale, the Multidimensional Scale of Perceived Social Support and the General Self-efficacy Scale. The data analysis employed χ2-tests, t-tests and hierarchical regression models. Results: The proportion of Chinese male nursing students who are interested in nursing and do not intend to leave the major has increased after the pandemic (65.17% vs. 29.47%, 61.80% vs. 39.47%, respectively). Male nursing students exhibited greater professional commitment (3.30 ± 0.63) after the pandemic compared to before the pandemic (2.77 ± 0.43). The various factors, such as grade, intend to leave the major, interest in nursing, social support, and general self-efficacy, were linked to professional commitment of male nursing students in China. Conclusions: Male nursing students in China exhibited greater professional commitment after the pandemic. This phenomenon may be attributed to the public's increased recognition of the significance of nursing work during the pandemic, and the social status and image of nursing profession have been improved. Given the changes brought about by the COVID-19, strategies should be considered by nursing decision makers and schools to strengthen the professional commitment of male nursing students and increase the number of male nurses in the post-pandemic era. [ABSTRACT FROM AUTHOR]

Purpose: On average, about 50% of cancer patients use complementary and alternative medicine (CAM) in addition to conventional cancer treatment. Since there is a high need for information, patients often search for information about CAM and share experiences with peers, especially in self-help groups. In this study, we tested and evaluated an educational concept developed for group leaders of cancer self-help groups on how to approach the topic of CAM in their peer groups. Methods: The educational concept has been developed and piloted with health care professionals and representatives from different self-help organizations in Germany. It aims to inform and discuss the possibilities and limitations of CAM in terms of scientific evidence, to reflect user behavior, and to provide a guide on how to find and evaluate reliable and evidence-based information sources. First, self-help group leaders took part in an on-site training where they were educated on various CAM topics with the goal of being able to conduct the educational concept in their respective self-help groups. Then, the educated group leaders performed this concept in their groups. The educational concept was evaluated by both the group leaders and participants with respect to acceptance, usefulness, and satisfaction using paper-pencil questionnaires. The study was conducted in Germany based on an observational study design with a six-month follow-up. For the analyses, descriptive and univariate statistics for dependent samples were used. Results: A total of n = 50 interested group leaders conducted the educational program in their groups. The most common implementation barriers were organizational or structural problems, as well as the feeling of being overwhelmed with managing the program in their groups. A total of n = 423 participants were educated with this program by their respective group leaders. The majority felt satisfied with the educational program and improved their knowledge about CAM. At the six months follow-up (T2), significantly more participants had consulted their physicians to inform themselves about CAM and felt more confident in finding reliable information about CAM. Conclusions: In this observational study, we have managed to successfully implement an educational concept with respect to the topic of CAM in cancer self-help groups. Based on the results, the concept approach will be modified to include both a CAM- professional and group leader to train the self-help groups. In the future, the effects of the program should be tested by a randomized trial. [ABSTRACT FROM AUTHOR]

While undisputedly important, and part of any systematic review (SR) by definition, evaluation of the risk of bias within the included studies is one of the most time-consuming parts of performing an SR. In this paper, we describe a case study comprising an extensive analysis of risk of bias (RoB) and reporting quality (RQ) assessment from a previously published review (CRD42021236047). It included both animal and human studies, and the included studies compared baseline diseased subjects with controls, assessed the effects of investigational treatments, or both. We compared RoB and RQ between the different types of included primary studies. We also assessed the "informative value" of each of the separate elements for meta-researchers, based on the notion that variation in reporting may be more interesting for the meta-researcher than consistently high/low or reported/non-reported scores. In general, reporting of experimental details was low. This resulted in frequent unclear risk-of-bias scores. We observed this both for animal and for human studies and both for disease-control comparisons and investigations of experimental treatments. Plots and explorative chi-square tests showed that reporting was slightly better for human studies of investigational treatments than for the other study types. With the evidence reported as is, risk-of-bias assessments for systematic reviews have low informative value other than repeatedly showing that reporting of experimental details needs to improve in all kinds of in vivo research. Particularly for reviews that do not directly inform treatment decisions, it could be efficient to perform a thorough but partial assessment of the quality of the included studies, either of a random subset of the included publications or of a subset of relatively informative elements, comprising, e.g. ethics evaluation, conflicts of interest statements, study limitations, baseline characteristics, and the unit of analysis. This publication suggests several potential procedures. [ABSTRACT FROM AUTHOR]

Background: Dietary supplement (DS) use is common and increasing among older adults, though much data available on use frequencies are from surveys and performed cross-sectionally. This paper sought to assess the frequency and pattern of dietary supplement use among older adults over time. Methods: A secondary analysis of data from the AAA LongROAD study, a longitudinal prospective cohort study of older adult drivers, using data from baseline and the first two years of follow up included a total of 2990 drivers aged 65–79 years recruited at five study sites across the US from July 2015 to March 2017. Participants underwent baseline and annual evaluations, which included a "brown bag" medication review. DS were identified and categorized according to type and key components. Prevalence and pattern of DS use over time and relationship to demographics were measured with frequency and Chi squared analyses. Results: 84% of participants took at least one dietary supplement during the 2-year study period, and 55% of participants continually reported use. DS accounted for approximately 30% of the total pharmacologic-pill burden in all years. Participants who were White non-Hispanic, female, 75–79 years of age at baseline, and on more non-supplement medications took significantly more dietary supplements (P < 0.05). Vitamin D, multivitamins, calcium, and omega-3 formulations were the most common supplements, with stable use over time. Use of individual herbal supplements and cannabis products was uncommon (< 1% participants per year). Conclusions: DS use among older adults is common and relatively stable over time and contributes to polypharmacy. In clinical settings, providers should consider the influence of DS formulations on polypharmacy, and the associated cost, risk of medication interactions, and effect on medication compliance. [ABSTRACT FROM AUTHOR]

Introduction: In orthodontics, the triage system is used to assess the preadolescents to rule out interventions needed earlier and to assess the nature of orthodontic problems as complex or moderate. The objective of this study was to determine the knowledge and awareness of orthodontic triage and its uses among dental healthcare professionals (DHCP). Materials and methods: A triage awareness questionnaire (TAQ) was formulated and validated as reliable by a panel of five orthodontic specialists which was then circulated online among 400 DHCP. The questionnaire consisted of nine sections that assessed the current knowledge and usage of orthodontic triage among the dental community. Frequencies and percentages were reported for all categorical variables. Chi-square was used to assess the association among the variables. Results: The response rate was 28.2% with the majority of participants being general dentists. Regarding the knowledge and use of triage, 40% of DHCP were only familiar with the word "orthodontic triage" while being unaware of how it works and 79% denied using orthodontic triage. Regarding the management of anomalies, 42% of DHCP preferred extraction as the management of supernumerary teeth (p = 0.013). Practitioners belonging to private setups performed visual inspection in growing patients for assessment of their facial features (p = 0.012). Clinicians with more than one year of experience referred young patients to orthodontic specialists for the management of crossbite (p = 0.024). Younger clinicians (25–35 years) with more than one year of experience referred adult patients to orthodontists for correction of their unesthetic smile (p = 0.013). Conclusions: This paper provides foundational data for the development of future policies and protocols supporting structured, evidence-based approaches to patient management via use of orthodontic triage. This study underscores the importance of targeted educational interventions to enhance understanding and implementation of orthodontic triage principles in clinical practice. Further probing is necessary to discern the disparity between understanding the orthodontic triage and effective employment of its components among practicing dental healthcare professionals. [ABSTRACT FROM AUTHOR]

Informal healthcare providers (IHPs) often serve as the first point of contact for healthcare services for non-communicable diseases in urban slums and their ability to identify risk factors and symptoms of the diseases is crucial for early detection and management. This paper assesses level of knowledge of hypertension and diabetes mellitus (DM) among IHPs. A cross-sectional survey was conducted in eight slums in Enugu and Onitsha cities in south-eastern Nigeria. Data was collected from 238 IHPs including patent medicine vendors, traditional birth attendants, traditional bonesetters, and herbalists. Knowledge scores were computed for each respondent. Adequate knowledge was set at ≥ 50% score and inadequate knowledge at < 50%. Binary logistic regression analysis was used to identify factors/independent variables associated with adequate knowledge among IHPs. Independent variables in the regression model were seven items that describe the profile of IHPs and can influence their access to information on non-communicable diseases. Knowledge of risk factors and symptoms of hypertension and DM among IHPs was low since only 21 (8.82%) and 19 (7.98%) of them had adequate knowledge of hypertension and DM, respectively. In regression analysis, IHPs who had received formal training in the past demonstrated significantly higher levels of knowledge, with odds of adequate knowledge in hypertension being 14.62 times greater for trained providers, and the odds of adequate knowledge of both non-communicable diseases being 21.34 times greater for trained providers. Training of IHPs is needed to address the critical knowledge deficit of risk factors and symptoms of hypertension and DM. This would contribute to better health outcomes and reduced disease burden in urban slums. [ABSTRACT FROM AUTHOR]

