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Background High-risk human papillomavirus (HR-HPV) is a known cause of cervical cancer (CC). Latvia has a high incidence of CC compared with the average incidence in the European Union. This study aims to fill the data gap on the HR-HPV burden in Latvia, providing information on its prevalence and associated factors. Methods The cross-sectional study was conducted from February 2021 to April 2022. Participants 25–70 years old visiting a general practitioner (general population) or those referred to a colposcopy clinic with changes in their cervical cytology (colposcopy population) collected vaginal self-sample and completed a paper-based questionnaire. Samples were analyzed with Cobas 6800 System (Roche) for HPV16, HPV18 and other HR-HPV (HPV31/33/35/39/45/51/52/56/58/59/66/68). Descriptive statistics for categorical variables were performed. The Chi-square test was used to determine for the statistical significance of differences in the proportions of the dependent variable between subgroups of the independent variable. Univariate and multivariate binary logistic regression were used to identify factors associated with positive HR-HPV status. Results were considered statistically significant at P  < 0.05. Results A total of 1274 participants provided a valid sample. The prevalence of any HR-HPV infection was 66.8% in the colposcopy group and 11.0% in the general population. Factors associated with positive HR-HPV status were marital status single/divorced/widowed (vs. married/cohabiting) [adjusted OR (aOR) 2.6; P  = 0.003], higher number of lifetime sex partners [aOR 5.1 (P  < 0.001) and 4.0 (P  = 0.001)] for six or more and three to five partners in the general population; in the colposcopy group, the statistical significance remained only for Latvian ethnicity (vs. other) (aOR 1.8; P  = 0.008) and current smoking (vs. never) (aOR 1.9; P  = 0.01). Conclusion We documented a comparison to European Union HR-HPV infection burden in Latvia. Any HR-HPV positivity was significantly associated with sexual and other health behavior. [ABSTRACT FROM AUTHOR]

Background Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%. Objectives This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results. Results The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated. Limitations Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data. Conclusion The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate. [ABSTRACT FROM AUTHOR]

This is a correction to: Apichat Asavamongkolkul, Nath Adulkasem, Pojchong Chotiyarnwong, Ekasame Vanitcharoenkul, Chandhanarat Chandhanayingyong, Panai Laohaprasitiporn, Krabkaew Soparat, Aasis Unnanuntana, Prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults: a nationwide cross-sectional study, JBMR Plus, Volume 8, Issue 2, February 2024, ziad020, https://doi.org/10.1093/jbmrpl/ziad020In the originally published version of this manuscript the graphical abstract was inadvertently omitted. It has now been added to the paper. [Extracted from the article]

Aims: This paper aims to assess kinematic parameters related to functional capacity, fatigue, and breathlessness during the 6-min walk test (6MWT) in patients with heart failure with preserved ejection fraction (HFpEF). Methods and results: A cross-sectional study was conducted in which adults 70 years or older with HFpEF were voluntarily recruited between April 2019 and March 2020. An inertial sensor was placed at the L3–L4 level and another on the sternum to assess kinematic parameters. The 6MWT was divided into two 3-min phases. Leg fatigue and breathlessness, assessed by the Borg scale, the heart rate (HR), and the oxygen saturation (SpO2), were measured at the beginning and the end of the 6MWT. The difference in kinematic parameters between the 6MWT two 3-min phases was also calculated. Bivariate Pearson correlations and subsequent multivariate linear regression analysis were performed. Seventy older adults with HFpEF (mean = 80.74 years old) were included. Kinematic parameters explained 81.00% of the functional capacity, 45.50% of the leg fatigue and 66.10% of the breathlessness variance. Moreover, kinematic parameters could explain 30.90% of the SpO2 variance at the end of the 6MWT. Kinematic parameters also explained 33.10% of the SpO2 difference between the beginning and end of 6MWT. Kinematic parameters explained neither the HR variance at the end of 6MWT nor the HR difference between the beginning and end. Conclusion: Gait kinematics from L3-L4 and sternum explain a part of the variance in subjective outcomes, assessed by the Borg scale, and objective outcomes such as functional capacity and SpO2. The kinematic assessment allows clinicians to quantify fatigue and breathlessness through objective parameters related to the patient's functional capacity. Registration: ClinicalTrials.gov NCT03909919. Graphical Abstract [ABSTRACT FROM AUTHOR]