Background: Preoperative education can improve postoperative quality of life in patients undergoing stoma surgery. However, the prevalence and when, where, and how preoperative education is implemented are unclear. Therefore, this study aimed to assess the current status of outpatient preoperative education for patients undergoing stoma surgery for rectal cancer as perceived by nurses. Additionally, it sought to identify the information provided by Japanese healthcare providers as a part of preoperative education. Methods: This cross-sectional study included 1,716 wound, ostomy, and continence nurses (WOCNs) in charge of stoma clinics at Japanese hospitals. Unsigned self-administered survey forms were mailed to the participants, and paper- or web-based responses were obtained. The main questions included: overview of the participants and their facilities, provision of outpatient preoperative education, status of implementation, and preoperative education components. To examine the factors associated with preoperative education, the independent variable was the presence or absence of preoperative education in the clinic, and the explanatory variables were the years of experience as a nurse, years of experience as a WOCN, type of hospital, number of beds, and number of intestinal stoma surgeries per year. Regression analysis was performed. Results: We received 773 valid responses (valid response rate: 45%). Duration of experience as a nurse and as a WOCN were 24.6 and 10.9 years, respectively. Outpatient preoperative education was provided by 24% of the participants. Most preoperative education sessions were conducted for patients or caregivers. Preoperative education took 31–60 min per patient, and one to five patients received preoperative education each month. Booklets, ostomy appliances, and stoma models/dolls were used as supplementary materials for preoperative education. The most frequently mentioned components of preoperative education were stoma care, daily life, social security, stoma clinic, traveling and going out, quality of life after stoma surgery, and precautions for medical treatment. In addition, education on the use of restrooms on the go, disaster preparedness, defecation disorders after restorative proctectomy, and complications after stoma closure were considered necessary. Conclusions: The implementation rate of outpatient preoperative education was low (24%). Future challenges include the development of specific educational content and procedures suitable for the Japanese medical environment and the establishment of preoperative medical care teams for stoma surgery to promote the provision of outpatient preoperative education. [ABSTRACT FROM AUTHOR]

Background: In Italy, there is a network of centres headed by the Italian Association of Pediatric Hematology and Oncology (AIEOP) for the diagnosis and treatment of paediatric cancers on almost the entire national territory. Nevertheless, migration of patients in a hospital located in a region different from that of residence is a widespread habit, sometimes motivated by several reasons. The aim of this paper is to assess the impact of migration of children with cancer to AIEOP centres in order to verify their optimal distribution throughout the national territory. Methods: To this purpose, we used information on 41,205 registered cancer cases in the database of Mod.1.01 Registry from AIEOP centres, with age of less than 20 years old at diagnosis, diagnosed from 1988 to 2017. Patients' characteristics were analysed and compared using the X2 or Fisher's exact test or Mann–Whitney test, when appropriate. Survival distributions were estimated using the method of Kaplan and Meier, and the log-rank test was used to examine differences among subgroups. Results: Extra-regional migration involved overall 19.5% of cases, ranging from 23.3% (1988–1997) to 16.4% (2008–2017) (p < 0.001). In leukaemias and lymphomas we observed a mean migration of 8.8% overall, lower in the North (1.2%) and Centre (7.8%) compared to the South & Isles (32.3%). In the case of solid tumours, overall migration was 25.7%, with 4.2% in the North, 17.2% in the Centre and 59.6% in the South & Isles. For regions with overall levels of migration higher than the national average, most migration cases opted for AIEOP centres of close or even neighbouring regions. Overall survival at 10 years from diagnosis results 69.9% in migrants vs 78.3% in no migrants (p < 0.001). Conclusions: There is still a certain amount of domestic migration, the causes of which can be easily identified: migration motivated by a search for high specialization, migration due to lack of local facilities, or regions in which no AIEOP centres are present, which makes migration obligatory. Better coordination between AIEOP centres could help to reduce so-called avoidable migration, but technical and political choices will have to be considered, with the active participation of sector technicians. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. Methods: The data collected from 479 Belgian practices during 2020–2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. Results: Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. Conclusions: Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care. [ABSTRACT FROM AUTHOR]

Background: Menstruation is a major physiological change in a woman's life, but lack of knowledge, poor practices, socio-cultural barriers, poor access to products and their improper disposal have significant consequences on health, dignity and well-being of women and adolescent girls. Objectives: This study aimed to assess the knowledge and practices related to menstrual health and hygiene amongst females of 10–49 years of age; explore the experiences and challenges of women during menstruation; and identify the key predictors of healthy menstrual health and hygiene. Methods: Using a cross-sectional study design, we adopted a mixed methods approach for data collection. For quantitative household survey, a total of 921 respondents were selected from three districts of Odisha. Qualitative findings through focus group discussions and in-depth interviews supplemented the survey findings and helped to identify the barriers affecting good menstrual practices. Epi data version 2.5 and R 4.2.2 was used for data entry and data analysis, respectively. Descriptive statistics was used to calculate proportion, mean and standard deviation; Chi square test was used to measure the association between categorical variables. Bivariate and multivariate logistics analyses were done to identify predictors of healthy menstrual health and hygiene. For qualitative data analysis, thematic analysis approach was adopted using software Atlas.ti 8. Results: For 74.3% respondents, mothers were the primary source of information; about 61% respondents were using sanitary pad. The mean age at menarche was 12.9 years and almost 46% of respondents did not receive any information about menstruation before menarche. Lower age and education up to higher secondary level or above had statistically significant associations with the knowledge about menstruation. Age, caste, respondent's education, mother's education, sanitation facility, availability of water, accessibility and affordability for sanitary pads were found to be strongly associated with good menstrual hygiene practices. Conclusion: Traditional beliefs regarding menstruation still persists at the community level. Educating mothers, increasing awareness about safe menstrual hygiene, providing adequate water and sanitation facilities and ensuring proper disposal of menstruation products need priority attention. [ABSTRACT FROM AUTHOR]

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

Background: While research has explored the risk of periodontal disease in various eye conditions, the link between dry eye and periodontal disease remains underexplored, especially in Japanese adults. This study aims to investigate the association between dry eye and periodontal disease in community-dwelling Japanese adults. Methods: This study is a subset of the Uonuma cohort study, which includes Japanese adults aged 40 years and older residing in the Uonuma area of Niigata Prefecture, Japan. Participants completed a self-administered, paper-based questionnaire. Statistical analyses, including the chi-square test, independent t test, ANOVA test, and logistic regressions, were employed to assess the association of periodontal disease with independent variables. Results: Among 36,488 participants (average age 63.3 years, 47.4% men), 39.3% had a history of periodontal disease, and gender differences were statistically significant (p < 0.001). Significant associations were found between periodontal disease and dry eye diagnosis or symptoms. Univariable logistic regression revealed links between periodontal disease and age, gender, living status, alcohol consumption, remaining teeth, bite molar availability, and history of dry eye disease or symptoms. Multiple-adjusted regression found that doctor-diagnosed dry eye was associated with a higher likelihood of periodontal disease (odds ratio, 1.12; 95% confidence interval, 1.03–1.22). Participants who never experienced dryness or foreign body sensation had lower ORs of periodontal disease than those who always experienced such symptoms across all models. Conclusion: A significant correlation was found between dry eye and periodontal disease in Japanese adults. Regular check-ups, early detection, and effective management of both conditions are strongly recommended. [ABSTRACT FROM AUTHOR]

Introduction: Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods: This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration. Results: The quantitative results found that women achieved "at target" glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery. Conclusions: The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women's mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. Methods: This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. Results: A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005]. Conclusion: Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Molar–incisor hypomineralization (MIH) is a qualitative enamel defect that is highly prevalent in children. It has been reported that patients with MIH have higher caries occurrence with an increased need and frequency of dental treatment compared to patients without MIH. The objective of this study was to analyze the association between MIH and a series of factors related to maternal health status during pregnancy and children´s medical history in early childhood. Methods: A retrospective study of cases (patients with MIH) and controls (patients without MIH) was designed between 2023 and 2024. A total of 280 children (cases = 140; controls = 140) aged 6 to 14 years (138 boys and 142 girls) were examined according to the European Academy of Pediatric Dentistry (EAPD) criteria for MIH. A survey was carried out with mothers regarding the potential exposure of their children to etiological factors of MIH. Possible prenatal and postnatal etiological factors were obtained through a personal interview with the patients' mothers. The statistical analysis was carried out with the contrast test and the chi-square test. Results: During pregnancy, folic acid consumption, alcohol intake, systemic viral and/or bacterial infections, and gestational diabetes were statistically significantly related to MIH, as were breastfeeding, asthma, and corticosteroid consumption during childhood. Conclusions: Although there are different factors that may have statistically significant relationships with MIH, they cannot be predicted. Therefore, longitudinal studies, with a large sample size, are needed to determine the influence of prenatal and postnatal factors on the prevalence and severity of MIH in children. [ABSTRACT FROM AUTHOR]

Background: Submicroscopic Plasmodium infections can be a source of persistent malaria transmission. The aim of this study was to assess their frequency, distribution, morbidity and associated factors in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau, where the Plasmodium falciparum is the predominant Plasmodium species. Methods: Dried fingerprick whole blood samples from 601 participants in the 2017 national, household-based, cross-sectional survey to estimate malaria prevalence were subjected to DNA extraction. The DNA was used in nested end-point PCR assays targeting genus- and species-specific regions of the Plasmodium 18S rRNA genes. Statistical analysis of socio-demographic, clinical and molecular data was carried out using the Statistical Package for the Social Sciences, version 29. Factors associated with submicroscopic P. falciparum infections and their magnitude were sought using Chi-square test and multiple logistic regression models, respectively. Statistically significant level was considered at P-value < 0.05. Results: Nested PCR assays detected submicroscopic P. falciparum infections in 20.3% (95% CI = 16.8–23.8) of individuals microscopically negative for Plasmodium species in the general population and in 21.4% (95% CI = 9.9–36.5) of microscopically negative pregnant women. Submicroscopic Plasmodium malariae infections were also detected as co-infections in 3.0% individuals who were microscopically positive only for P. falciparum. Infections with other Plasmodium species were not detected. Submicroscopic P. falciparum infections were not associated with age, sex, or the presence of fever. A logistic regression model adjusted for ethnicity and health region showed that individuals from the Balanta and Bijagos ethnic groups, most of whom live in the low malaria-transmission areas of Quinara and Bissau, and the Bijagos archipelago, respectively, were less likely to have submicroscopic P. falciparum infections than individuals from the large Fula ethnic group, most of whom live in the high malaria-transmission area of Gabu. Submicroscopic P. falciparum infections were not associated with anaemia in children under 5 years of age. Conclusion: The results obtained highlight the contribution of asymptomatic and submicroscopic P. falciparum infections to malaria transmission in high malaria-transmission areas and the need for molecular-based tools to detect submicroscopic Plasmodium species. [ABSTRACT FROM AUTHOR]

Background: To explore the association between periodontitis and all-cause as well as cause-specific mortality rates in U.S. adults with hyperlipidemia. Methods: Participants were extracted from NHANES during 1988–1994, 1999–2004 and 2009–2014 periods. To assess the association between moderate-to-severe periodontitis and mortality rates for both all-cause and cause-specific mortality, hazard ratios (HRs), time ratios (TRs), and their respective 95% confidence intervals (CIs) were calculated using Cox proportional hazards and Weibull accelerated failure time (AFT) models. Results: Over a median follow-up duration of 11.83 years, 4,623 deaths of 16,848 participants were recorded. Multivariate Cox regression and AFT analyses showed moderate-to-severe periodontitis were associated with an increased risk of all-cause (HR: 1.31, 95% CI: 1.20–1.44, P < 0.001; TR: 0.85, 95% CI: 0.80–0.90, P < 0.001), cardiovascular disease (CVD)-related (HR: 1.36, 95% CI: 1.14–1.63, P = 0.001; TR: 0.83, 95% CI: 0.75–0.92, P < 0.001) and cancer-related mortality (HR: 1.35, 95% CI: 1.12–1.63, P = 0.002; TR: 0.82, 95% CI: 0.72–0.93, P = 0.002). Meanwhile, there was a significant upward trend in the risk of mortality with increasing severity of periodontitis (P for trend < 0.001). Conclusions: Our study highlights the moderate-to-severe periodontitis is associated with an increased risk of all-cause, CVD-related and cancer-related mortality among U.S. adults with hyperlipidemia. And the mortality risk increasing alongside the severity of periodontitis. [ABSTRACT FROM AUTHOR]

Background: It is very important to provide the correct nursing care for patients with intracerebral hemorrhage (ICH), but the level of critical care needs in patients with intracerebral hemorrhage is not clear. The purpose of this study is to establish a risk model based on the epidemiological and clinical characteristics of ICH patients, to help identify the critical care needs of ICH patients. Methods: The clinical data of ICH patients from January 2018 to September 2023 were analyzed retrospectively. The full cohort was used to derive the clinical prediction model and the model was internally validated with bootstrapping. Discrimination and calibration were assessed using the area under curve (AUC) and the Hosmer-Lemeshow tests, respectively. Results: 611 patients with ICH were included for model development. 61.21% (374/611) ICH patients had received critical care interventions. The influencing factors included in the model were Glasgow Coma Scale (GCS) score, intraventricular hemorrhage, past blood pressure control, systolic blood pressure on admission and bleeding volume. The model's goodness-of-fit was evaluated, which yielded a high area under the curve (AUC) value of 0.943, indicating a good fit. For the purpose of model validation, a cohort of 260 patients with ICH was utilized. The model demonstrated a Youden's index of 0.750, with a sensitivity of 90.56% and a specificity of 78.22%. Conclusion: GCS, systolic blood pressure, intraventricular hemorrhage, bleeding volume and past blood pressure control are the main factors affecting the critical care needs of patients with ICH. This study has deduced a clinical predictive model with good discrimination and calibration to provide scoring criteria for clinical health care providers to accurately evaluate and identify the critical care needs of ICH patients, to improve the rational integration and allocation of medical resources. [ABSTRACT FROM AUTHOR]

Background: With the evolution of disease patterns and the continuous pursuit of persons for high-quality nursing services, new nurses are the reserve talents of the nursing team and shoulder a major mission. However, due to their low work performance and high turnover rate, this is not conducive to the stable development of nursing teams, and it is urgent to solve this problem. The purpose of this study was to explore the effect of work readiness on the work performance of new nurses, focusing on the mediating role of organizational justice and professional identity. Method: A cross-sectional design was employed. Using convenience sampling methods, 607 new nurses were surveyed in 5 hospitals in Henan Province, China, from January to February 2023. Data were collected using demographic characteristics questionnaire, the Work Performance Scale, the Work Readiness Scale for Graduate Nurses, the Organizational Justice Scale, and the Professional Identity Rating Scale for Nurses. AMOS 26.0 was used for model drawing and mediation path testing, and SPSS 25.0 was used for data analysis. Results: The mediation model shows a good fit (χ2 /df = 2.747, CFI = 0.987, GFI = 0.948, AGFI = 0.926, TLI = 0.984, IFI = 0.987, and RMSEA = 0.054). In this study, we found professional identity is a mediating variable between work readiness and the work performance of new nurses (β = 0.113, P<0.01), organizational justice is a mediating variable between work readiness and the work performance of new nurses (β = 0.269, P<0.01) and Organizational justice and professional identity play a chain mediating role in work readiness and work performance (β = 0.066, P<0.01). Conclusions: The study highlights the importance of improving the work performance of new nurses. To improve work performance, managers should create a fair atmosphere, formulate transparent policies, improve the organizational justice of new nurses, and promote the professional identity and work readiness of new nurses by holding activities or conducting lectures. This will help stabilize the nursing team, improve the medical environment, stimulate the work enthusiasm of new nurses, and contribute to the development of the hospital. [ABSTRACT FROM AUTHOR]