Background Rising global temperatures due to climate change pose a health risk. Mortality and morbidity increase during heat events affects various organ systems. While warmer countries face higher risks, even colder regions show elevated mortality during hot periods. This study examines physiological responses to heat exposure using data from the general Danish population cohort Lolland–Falster Health Study (LOFUS) during the summers of 2016–2019. Methods In this cross-sectional study, we analysed health data from 3804 individuals aged ≥15 years. Data were analysed across organ systems: cardiovascular system, lung function, renal system, inflammation, coagulation, and liver function. Meteorological data from the Danish Meteorological Institute provided information on temperature and humidity. Heat exposure was defined as one day ≥28°C heat index the day prior to examination. Adjusted multiple linear regression was applied to analyse differences between the two groups. Results There were 46 of 368 days with temperatures ≥28°C heat index. In total, 396 participants were heat-exposed (exposure group), while 3408 constituted the unexposed group. Heat exposure was associated with lower systolic blood pressure (−3.82 mm Hg [−5.72; −1.93]), higher heart rate (1.71 beats/min [0.45; 2.98]), lower oxygen saturation (−0.28% [−0.45; −0.10]), higher sodium (0.56 mmol/l [0.33; 0.79]), and higher urine albumin (0.14 mg/l [0.02; 0.27]). No significant differences were observed in inflammation, coagulation, or liver function. Conclusion This study reveals early physiological responses to heat with one day of heat exposure ≥28°C, particularly in the cardiovascular, pulmonary, and renal systems. These findings underline the need for tailored strategies to mitigate health risks associated with rising temperatures. [ABSTRACT FROM AUTHOR]

The role of the social environment can facilitate positive health outcomes through active community engagement, normalization of healthy behaviors, and stress buffering. We aim to examine the associations of neighborhood social cohesion with changes in BMI over time. A total of 7641 participants from The Maastricht Study between the ages of 40 and 75 years were analyzed. Weight and height were measured at baseline, and weight was self-reported annually up to 10 years of follow-up (median = 4.7 years). Perceived social cohesion was obtained by questionnaire. Home addresses for each participant were linked to geographic information system data from the Geoscience and Health Cohort Consortium to create neighborhood exposure variables including area level social cohesion, neighborhood walkability, and food environment within a 1000 m Euclidian buffer. Linear regression analyses were performed with BMI adjusted for socioeconomic variables. A mixed model analysis was carried out to examine changes in BMI. Living in the highest quartile area of individually perceived social cohesion was associated with lower BMI (Q4 B: −.53; 95% CI = −.79, −.28) compared to the lowest quartile. Similar findings were discovered using the area level measure (Q4 B: −.97; 95% CI = −1.29, −.65). There was no longitudinal association between social cohesion and BMI. Neighborhood social cohesion was associated with lower BMI classifying it as an obesogenic area characteristic that influences weight, independent of conventional built environment features. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) pandemic impacted cancer services worldwide. We examined the effect of the first three pandemic waves on the number of electronic (e)-referrals to rapid access clinics (RACs) for breast, lung and prostate cancer in Ireland. Methods This study used a retrospective, repeated cross-sectional design. The predicted weekly number of e-referrals by suspected cancer types from March 2020 to May 2021 was calculated using the Holt-Winters seasonal smoothing method, based on the observed numbers from a representative pre-pandemic period (01 January 2019 to 01 March 2020) and compared this with the observed number across the first three pandemic waves (02 March 2020 to 09 May 2021). Percentage differences were calculated between observed and predicted numbers of e-referrals for the three RACs and patterns were examined in each wave. Results Observed e-referrals were lower than predicted for all three RACs in the first wave of the pandemic (15.7% lower for breast, 39.5% lower for lung and 28.1% lower for prostate) with varying levels of recovery in the second and third waves for the three e-referral types. Conclusions The COVID-19 pandemic impacted patterns of e-referrals to RACs in the first three pandemic waves in Ireland. Early identification of changes in engagement with health services, such as a decrease in primary care presentations with a resultant decrease in e-referrals to RACs can allow for a rapid response from cancer control programmes. Continued surveillance of the impact of service disruption on cancer services allows policy makers and strategic leaders in cancer control programmes to respond rapidly to mitigate the impact on cancer outcomes. [ABSTRACT FROM AUTHOR]