Background: Transgender patients often cannot access a provider who is knowledgeable about providing gender-affirming hormone therapy (GAHT). This study evaluated primary care provider (PCP) comfort and experience with, opinions about, and knowledge of prescribing GAHT to adults. Methods: An anonymous Qualtrics survey was distributed to PCPs in San Diego County. Fisher's exact test assessed any association between age, years in practice, or practice setting and 1) comfort in prescribing GAHT and 2) favorable statements about learning about, providing, and benefitting from training in GAHT. T-tests determined relationship between age, years in practice, or practice type setting with number of correctly answered multiple choice knowledge-based questions out of 4. Results: Out of 220 responses, median age was 41, 60% had practiced for ≤ 10 years, and 19% had practiced in an academic setting. Forty-two percent did not receive any education about transgender healthcare during medical training. The most commonly reported barrier to providing GAHT was lack of training (74%). PCPs age ≤ 41 (67% vs 49%, p = 0.009), PCPs practicing for ≤ 10 years (65% vs 51%, p = 0.037), and PCPs in non-academic settings (64% vs. 41%, p = 0.013) were more likely to report being comfortable with prescribing GAHT. PCPs age ≤ 41 (89% vs 62%, p < 0.001) and PCPs practicing for ≤ 10 years (86% vs 66%, p < 0.001) were more likely to show interest in learning about GAHT. PCPs age ≤ 41 (74% vs 46%, p < 0.001) and PCPs practicing for ≤ 10 years (70% vs 50%, p = 0.003) were more likely to show interest in prescribing GAHT. Knowledge scores were higher for PCPs age ≥42 (mean 1.7 vs 1.4, p = 0.033) and PCPs working in academic centers (mean 2.0 vs 1.4, p = 0.002). Conclusion: Younger (age ≤ 41) and early career (practicing for ≤ 10 years) PCPs reported being more comfortable with prescribing GAHT and had more favorable opinions in learning about, providing, and benefitting from training in GAHT. They are interested in providing GAHT; however, few prescribe GAHT with most reporting lack of training as a major barrier. This was evident with overall low knowledge scores regardless of age, experience, or clinical setting and underscores the need for increased educational efforts in transgender care throughout medical training. [ABSTRACT FROM AUTHOR]

This post hoc analysis explored the age-specific risk of cervical precancer in women infected with human papillomavirus (HPV), using data from a cohort of 7263 participants aged 21-71years undergoing cervical screening. We found a slightly varied prevalence of high-risk HPV (hrHPV) in different age, with highest in women under 30 years old (9.28% for 13 hrHPVs tested by HC2-HPV, 10.82% for 14 hrHPVs tested by DH3-HPV). However, the prevalence of cytology abnormalities peaked in age 30–39 years (~ 3.6%). A total of 5840 women completed 3-year follow-up. Among them, 558 were positive for HC2 assay and 583 were positive for DH3-HPV at baseline. Of note, the 3-year cumulative risks for cervical intraepithelial neoplasia grade 2+ (CIN2+) or grade 3+ (CIN3+) in women infected with high-risk HPV did not increase with age but declined (e.g., 41.67%, 27.78%, 26.42%, 15.98%, and 18% for CIN2 + risk in HC2-positive women at year 25–29, year 30–39, year 40–49, year 50–59, and year 60–71, respectively). If stratified by the median age, younger women (25–48 years) positive with HC2-HPV at baseline had a higher 3-year CIN2+/CIN3 + risk than older women (49–71 years) [26.55% (95%CI = 21.8-31.92%) vs. 18.28% (95%CI = 14.11-23.34%), P = 0.019; 15.52% (95%CI = 11.81-20.14%) vs. 9.7% (95%CI = 6.71-13.83%), P = 0.039]. Similarly, for women positive with DH3-HPV at baseline, younger group had a higher 3-year CIN2+/CIN3 + risk than older group [26.44% (95%CI = 21.73-31.75%) vs. 17.01% (95%CI = 13.11-21.78%), P = 0.006; 15.25% (95%CI = 11.6-19.8%) vs. 9.03% (95%CI = 6.24-12.9%), P = 0.021]. These findings indicate the potential value of age-specific risk assessment in cervical cancer screening. [ABSTRACT FROM AUTHOR]

Background: With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies. Objective: This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS. Methods: A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute. Results: The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them. Conclusion: The chronic disease patients' preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients' demand in different regions. [ABSTRACT FROM AUTHOR]

Background: A thorough psychosocial assessment is time-consuming, often requiring multiple sessions to uncover the psychological factors contributing to mental illness, such as depression. The duration varies depending on the severity of the patient's condition and how effectively the psychotherapist can establish rapport. However, prolonged assessment periods pose a significant risk of patient deterioration. Methods: The comprehensive psychosocial intervention, led by the Multi-Criteria Decision-Making (MCDM) approach utilizing the Multi-Objective Optimization by Ratio Analysis (MOORA) method, played a pivotal role in identifying the key psychological factors contributing to the depression of the client among the 21 factors specified by BDI-II analysis. Results: The integration of the MOORA strategy compared to traditional psychotherapy on 254 samples demonstrates a Jaccard similarity coefficient of 0.8, with a minimum error margin of 7% (vulnerability index = 0.57), indicating a significant agreement between the two approaches, both converging towards a similar solution. For patients with extreme depression, the number of sessions reduced from 18 ± 2 to 11 ± 2, showing a 33–35% reduction (χ2 = 6.94, p = 0.008). Severe depression patients experienced a reduction from 14 ± 2 to 8 ± 1 sessions i.e., 34–39% reduction (χ2 = 8.32, p = 0.004). Moderate depression patients saw sessions drop from 9 ± 1 to 5 ± 1, i.e., 37–43% reduction (χ2 = 0.29, p = 0.001). The accuracy for detecting dominant psychological factors improved to 82.88% for extreme, 86.74% for severe, and 90.34% for moderate depression, respectively. Conclusion: The implementation of MOORA facilitated the identification and prioritization of key psychosocial intervention strategies, making the process significantly faster compared to traditional methods. This acceleration greatly enhanced the precision and efficacy of the work. Additionally, critical vulnerable factors were identified through ordered statistics and correlation analysis [Pearson (r) = 0.8929 and Spearman's rank (ρ) = 0.7551] on the Beck Depression Inventory-II model. These findings were supported by other MCDM schemes such as EDAS and TOPSIS, demonstrating high stability and robustness in dynamic decision-making environments, maintaining consistency across scenarios adapted by different psychotherapists. Overall, the combined application of MCDM (MOORA) and targeted psychological interventions yielded substantial positive outcomes in enhancing the well-being of individuals with psychological illnesses, such as depression, cognitive, affective, and somatic syndromes. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of Balint Group in improving stress, negative mood and empathy of psychiatric nurses. Method: In March 2022-March 2023, 150 psychiatric nurses from four hospitals in Lanzhou were selected for the study, randomly grouped into experimental group and control groups (75 per group), the experimental group participated the Balint Group activities biweekly, the control group only attended mental health knowledge lectures. Job stress, negative emotion and empathy of the two groups before and after the intervention were evaluated and compared by using job stressor Scale, coping style Assessment Scale, self-assessment scale for depression, self-assessment Scale for anxiety and Jefferson Empathy Scale. Results: After intervention, the job stressor scale and coping style evaluation of nurses in the two groups were significantly decreased, and the experimental group was lower than the control group (P < 0.05). The depression and anxiety of nurses in the two groups were significantly improved, and the experimental group was better than the control group (P < 0.05). The differences in the total score and dimensions of Jefferson Empathy scale in the experimental group after intervention were higher than those in the control group (P < 0.05). Conclusion: Balint group activities can effectively relieve the stress, depression and anxiety of psychiatric nurses, and improve the ability of empathy at work. [ABSTRACT FROM AUTHOR]

Background: Pulse oximetry is a standart of anesthesia for perioperative monitoring. Due to the principles of Hb oxygen dissociation curve, peripheral oxygen saturation has an approximate sensitivity and specificity of 90% for the detection of hypoxemia. Objectives: The primary outcome of the study was to evaluate ORiⓇ as an early parameter to determine hypoxia in morbidly obese patients. The secondary outcome was to compare the effectiveness of ORiⓇ with SpO2 in non-obese patients. Design: Prospective, observational study. Setting: Department of elective operating room at tertiary hospital. Patients and methods: Observational study included written informed consent from 51 patients with 19 < BMI < 25 kg/m2 and 51 patients with BMI > 40 kg/m2 undergoing an elective surgery requiring tracheal intubation. In addition to standard monitors, an ORi sensor was placed and baseline values were recorded. The patients were preoxygenated until end tidal expiratory oxygen concentration is reached to 90%. After anesthesia induction and tracheal intubation, the breathing circuit was not connected tracheal tube until the SpO2 decreased to 95%. Shapiro-Wilk, Pearson Chi-square, t-test, and Mann Whitney U test were used for the study. Main outcome measures: Times of tolerable apnea, ORiⓇ and SpO2 values at the end of preoxygenation, beginning of intubation, beginning of the ORi alarm, when SpO2 reached 95%, and when ORi reaches a plateau. Sample size: 102 patients. Results: The alert period: time to reach ORiⓇ from 0.24 to a value of 95% SpO2 was observed as 32 s in morbidly obese patients and 94 s in patients with a normal body mass index. The SpO2 alert period was determined as time difference between 97% and 95% SpO2. The data were recorded as 15 s and 36 s, respectively. It was observed that tolerable apnea, ORiⓇ, SpO2 and added alert times were longer in patients with normal BMI compared to morbidly obese patients. Conclusions: As a result, ORiⓇ can provide an early warning to prevent unexpected hypoxia before saturation begins to decrease in morbidly obese patients. Limitations: Inability to perform arterial blood gas sampling in the time periods when we looked at the parameters to determine the relationship between ORiⓇ and PaO2. Clinical trials. gov identifier: NCT05480748 registered 2022-07-29. [ABSTRACT FROM AUTHOR]

Background: This study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions. Methods: We conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1). Results: The MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05). Conclusions: In children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were twofold: (1) to compare gait characteristics between cerebral small vessel disease (CSVD) patients with low-risk oral frailty (OF) and high-risk OF, particularly during dual-task walking (DTW); (2) to investigate the association of OF, the gait characteristics of DTW, and falls among older adults patients with CSVD. Methods: A total of 126 hospitalized patients diagnosed with CSVD were recruited and classified into a low-risk group (n = 90) and a high-risk group (n = 36) based on OF status in our study. Comprehensive data pertaining to basic parameters (cadence, as well as stride time, velocity and length), variability, asymmetry, and coordination were gathered during both single-task walking (STW) and DTW. Additionally, the number of falls was calculated. Subsequently, t-test or chi-squared test was used for comparison between the two groups. Furthermore, linear regression analysis was employed to elucidate the association of the OF index-8 score and gait parameters during cognitive DTW. Also, logistic regression models were utilized to assess the independent association of OF risk and falls. Results: During cognitive DTW, the high-risk group demonstrated inferior performance in terms of basic parameters (p < 0.01), coefficient of variation (CV) of velocity and stride length (p < 0.05), as well as phase coordination index (PCI) when compared with the low-risk group (p < 0.05). Notably, differences in basic gait parameters were observed in cognitive DTW and STW conditions between the two groups (p < 0.01). However, only the high-risk group evinced significant variations in CV and PCI during cognitive DTW, as opposed to those during STW (p < 0.05). Furthermore, our findings also revealed the association of OF, the gait characteristics of cognitive DTW, (p < 0.01) and falls (p < 0.05). Conclusion: CSVD patients with a high risk of OF need to pay more attention to their gait variability or coordination. Also, they are recommended to undergo training involving dual-task activities while walking in daily life, thereby reducing the deterioration and mitigating the risk of falls. Besides, this study has confirmed an association of OF and DTW gait as well as falls in patients with CSVD. [ABSTRACT FROM AUTHOR]

Background: Most medical organizations accept many nursing students each year who gain clinical practice skills under the supervision of clinical nurses. However, there are no assessment tools to measure the contributions nursing students make to the clinical setting during clinical practicum. This study aimed to translate the 'Nursing Student Contributions to Clinical Settings' scale into Chinese and test its reliability and validity from the perspective of Chinese clinical nurses. And to explore whether nurses' personal and professional characteristics are related to nurses' perception of nursing students' contributions to the clinical settings. Methods: The original scale was translated into Chinese following the Brislin translation model. A convenience sample of 935 clinical nurses was selected from January to March 2024 for the survey. The content validity of the scale was assessed by expert consultation and content validity index. Exploratory factor analysis and confirmatory factor analysis were performed to assess the construct validity of the scale. The reliability of the scale was measured using internal consistency, split-half reliability, and test–retest reliability. The measurement quality of the scales was assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments. One-way analysis of variance was used to identify variables related to students' contributions. Results: The content validity index of the scale was 0.983. Exploratory factor analysis supported a one-factor structure, and the cumulative variance contribution was 71.177%. Confirmatory factor analysis showed that the model fit indicators were all within the acceptable range. The McDonald's Omega coefficient and Cronbach's alpha coefficient for the scale were 0.983. Nurses perceive that nursing students' contribution to the clinical settings is influenced by nurses' personal characteristics, professional characteristics, and the hospital environment. Conclusion: The Chinese version of the Nursing Student Contributions to Clinical Settings scale has good reliability and validity and can effectively and reliably measure the contributions of Chinese nursing students to clinical settings. [ABSTRACT FROM AUTHOR]

Background: Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events. Methods: We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories. Results: Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more). Conclusions: While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices. Methods: This study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05). Results: A significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%). Conclusions: The findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures. [ABSTRACT FROM AUTHOR]

Background: Although the co-occurrence of psychotic experiences (PEs) and psychological distress symptoms is growingly recognized in several previous studies, there is still a lack of literature, which clearly outlines how these two psychopathological entities affect each other over time. This study is intended to add to the literature by examining: (a) the longitudinal, bidirectional associations between PEs and psychological distress in a sample of Tunisian adolescents, and (b) whether these associations are moderated by sex. Methods: 510 adolescent students (mean age of 16.05 ± 1.01 years, 61.2% females) took part in a prospective longitudinal study. PEs and psychological distress were measured at three occasions over a one-year period. The cross-lagged panel modeling approach was adopted. Results: The current results showed that the experience of PEs at baseline tended to temporally precede prospective increases in psychological distress (at 6 months), which had in turn led to further exacerbation of psychological distress at 12 months of follow-up. Temporally primary psychological distress symptoms were not a significant predictor for the development of later psychotic symptoms in the whole sample. However, temporal patterns between adolescent distress and psychotic symptoms differed for girls and boys. Endorsing PEs at baseline was followed by greater psychological distress at 6 months, which was in turn associated with a significant increased risk of subsequent exacerbation of PEs at 12 months in boys, whereas psychological distress at 12-month follow-up was significantly predicted by pre-existing PEs in girls. Conclusion: These findings suggest that clinicians and support workers are recommended to take into account different social risk profiles for boys and girls when considering interventions to address PEs and distress in adolescents. [ABSTRACT FROM AUTHOR]

Background: Dietary supplements are commonly used by older adults, but their inappropriate use may lead to adverse events. To optimise medication use, general practitioners (GPs) ideally are aware of all substances that patients use, including supplements. This cross-sectional study explored the use of dietary supplements by older patients with polypharmacy, the rate at which they disclosed this use to their GPs, and compared patients' and GPs' attitudes towards discontinuing dietary supplements. Methods: Ten GPs in Swiss primary care recruited five to ten of their older patients taking ≥ 5 regular medications. Both GPs and their patients completed a survey on patients' use of dietary supplements and attitudes towards deprescribing those. We described and compared their responses. We assessed the association of supplement disclosure with patient characteristics using multilevel logistic regression analysis. Results: Three out of ten GPs (30%) were female, and GPs' average age was 52 years (SD = 8). 45% of patients were female (29/65). Most patients (n = 45, 70%) were taking ≥ 1 supplement. On average, patients reported to be using three supplements (SD = 2). In 60% (n = 39) of patients, GPs were unaware of ≥ 1 supplement used. We did not find evidence for an association between supplement disclosure to GPs and patient characteristics. Only 8% (n = 5) of patients and 60% (n = 6) of GPs reported ≥ 1 supplement they would be willing to deprescribe and none of the supplements reported by GPs and patients to deprescribe matched. Conclusion: Swiss GPs were unaware of many dietary supplements used by their older patients, which may affect medication optimisation efforts. [ABSTRACT FROM AUTHOR]

Introduction: E-cigarettes smoking is a global health concern due to its associated risks and unexpected rise in e-cigarette smoking among adults and nonsmokers. This study aims to investigate gender differences in e-cigarette knowledge, attitude, and practice among adults in Bahrain. Methods: The data was collected using an online questionnaire covering demographics, knowledge, attitude, and practice. Data were analyzed using SPSS software, reporting mean and SD for continuous variables, frequencies, and percentages for categorical variables. A chi-square test was conducted to assess the association between variables and gender with a significance level of p < 0.05. Results: A total of 555 participants completed the questionnaire, with the majority being females (66.8%), with a mean age of 31 (SD 8.5). Among respondents, 23.2% were smokers with a higher percentage of male smokers 58.7% compared to female smokers 5.7%. E-cigarette smoking was prevalent among 18% of participants, with 86% of them being male e-cigarette smokers compared to 14% of female e-cigarette smokers. The chi-square test showed that there was statistical significance between males and females when it comes to knowledge and attitudes toward e-cigarette smoking (p = 0.000). Males have inadequate knowledge and positive attitudes toward e-cigarette smoking compared to females. There was no statistical difference in the analysis of practice between both genders. Conclusion: E-cigarette smoking is very prevalent among adults in Bahrain, especially among males. Educational interventions and robust laws and policies should be implemented to address this issue and contribute to improving community health. [ABSTRACT FROM AUTHOR]