Background Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. Reliability and validity of adherence to NPIs in accordance with normalization process theory (NPT) in coherent and convenient social subgroups using reflective measurement model assessment has not been evaluated. Methods In February 2021, a sample of medical students and people with substance use disorders in treatment as coherent (based on continuous probability distribution) vs. convenient groups (based on convenience, not equal probability) composed of travellers and COVID-19 suspected persons from Split-Dalmatia County (SDC) (n  = 656) in the Mediterranean completed self-administered surveys. Partial least squares structural equation modelling (PLS-SEM) was used to measure reflective model assessment of adherence to NPIs according to NPT. Results PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined adherence to NPIs with excellent goodness-of-fit [ χ 2 = 1.292, df = 1; P  = 0.297, CFI = 1, TLI = 0.997, RMSEA = 0.011 (90% CI 0–0.105), RMSEA P  = 0.604, SRMR = 0.008, Hoelter CN (α = 0.05) = 2322.757]. Significant negative factors covariance estimate (−0.716) revealed an inverse relationship between first (adherence to NPIs and internal locus of control (LoC) (0.640)) and second factor; young adulthood age (≤25) and highest level of education (1362). As the first factor increased the second tended to decrease. LoC is expected potential mechanism by which sex (MLsex = −0.017, SE = 0.007, P  < 0.016) and belonging to coherent subgroups (MLgroup = −0.008, SE = 0.003, P  = 0.015) can produce indirect effect of adherence to NPIs. Conclusions Coherent subgroups had a more pronounced tendency toward integration of NPIs in everyday life. Group factors that facilitate the normalization were higher educated younger adults with a tendency toward external LoC. [ABSTRACT FROM AUTHOR]

Background Consumption of alcohol is a risk factor for non-communicable and infectious diseases, mental health problems, and can lead injuries and violence. The aim of this study was to evaluate the prevalence of alcohol-involved deaths among decedents who died of external causes and underwent autopsy in Lithuania. Methods Study includes age persons of any age (from 0 to 110 years) who died and were autopsied in Lithuania from 1 January 2017 to 31 December 2020. Data were obtained from the Lithuanian State Register of Deaths and Their Causes. Results Among external causes of death, the presence of alcohol was detected in 55.0% of cases. Male decedents had a significantly higher number of positive BAC level recorded, at 46.6%, compared with female decedents (32.1%; P  < 0.001). The highest incidence of deaths where the alcohol was detected in the deceased's blood was found when the decedent was listed as being in the victims of assault group (71.5%, 95% CI 65.4–77.2). However, the highest median BAC score was found for those in the accidents group (59.7%, 95% CI: 58.2–61.2, BAC 2.42 ‰, IQR 1.86). Conclusions The findings of this study suggest that alcohol use may be a contributing factor in a wide range of fatal incidents, including accidents, injuries, and cases of violent intent. Inequalities between males and females were identified, with a higher proportion of males with alcohol detected in blood at the time of death. [ABSTRACT FROM AUTHOR]

Objective The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE). Methods Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5–C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, and width) of the common wrist extensor tendon and extensor carpi radialis brevis muscle as well as the thickness of the supinator muscle were assessed. Results Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space on the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123–0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268–0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side. Conclusions This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE. Impact Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE. [ABSTRACT FROM AUTHOR]