Background: Quantifying the professional ethical challenges that nurses encounter is crucial for both theoretical insights and practical outcomes. The objective of this research is to assess the psychometric properties of the Chinese adaptation of the Moral Distress Scale for Healthcare Professionals (MD-APPS). Methods: In 2024, a survey approach was utilized to engage with several tertiary-level healthcare institutions throughout China. A cohort of 448 nursing professionals who satisfied the specified selection benchmarks was consequently incorporated into the study. To evaluate the scale's reliability and validity, methods including the Content Validity Index (CVI), Factor Analysis—both Exploratory (EFA) and Confirmatory (CFA)—alongside assessments of internal consistency and test-retest reliability were employed. Results: Expert evaluations yielded an I-CVI of 0.90, suggesting good content validity for the MD-APPS's Chinese adaptation. Exploratory Factor Analysis (EFA) revealed a bi-dimensional framework with 7 components, explaining 56.34% of the cumulative variance. Confirmatory Factor Analysis (CFA) outcomes displayed a χ-square/df ratio of 1.542. The estimate for Robust RMSEA was 0.054, and the SRMR was ascertained to be 0.041. Indices for both Robust TLI and Robust CFI surpassed the 0.9 threshold, indicating an acceptable fit; this aspect was supported by a P-value (Chi-square) of 0.094. The internal consistency, measured by Cronbach's α, was found to be 0.74, while the test-retest reliability over a two-week period reached 0.964. These findings provide initial evidence for the psychometric properties of the Chinese MD-APPS. Conclusion: The Chinese adaptation of the MD-APPS demonstrates promising initial psychometric properties, suggesting its potential suitability for exploring nurses' professional ethical challenges within the Chinese cultural context. This scale may facilitate the identification of diverse elements influencing nurses' professional ethics and the assessment of the ethical climate in nursing practices. However, further validation studies are needed to fully establish its psychometric robustness across various healthcare settings in China. [ABSTRACT FROM AUTHOR]

Background: Patients diagnosed with gynecological cancers often face a range of complications that can impact their quality of life and increase their anxiety. Nursing models combined with mobile phone applications have the potential to improve outcomes for these patients. This study aimed to assess the impact of a continuous care model utilizing a smartphone application on quality of life and anxiety levels among gynecologic cancer patients. Methods: This study involved two phases: (1) mobile App development and (2) implementation of the intervention. The two-group randomized controlled trial included 70 participants with gynecological cancers referred to medical centers affiliated with Shahrekord University of Medical Sciences in 2023. The participants were randomized into control or intervention groups (n = 35 per group). Finally, 68 patients completed the trial. The intervention group received an 8-week intervention incorporating the continuous care model, whereas the control group received routine care (the standard support provided by nurses both during and after hospitalization). The participants completed the Spielberger state-trait anxiety and quality of life (QLQ-C30) questionnaires before, immediately after, and two months after the intervention. The data were analyzed via the chi-square test, independent samples t test, analysis of covariance, and repeated-measures ANOVA. Results: There were no significant differences in the baseline data between the two groups. However, after the intervention, the intervention group reported a significant increase in quality of life, with mean scores rising from 68.90 ± 17.50 to 73.78 ± 16.79 immediately after the intervention and to 80.61 ± 9.90 at the two-month follow-up. In contrast, the control group showed no significant improvement. Additionally, state anxiety significantly decreased in the intervention group from 51.64 ± 14.97 to 40.20 ± 11.70 at the follow-up, and trait anxiety scores in the intervention group decreased significantly from 49.91 ± 14.96 to 39.82 ± 10.28 at the follow-up, whereas the scores of the control group worsened. Conclusion: The intervention improved quality of life and reduced anxiety in patients with gynecological cancers. Given the scant attention given to mobile application-based follow-up in gynecologic cancer patients in previous studies, this approach can be incorporated into routine care to support patients, and it is recommended for nurses, health care providers, and physicians. Trial registration: The study was registered as a randomized controlled trial in the Clinical Trial Registration Center of Iran. Registration Date: 2024-02-14, Registration Number: IRCT20231107059977N1. [ABSTRACT FROM AUTHOR]

Background: The Otago Exercise Programme is an effective intervention for falls prevention. However, there is limited evidence in relation to studies that compare efficacy for falls prevention when delivered Otago Exercise Programme in a group or individual format in a primary care context. Objective: To compare the Otago Exercise Programme delivered as a group vs. individual format for community dwelling older adults, over a one year period. The hypothesis was that neither format would be inferior to the other. Methods: Design: A four-year multicentre, randomized, non-inferiority clinical trial, with two arms— Otago Exercise Programme group training and individual Otago exercise training. Setting(s): 21 primary healthcare centers. Participants: A sample size of 728 participants was established. Participants were aged between 65 and 80 years; living in the community; able to walk independently; and agreed to take part in the study and provided signed informed consent. Intervention: The Otago Exercise Programme was delivered mainly by nurses in primary care, with five face to face sessions, and a reinforcement 6 months later. Participants were encouraged to exercise at home between face to face sessions. Data collection: at baseline and after 6 and 12 months from October 2017 to 2020. Primary outcome: people who reported at least one fall. Secondary outcomes: number of falls, cause of falls, consequences and assistance, adherence and satisfaction. Group allocation was blinded to the researchers involved in analysis. Reporting: Consolidated Standards of Reporting Trials recommendations for the Statement for Randomized Trials of Nonpharmacologic Treatments. Results: Eight hundred twenty-seven participants were randomized (226 were allocated in group training and 272 in individual training). The analysis of the proportion of people who reported at least one fall and number of falls showed no differences between individual and group training. Assessment of the equivalence between the interventions at 12 months showed that the confidence interval for the difference of people who reported at least one fall was found to be within the equivalence limit of 10% considered. However, in those participants with a previous history of falls, group format showed potentially greater benefit. The participants in individual training presented higher scores on the Exercise Adherence Rating Scale test. No differences were found in satisfaction between the groups. Conclusions: The group Otago Exercise Programme is equivalent to individually delivered Otago Exercise Programme in terms of prevention of falls over a 12-month follow up. Adherence was higher in individual training. Implications: Healthcare professionals could offer either Otago Exercise Programme format dependent on patient preference and be confident that that standardized intervention provides patient benefit. Trial Registration: ClinicalTrials.gov (NCT03320668). Data registration 31/10/2017. [ABSTRACT FROM AUTHOR]

Background: Hand hygiene (HH) is recognized as an important measure to avoid the transmission of harmful germs, and assists significantly in preventing healthcare-associated infections. HH compliance among health care workers (HCWs) is a result of their knowledge and perceptions. Aim: To investigate the knowledge and perceptions of WHO hand hygiene guidelines among HCWs, and the perceived barriers to compliance with hand hygiene in a major public hospital in Cyprus. Methods: A descriptive correlational study was conducted in September of 2019. The target population was all of the HCWs in Nicosia General Hospital (N = 1,386). The final sample consisted of 820 participants (119 physicians, 613 nurses, 27 physiotherapists, 59 ward assistants, 2 unidentified). This study used the HH knowledge and perception questionnaire that was developed by the WHO. Results: The results revealed that the average percentage score for knowledge among our sample was 61%, and statistically significant differences were observed among HCWs with regard to certain questions. It was found that HCWs, in most of their responses, presented high percentages of correct answers regarding their perceptions on hand hygiene guidelines but several perceived barriers to compliance on HH guidelines were identified as well. Conclusions: Knowledge and perceptions of HH guidelines among HCWs were moderate and good respectively. In addition, several perceived barriers to compliance on HH recommendations were identified. HH education is recognized as an important tool for removing these barriers but the recommended HH strategy should be multi-modal and consider local resources, administrative support and barriers to compliance with HH. [ABSTRACT FROM AUTHOR]

Background: Organizational agility is the cornerstone of the complex dynamics for the success of healthcare organizations and the sustenance of nurses' career planning and professional development. Aim: Assess the organizational agility and the extent of nurses' career planning. It also sought to investigate the association between the two and the intermediating function that nurses' grit plays in this association. Design: A cross-sectional descriptive design following STROBE guidelines was carried out. Methods and tools: Data were collected from 300 nurses who made up the entire population sample that we used (a judgmental non-probability sampling technique) working across all in-patient care units at Itay El-Baroud General Hospital, in El Behaira governorate, using structured questionnaires as follows: the organizational agility questionnaire, the career planning scale, and the grit scale. The sociodemographic characteristics of the studied nurses were also collected. Statistical analyses were used to analyze the data, including ANOVA, Pearson correlation, and SEM, to determine whether career development may act as a mediator between organizational agility and the nurses' career planning. Results: Rendering the findings of this study, more than half of nurses have a high perception regarding organizational agility and career planning. In contrast, the majority of them have a moderate perception regarding grit. In addition, there is a statistically high significant relationship between organizational agility and career planning. Also, there is a statistically high significant relationship between organizational agility and grit. There is a statistically high significant relationship between career planning and grit. Conclusion: The statistically substantial correlations among grit, career planning, and organizational agility demonstrate how interrelated they are. This implies that encouraging organizational flexibility and effective career planning techniques may have a good impact on nurses' resilience, which would ultimately result in a workforce of nurses who are more resilient and engaged. Additional investigation into the precise mechanisms behind these associations may yield important information for improving nurse wellbeing and retention. Nursing implications: According to this study, putting organizational agility and career planning first can have a good impact on nurses' grit, which will make them more resilient and engaged workers. To encourage flexibility and growth among nurses, healthcare institutions should make training investments, provide clear career tracks, and support work-life balance. More investigation into the precise mechanisms underlying these connections may yield insightful information that improves nurse well-being and retention. The importance of organizational agility in creating a supportive work environment for nurses' career growth should be acknowledged by healthcare companies. This can lead to increased job satisfaction and lower turnover. [ABSTRACT FROM AUTHOR]

Background: Klotho plays a pivotal role in human aging. Metabolic syndrome (MetS) is composed of multiple conditions that are also risk factors for cardiovascular disease and diabetes. We try to discuss gender-specific differences in Klotho and the associations between Klotho and MetS components. Materials and methods: The National Health and Nutrition Examination Survey database from cycle 2015–2016 was analyzed. MetS was defined according to the 2005 updated criteria by the American Heart Association and National Heart Lung and Blood Institute. Gender-specific differences in serum Klotho, and associations between Klotho level and MetS components were examined. Results: A total of 2475 participants (40–79 years old) with comprehensive data were included (52% women). In general, lower Klotho was associated with advanced age, male sex, tobacco use, elevated triglycerides, renal insufficiency, inflammation, low estradiol, and low sex hormone-binding globulin (SHBG). The correlation between MetS and Klotho was more obvious in women, mainly in waist circumference and triglyceride. There were no gender-specific differences in the associations between Klotho and renal dysfunction, but multivariate linear regression analysis showed gender differences in other factors associated with Klotho. Estradiol, SHBG, high-density lipoprotein cholesterol (HDL), and high-sensitivity C-reactive protein (CRP) were associated with Klotho levels independent of age and renal function in men, whereas in women, Klotho was independently associated with triglycerides and white blood cell count. Conclusion: Klotho levels had gender disparities regardless of age, renal function, and sex hormones. In the current cohort, triglycerides were the major component of MetS that was independently associated with serum Klotho levels, and the association was particularly seen in women. However, HDL was found to be the male-specific MetS component independently associated with Klotho. [ABSTRACT FROM AUTHOR]

Objective: To assess the current status of digital technology (DT) implementation in prosthodontics post-graduate (PG) programs in Saudi Arabian dental institutions. Methodology: A 19-item survey was created using Google forms and the link was emailed to the 29 prosthodontics PG program directors (advanced clinical training and joint program) in Saudi Arabia. The questionnaire contained five Sect. 1) didactic training and DT usage in PG preclinical, clinical and laboratory training, 2) incorporation of DT in PG program, 3) utilization of DT and the types of cases treated by PG students during their course, 4) information on the faculties involved in prosthodontics PG education, and 5) potential challenges encountered and program directors' satisfaction of the PG program. Descriptive statistics was used to present the frequencies and proportions, and Chi square inferential test was used to compare the participants' response based on the type of PG programs (α = 0.05). Results: Only 28 program directors responded to the survey, yielding a 95.5% response rate. Among the program directors, 24 (85.7%) and 4 (14.3%) directors supervised the advanced clinical training and joint programs, respectively. Among the DT, CAD/CAM was the most used technology (50–80%), followed by intra-oral scanning (28–96%). Digital technology implementation was largely limited by lack of resources or equipment (67%), cost (53%) and scarcity of PG teaching staff (46%). A significant difference was observed between the programs regarding the mandatory use of DT for their cases (p = 0.03). Conclusions: This multi-institutional survey of program directors revealed that DT is continuously implemented in the last few years. Saudi dental institutions must prioritize implementing and utilizing DT in PG training to graduate competent prosthodontists in this fast-paced digital era. While DT is pivotal in dental education, its implementation is limited in many institutions due to resources or equipment, cost, and lack of trained faculty. [ABSTRACT FROM AUTHOR]

Background: The use of Complementary and alternative medicine (CAM) in chronic liver disease (CLD) patients in Germany is unknown. This study investigated the frequency of CAM use and associated sociodemographic, clinical and personality factors in CLD patients in Germany. Methods: This is a cross-sectional multicenter study of CLD patients attending liver outpatient clinics of university hospitals in Halle(-Saale) and Homburg between 2015 and 2017. Dedicated questionnaires recorded CAM use, sociodemographic and personality factors (evaluated with the "Big five" model, "Hospital Anxiety and Depression"-, "Multidimensional Health Locus of Control"- score). Uni- and multivariate analyses assessed factors associated to CAM use. Results: Overall 378 patients were recruited, 92 (24.3%) reported to CAM use. On univariate analysis, female CAM users were older (p = 0.001) and more physically active (p = 0.002), male CAM users more often used homeopathy (p = 0.000), actively promoted their health (p = 0.010) or had UDC in their medication (p = 0.004). Logistic regression analysis adjusted for personality factors showed significant association of age, physical exercise (females) and satisfaction with alternative medicine (females, males) to CAM use. Conclusions: CAM use is prevalent among CLD patients in Germany and is significantly associated to satisfaction with alternative medicine (females, males), physical exercise and older age (females). Doctors should actively inquire CLD patients about CAM use, as hepatotoxicity or interaction with medication can occur. [ABSTRACT FROM AUTHOR]

Background: In Nigeria, the attitudes of community pharmacists toward providing pharmaceutical care (PC) for people with mental illnesses remain unclear. This study aimed to assess the community pharmacists' attitudes and barriers toward providing PC services for clients with mental disorders in Enugu, Nigeria. Methods: A cross-sectional survey was conducted among all eligible community pharmacists in Enugu, Nigeria. The data were obtained using validated self-administered questionnaire adapted from the literature and a sociodemographic form. The data collected were analyzed using descriptive statistics and Chi-square/Fisher's Exact test. P values less than 0.05 were considered significant. Results: A total of 155 community pharmacists took part in the survey, giving a response rate of 95.6%. The findings showed that more than half of the community pharmacists (n = 80, 51.6%) had positive attitudes toward providing PC services for patients with mental illness. Positive attitudes were associated with having a family member with mental illness (p = 0.038) and a good self-rated knowledge of mental illness (p < 0.001). The most frequently reported barriers to PC were patient factors associated with their symptoms (59.4%) and a lack of patient information (52.9%). Conclusion: The attitudes of community pharmacists toward providing PC for patients with mental illness is largely positive but suboptimal. Patient factors related to their symptoms were cited as the major obstacle to providing PC. Therefore, continued education and training and supportive environment are encouraged to improve the situation. [ABSTRACT FROM AUTHOR]

Background: The WHO global action plan on antibiotic resistance (ABR) emphasises improving awareness of ABR and optimising antibiotic use. Objectives: To assess physicians' and pharmacists' knowledge and perceptions of ABR and antibiotic stewardship (AS) and hospital preparedness to implement AS. Methods: This descriptive cross-sectional survey included 124 physicians and 61 pharmacists from the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria. Participants were given a 16-item questionnaire during their clinical/review meetings. The data were analysed with SPSS version 25.0. Results: Both physicians (98%) and pharmacists (97%) perceived ABR as a global and national concern. Only 47% of physicians and 53% of pharmacists accurately defined AS. More pharmacists (70%) than physicians (45%) knew that excessive antibiotic usage in agriculture and livestock causes resistance (p = 0.002) and that prompt de-escalation of empirical antibiotic therapy based on culture/sensitivity results reduces ABR (93% vs. 79%, respectively, p = 0.013). Knowledge scores varied among physicians according to position (p = 0.002), length of practice (p < 0.001), and age (p = 0.002); only pharmacists' age (p = 0.046) was associated with their knowledge level. Conclusions: Participants demonstrated good knowledge of ABR and AS strategies but little awareness about the hospital's intention to implement AS programmes. Hospital management should emphasise optimising antibiotic use through AS programmes. [ABSTRACT FROM AUTHOR]