Tumor mutation profiling (MP) is often conducted on tissue from biopsies conducted for clinical purposes (diagnostic tissue). We aimed to explore the views of patients with cancer on who should own tumor biopsy tissue, pay for its storage, and decide on its future use; and determine their attitudes to and predictors of undergoing additional biopsies if required for research purposes. In this mixed methods, cross-sectional study, patients with advanced solid cancers enrolled in the Molecular Screening and Therapeutics Program (n  = 397) completed a questionnaire prior to undergoing MP (n  = 356/397). A subset (n  = 23) also completed a qualitative interview. Fifty percent of participants believed they and/or relatives should own and control access to diagnostic tissue. Most (65.5%) believed the government should pay for tissue preparation. Qualitative themes included (1) custodianship of diagnostic tissue, (2) changing value of tissue across time and between cultures, (3) equity regarding payment, and (4) cost-benefit considerations in deciding on additional biopsies. Policy and regulation should consider patient perspectives. Extension of publicly funded health care to include tissue retrieval for clinical trials should be considered. [ABSTRACT FROM AUTHOR]

Objective Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. Methods This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. Results At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97–6.06), obesity (odds ratio = 1.79; 95% CI = 1.26–2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20–8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17–2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48–0.90), and student status (odds ratio = 0.58; 95% CI = 0.37–0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46–0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01–2.13). Conclusions This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. Impact In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity. [ABSTRACT FROM AUTHOR]

Objective This study compared adults with peripheral vestibular hypofunction (VH) to healthy controls and assessed the sensitivity and specificity of the Cervical Torsion Test (CTT) and the Head-Neck Differentiation Test (HNDT). This study aimed to determine whether neck problems affected primary outcomes. Methods This cross-sectional study included adults from a specialist consultation for dizziness. VH had been diagnosed with the video Head Impulse Test. Exclusion criteria were conditions following head or neck trauma and diseases of the central nervous system. The sensitivity and specificity of the index tests were calculated, and regression analyses were performed to test for contributing factors. Results A total of 19 patients with VH and a historical cohort of 19 matched healthy controls were included. Most patients with VH (84.2%) experienced symptoms in at least 1 test component, compared to 5.2% of the control group. Of patients with VH, 78.9% had symptoms during the HNDT "en bloc" (en bloc = head and trunk rotated together), whereas only 26.3% reported symptoms during the CTT en bloc. The best discriminatory validity was found for the HNDT en bloc, with a sensitivity of 0.79 (95% CI = 0.54–0.94), a specificity of 0.86 (95% CI = 0.65–0.97), and a positive likelihood ratio of 5.79 (95% CI = 1.97–17.00). The number of symptoms of CTT "in torsion" (in torsion = trunk rotated actively with fixed head) was increased by a factor of 1.13 (95% CI = 1.01–1.27) for every additional point on the Neck Disability Index. Conclusion The CTT and HNDT can serve as non-laboratory tests for patients with dizziness. The HNDT en bloc has the best discriminatory validity, finding those with and those without VH. Symptom reproduction during torsion may help to identify when neck problems may contribute to dizziness. Impact The HNDT en bloc may be useful for ruling VH in or out in patients with dizziness. Positive CTT and HNDT in torsion components may verify the likelihood of additional neck involvement. [ABSTRACT FROM AUTHOR]

Engaged communication between mother and a child in their early developmental stages is one of the predictors of children's development of higher-order thinking skills. For deaf children, this engaged communication between mother and child hinges on the home language environment (HLE) being fully accessible to the child. This research uses agogical phenomenology in exploring the lived experiences of participants' HLE where sign language is used, with particular focus on the opportunities for extended discourse. Data were collected via semistructured interviews with the deaf children and their parents and observations in the HLEs of five signing families with at least one deaf child in the southwestern United States. The aim of this study was to document and provide insights into how language use in deaf children's HLE can impact their knowledge development; these insights uncovered the essence of reciprocal and contingent family interactions as a central aspect of the deaf child's HLE. It is hoped that the qualitative phenomenological findings will frame subsequent quantitative investigations of the variability in language access to home language components. [ABSTRACT FROM AUTHOR]

This study examines the moderating effects of distant leader's practice of transformational leadership on the relationship between secondary traumatic stress (STS) and burnout among child welfare workers. Caseworkers and supervisors in a Midwest U.S. state (N = 210) rated their regional director's use of transformational leadership skills using a survey. Given the nature of the clustered data, multilevel modeling was employed to examine the main effects of transformational leadership on worker burnout and its cross-level interaction effect on the association between worker STS and burnout. Multilevel modeling demonstrated that worker burnout was positively associated with STS and negatively associated with organizational-level transformational leadership. The cross-level interaction between transformational leadership and STS was significant. Specifically, the positive association between workers' STS and burnout decreased as transformational leadership increased. These findings suggest that organizational approaches such as transformational leadership can influence workforce results. Further research will guide child welfare policymakers to develop more sophisticated training programs in leadership skills and strategies. [ABSTRACT FROM AUTHOR]

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake. Methods We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake. Results The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P  = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57–1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated. Conclusion Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions. [ABSTRACT FROM AUTHOR]

Background Socioeconomic inequalities constitute an important focus area for public health, and it has long been established that higher educational level and longer lifespan are correlated. Little is known about decennial time trends in poor self-rated health and mental distress. Methods This study linked decennial cross-sectional survey data on self-rated health and mental distress from the Trøndelag Health Study (HUNT) from 1984 to 2019 with educational registry data using personal identification numbers. Survey participation ranged from 50 807 to 77 212. Slope index of inequality (SII) and relative index of inequality (RII) were calculated using generalized linear models in Stata. Analyses were stratified by sex and age, using the age categories of 30–59 years and 60–80 years. Results Absolute inequalities in self-rated health and mental distress between educational groups have stayed relatively stable throughout all rounds of HUNT. Relative inequalities in self-rated health and mental distress have generally increased, and both men and women with the lowest education level were more likely to experience poor self-rated health and mental distress relative to those with the highest education level. RII in self-rated health increased over time for both sexes and both age groups. RII for mental distress increased in both sexes and both age groups, except for men and women aged 60–80. Discussion This study shows that relative inequalities in self-rated and mental health in the Norwegian population are still persistent and have increased. Further knowledge about groups with a disadvantageous health situation should have implications for health care resource allocation. [ABSTRACT FROM AUTHOR]

Objective The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer. Methods Forty women (mean age = 42.6 years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6 months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2 years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sørensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit. Results Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups. Conclusions Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10 months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis. Impact Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation. [ABSTRACT FROM AUTHOR]

Background The aim of the current study was to examine the prevalence and predictors of unmet need for contraception among women in sexual unions in Benin. Methods Data for the study was extracted from the recent 2017–2018 Benin Demographic and Health Survey. A weighted sample of 9513 women of reproductive age was included in the study. We used multivariable multilevel binary logistic regression analysis to examine the factors associated with unmet need for contraception. Results The prevalence of unmet need for contraception was 38.0% (36.7, 39.2). The odds of unmet need for contraception was higher among women with ≥4 births compared with those with no births, and among those who reported that someone else or others usually made decisions regarding their healthcare compared with those who make their own healthcare decisions. Wealth index was associated with a higher likelihood of unmet need for contraception. Also, the region of residence was associated with unmet need for contraception, with the highest odds being among women from the Mono region (adjusted odds ratio [aOR]=2.18, 95% CI 1.33 to 3.58). Conclusions Our study shows that the unmet need for contraception among women in Benin is relatively high. Our findings call on relevant stakeholders, including government and non-governmental organisations, to enhance women's empowerment as part of interventions that seek to prioritise contraceptive services for women. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor disorders are common and associated with impaired sexual function in women. Aim: To assess women with pelvic floor disorders and describe factors associated with not being sexually active and those associated with sexual function in sexually active women. Methods: A cross-sectional study was conducted that included nonpregnant women with symptoms of pelvic floor disorders who were referred to the urogynecologic and surgical outpatient clinic at 2 Norwegian university hospitals: St Olavs Hospital, Trondheim University Hospital, and the University Hospital of Northern Norway, Tromsø. Women answered a questionnaire anonymously. Outcomes: Pelvic Organ Prolapse Incontinence Sexual Questionnaire–IUGA Revised. Results: Of 157 respondents, 111 (71%) reported being sexually active (with or without a partner), and 46 (29%) reported not being sexually active. As compared with sexually active women, not sexually active women were older (mean ± SD, 60.2 ± 13.3 vs 51 ± 12.1 years; P < .001), more were menopausal (78% vs 47%, P = .001), and more had symptom debut <1 year (31% vs 9%, P < .001). They reported more distress related to pelvic floor disorders, especially pelvic organ prolapse. In a multivariate logistic regression analysis, menopausal women and women with symptom debut <1 year were 4 times more likely to be not sexually active than premenopausal women (odds ratio, 4.0; 95% CI, 1.7-9.2) and women with symptom debut ≥1 year (odds ratio, 4.0; 95% CI, 1.5-10.7). In sexually active women, colorectal-anal distress was negatively associated with 5 of 6 domains of sexual function: arousal/orgasm (ß = –0.36; 95% CI, –0.02 to –0.005), partner related (ß = –0.28; 95% CI, –0.01 to –0.002), condition specific (ß = –0.39; 95% CI, –0.002 to –0.009), global quality (ß = –0.23; 95% CI, –0.02 to –0.002), and condition impact (ß = –0.34; 95% CI, –0.02 to –0.006). Clinical Implications: Health care professionals should discuss sexual function in patients with pelvic floor disorders, especially menopausal women and women with colorectal-anal symptoms. Strengths and Limitations: The study used condition-specific measures and recruited women from 2 university hospitals with wide range of age. Limitations include the small sample size and wide confidence intervals. The number of women who considered themselves not sexually active was low, and item nonresponse levels among these women where somewhat high. Of 625 eligible women, 200 (32%) answered the questionnaire. Sexual health and sexual function are still surrounded with taboo, and some women were probably not comfortable answering the questions. Conclusion: Menopausal women and women with recent onset of symptoms of pelvic floor disorders are more likely to be sexually inactive, and colorectal-anal symptoms have the most negative impact on sexual function in sexually active women. [ABSTRACT FROM AUTHOR]