Background: Work-family enrichment refers to the extent to which experiences in one role improve the quality of life in another role, and the bidirectionality indicates that benefits derived from work can be applied to family and vice versa. Parent nurses, that is, female nurses who are raising preschool children, play a major role at work and in the family. Thus, work-family enrichment is significant for them. The Work-Family Enrichment Scale cannot be generalized to parent nurses. This study was aimed at developing and psychometrically validating a draft Work-Family Enrichment Scale for Parent Nurses. Methods: A questionnaire survey was conducted among 1,090 parent nurses who were randomly sampled from hospitals with more than 200 beds in Japan. The survey evaluated (1) a draft Work-Family Enrichment Scale for Parent Nurses, (2) the Japanese version of the Work-Family Enrichment Scale, and (3) the Positive Spillover Scale. The scales were psychometrically evaluated for internal consistency, construct validity, and criterion-related validity. Results: Data from 503 participants (age, mean ± standard deviation [range] 35.5 ± 4.96 [23–47] years) were analyzed. Results of exploratory factor analysis, the work to family enrichment direction yielded five factors for 23 items: "emotional fulfillment," "efficiency," "ability to lead," "displaying industriousness," and "self-growth." Cronbach's alpha coefficients ranged from 0.862 to 0.914. In the family-to-work enrichment direction, there were five factors for 28 items: "help-seeking," "receptiveness," "expansion of one's horizon," "efficiency," and "emotional fulfillment." Cronbach's alpha coefficients ranged from 0.790 to 0.907. Additionally, the correlation coefficients reporting criterion-related validity were 0.685 and 0.619 with regard to the Japanese version of the Work-Family Enrichment Scale and 0.596 and 0.534 with the Positive Spillover Scale for the Work-to-Family Enrichment Scale and the Family-to-Work Enrichment Scale for Parent Nurses, respectively. Conclusions: The Work-Family Enrichment Scale for Parent Nurses has adequate reliability and validity and can be used as an effective measure to assess the positive aspects of work and family roles among female parent nurses. [ABSTRACT FROM AUTHOR]

Aim: To construct evidence-based sensitive quality indicators for patients' rapid rehabilitation care after combined pancreaticoduodenectomy (PD) and to provide a reference for clinical nursing professionals to scientifically evaluate the quality of patients' rehabilitation post-PD. Background: Since PD is associated with higher surgical risk and anastomotic complications, it leads to higher complication rates and longer postoperative recovery cycles. This reiterates the need for rapid recovery of patients after PD; however, the evaluation of sensitive nursing care indicators regarding rapid recovery post-PD has not yet been established to date. Methods: Based on the Donabedian structure-process-result theory model, we used available literature, semi-structured interviews, the Delphi method, and hierarchical analysis to establish a sensitive indicator system for patients' rapid rehabilitation after PD and evaluate the importance of such indicators. Results: There were two rounds of expert correspondence, and the effective recovery rate of the questionnaires of these rounds was 100%. The expert authority coefficients, as well as the Kendall coordination coefficients of the expert opinions, were 0.859 and 0.872 as well as 0.423 and 0.431, with statistically significant differences (p < 0.05), respectively. Consequently, we developed a sensitive quality index system for patients' rapid rehabilitation care after combined PD, including 3 first-level, 12 s-level, and 23 third-level indexes, respectively. Conclusion: The constructed sensitive quality index system developed for patients' rapid rehabilitation nursing care after combined PD is standardized, practical, and aligned with the specialty characteristics. Furthermore, this might help greatly in improving the quality and safety of patients' rapid rehabilitation nursing care after combined PD, standardizing nursing management skills, and enhancing nursing quality. [ABSTRACT FROM AUTHOR]

Background: Mechanical ventilation is crucial for patient management in intensive care units, but it comes with complications such as pressure ulcers and ventilator-associated pneumonia (VAP). The impact of head-of-bed elevation angles on these complications remains a critical area for investigation. Methods: This systematic review and meta-analysis followed PRISMA guidelines and involved searches across PubMed, Embase, Web of Science, and Cochrane Library, conducted on September 19, 2023, with no date or language restrictions. We included randomized controlled trials that compared different head-of-bed elevation angles in adult ICU patients on mechanical ventilation. Data were extracted on study characteristics, quality assessed using the Cochrane risk of bias tool, and statistical analyses performed using chi-square tests for heterogeneity and fixed or random-effects models based on heterogeneity results. Results: Six studies met inclusion criteria out of an initial 601 articles. These studies showed minimal heterogeneity (I2 = 0.0% for pressure ulcers, p = 0.930; and for VAP, p = 0.797), supporting the use of fixed-effect models. Results indicated that a higher elevation angle (45°) significantly increased the risk of pressure ulcers (OR = 1.95, 95% CI: 1.12–3.37, p < 0.05) and decreased the incidence of VAP compared to a lower angle (30°) (OR = 0.51, 95% CI: 0.31–0.84, p < 0.05). Conclusions: While higher head-of-bed elevation can reduce the risk of VAP in mechanically ventilated patients, it may increase the risk of pressure ulcers. Clinical strategies should carefully balance these outcomes to optimize patient care in ICU settings. Registration: PROSPERO 2024 CRD42024570232. [ABSTRACT FROM AUTHOR]

Background: While Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, the nature of the relationship between their symptoms is not well understood. Network analysis of psychopathology allow for detailed examinations of symptom interactions, providing an effective approach to explore the patterns of comorbidity between TS and ADHD symptoms. Methods: This study included 3,958 participants (male/female = 3,004/954, age mean ± SD = 8.60 ± 2.25 years). We collected data on TS symptoms using the Motor Tic, Obsessions and Compulsions, Vocal Tic Evaluation Survey (MOVES), and ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV). Network analysis was employed to construct a combined network of TS and ADHD symptoms at the symptom level. We utilized the expected influence (EI) and bridge EI metrics to explore the core and bridge symptoms within the network. Results: The network structure demonstrated a moderate number of non-zero connections between TS and ADHD symptoms, constituting 23.06% of all potential connections. Core symptoms in the comorbidity network included "Often has difficulty sustaining attention in tasks or play activities," "Certain bad words or thoughts keep going through my mind," and "Words come out that I can't stop or control." Bridging symptoms identified were "Words come out that I can't stop or control," "I do certain things like jumping or clapping over and over," "I can't control all my movements," and "Often talks excessively." Conclusion: The core and bridging symptoms identified in this study serve as potential therapeutic targets for the treatment of TS and ADHD comorbidity in clinical children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Despite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated. Methods: In June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0–16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023. Results: Among 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1–3 years, 42,3% 3–6 years, 26,5% 6–9 years, 11,4%, 9–12 years, and 2,6% 12–16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis. Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection. Conclusions: We reported a certain prevalence of nGAS infections in children, mainly those aged 3–6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool. In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV (WLWH) in low- middle-income countries (LMICs) face increased mortality risks from comorbidities despite progress in antiretroviral therapy. Palliative care (PC) is vital for these patients, yet its integration in LMICs, such as Nigeria, is suboptimal due to unique challenges. Objective: This study investigated the knowledge, perceived barriers, and facilitators influencing PC integration into routine HIV care within healthcare (HC) settings. Methodology: A cross-sectional survey was conducted among WLWH in twelve HC facilities throughout Nigeria. Data collection involved surveys focused on PC knowledge, attitudes, facilitators, and barriers. Logistic regression analyses were employed to examine the data. Results: This study revealed significant gaps in knowledge and attitudes towards PC among HIV + women at NISA-MIRCs. Over 90% were unaware of PC services, but many saw its potential to offer hope (55%) and improve quality of life (56.5%). The key predictors of PC knowledge included education, occupation, religion, having fewer children, urban residence, type of residence, and having a high income (p <.05). Despite the willingness to access PC, barriers such as negative HC worker attitudes, perceived high cost, and limited decision autonomy could hinder integration. Facilitators included low-cost services, positive HCW attitudes, physician recommendations, and perceived necessity for personal well-being. Conclusion: Knowledge gaps, diverse attitudes, and significant barriers highlight the need for targeted PC interventions for WLWH. Tailoring educational programs, addressing cost barriers, and improving healthcare infrastructure are crucial to enhancing PC accessibility and quality. These findings can guide policymakers and HC practitioners toward more effective and inclusive care strategies. [ABSTRACT FROM AUTHOR]