The phenomenon of social workers leaving the profession occurs frequently, underscoring the importance of understanding factors contributing to the intention to stay (ITS) in the profession. Based on the job demands–resources theory (JD-R), this study examined selected social worker workplace "demands" (i.e. their organizational sector of employment and level of work–family conflict) and "resources" (i.e. levels of meaning, locus of control, and salary satisfaction at work). Online survey data were obtained from 407 Israeli social workers. The findings showed that higher levels of meaning and salary satisfaction at work, greater professional seniority, and lower levels of work–family conflict were associated with greater ITS in the profession. Data were gathered during the COVID-19 pandemic, enabling examination of variables contributing to the ITS during times of crisis. These findings confirm that meaning at work is the main factor that motivates social worker ITS in the profession. Salary satisfaction was also found to be an essential factor, highlighting the recent escalation in social worker demands for fair compensation in Israel. Greater work–family balance also contributed to ITS. These findings should be considered by governmental decision makers and welfare service providers wishing to preserve this essential workforce, not just in Israel but also in other countries. [ABSTRACT FROM AUTHOR]

Background Low medication adherence among patients with type 2 diabetes mellitus (T2DM) is associated with significant morbidity and mortality globally. We investigated the prevalence of low medication adherence and its associated factors among patients with T2DM. Methods We used the Bengali version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in measuring medication adherence among patients with T2DM who were attending the diabetes clinic at Amana Regional Referral Hospital in Dar es Salaam, Tanzania, from December 2021 to May 2022. Binary logistic regression analysis under multivariate analysis was used to determine the predictors of low medication adherence after controlling for confounders. A two-tailed p-value <0.05 was considered significant. Results The prevalence of low medication adherence was 36.7% (91/248) of the subjects included in the study. Lack of formal education (adjusted odds ratio [AOR] 5.3 [95% confidence interval {CI} 1.717 to 16.312], p=0.004), having comorbidities (AOR 2.1 [95% CI 1.134 to 3.949], p=0.019) and drinking alcohol (AOR 3.5 [95% CI 1.603 to 7.650], p=0.031) were the independent predictors of low medication adherence. Conclusion More than one-third of the patients with T2DM in this study had low medication adherence. Our study also showed that a lack of formal education, having comorbidities and drinking alcohol were significantly associated with low medication adherence. [ABSTRACT FROM AUTHOR]

Introduction Cancer is a major public health problem in Rwanda and other low- and middle-income countries (LMICs). While there have been some improvements in access to cancer treatment, the cost of care has increased, leading to financial toxicity and treatment barriers for many patients. This study explores the financial toxicity of cancer care in Rwanda. Methods This prospective cross-sectional study was conducted at 3 referral hospitals in Rwanda, which deliver most of the country's cancer care. Data were collected over 6 months from June 1 to December 1, 2022 by trained research assistants (RAs) using a modified validated data collection tool. RAs interviewed consecutive eligible patients with breast cancer, cervical cancer, colorectal cancer, Hodgkin's and non-Hodgkin's lymphoma who were on active systemic therapy. The study aimed to identify sources of financial burden. Data were analyzed using descriptive statistics. Results 239 patients were included; 75% (n  = 180/239) were female and mean age was 51 years. Breast, cervix, and colorectal cancers were the most common diagnoses (42%, 100/239; 24%, 58/239; and 24%, 57/239, respectively) and 54% (n  = 129/239) were diagnosed with advanced stage (stages III-IV). Financial burden was high; 44% (n  = 106/239) of respondents sold property, 29% (n  =  70/239) asked for charity from public, family, or friends, and 16% (n  = 37/239) took loans with interest to fund cancer treatment. Conclusion Despite health insurance which covers many elements of cancer care, a substantial proportion of patients on anti-cancer treatment in Rwanda experience major financial toxicity. Novel health financing solutions are needed to ensure accessible and affordable cancer care. [ABSTRACT FROM AUTHOR]

Background A measles epidemic affected the Nouvelle-Aquitaine region from November 2017 to May 2018 with clusters among Travellers. This indicates that measles vaccination rates among Travellers remain lower than in the general population. The objective of this study was to estimate the 'declarative vaccination' against measles, mumps and rubella (MMR) and to propose a conceptual framework to help identify determinants of MMR vaccination uptake among adult Travellers in Nouvelle-Aquitaine in 2019–20. Methods A cross-sectional study using random sampling was performed and included 612 adult Travellers from 1 November 2019 to 31 March 2020. A conceptual framework to model vaccination adherence was tested among this underserved population by using structural equation modelling. This model included five latent variables: health literacy, attitudes toward preventive measures, stigma, accessibility to care and perceived needs and five measured variables: information received on vaccination, perception of barriers, support for administrative documents, social support and housing conditions. Results Individuals who did not answer all the questions linked to the variables included in the model were excluded, thus 347 adults were included in the final sample. The declared vaccination rate against MMR was 74.0%, and 72.4% of the participants were favorable to vaccination. Vaccination adherence was significantly correlated with favorable attitudes toward preventive measures such as having a history of MMR vaccination and not having already refused a recommended vaccine and finally satisfactory information received on vaccination. Discussion To improve vaccination adherence, health authorities should lean on personal history with vaccination and on transmitting information on vaccination. [ABSTRACT FROM AUTHOR]

Patients with diabetes are at an increased risk of intestinal parasitic infections (IPIs). We evaluated the pooled prevalence and OR of IPIs in patients with diabetes through a systematic review and meta-analysis. A systematic search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for studies reporting IPIs in patients with diabetes through 1 August 2022. The collected data were analyzed using comprehensive meta-analysis software version 2. Thirteen case-control studies and nine cross-sectional studies were included in this study. The overall prevalence of IPIs in patients with diabetes was calculated to be 24.4% (95% CI 18.8 to 31%). Considering the case-control design, the prevalence of IPIs in case (25.7%; 95% CI 18.4 to 34.5%) was higher than controls (15.5%; 95% CI 8.4 to 26.9%) and a significant correlation was observed (OR, 1.80; 95% CI 1.08 to 2.97%). Moreover, a significant correlation was seen in the prevalence of Cryptosporidium spp. (OR, 3.30%; 95% CI 1.86 to 5.86%), Blastocystis sp. (OR, 1.57%; 95% CI 1.11 to 2.22%) and hookworm (OR, 6.09%; 95% CI 1.11 to 33.41%) in the cases group. The present results revealed a higher prevalence of IPIs in patients with diabetes than in controls. Therefore, the results of this study suggest a proper health education program to preventing measures for the acquisition of IPIs in patients with diabetes. [ABSTRACT FROM AUTHOR]