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Background: The 24-hour movement guidelines (24-HMG) include screen time (ST), sleep duration, and physical activity. Previous studies have explored the associations of adherence to the 24-HMG with depression and anxiety symptoms among adolescents, ignoring changes in behaviors. This study aimed to examine whether changes in adherence to the 24-HMG were associated with depression and anxiety symptoms among adolescents. Methods: We recruited adolescents from Shenzhen, China in 2021 and followed them up 1 year later. Changes in adherence to the individual 24-HMG were categorized into four groups: persistent non-adherence, adherence to non-adherence, non-adherence to adherence, and persistent adherence. Changes in the numbers of adherence to the overall 24-HMG were obtained by subtracting the number of guidelines adhered to in wave 2 from that in wave 1. Results: We included 12,570 participants aged 9–18 years with 52.2% boys. Compared with persistent non-adherence for the ST/sleep duration guideline, non-adherence to adherence and persistent adherence were associated with lower depression and anxiety symptoms, but adherence to non-adherence was not. Changes in adherence to the physical activity guideline were not related to outcomes. The β coefficients (95% CIs) for each point increase in changes in the numbers of adherence to guidelines were − 0.58 (− 0.69, − 0.47) and − 0.43 (− 0.53, − 0.33) for depression and anxiety symptoms, respectively. The association of persistently adhering to sleep guideline with anxiety symptoms and the associations of changes in the numbers of adherence to the 24-HMG had sex differences. Conclusions: Maintaining and strengthening healthy movement behaviors to meet more guidelines of the 24-HMG, especially sleep and ST, may be beneficial for preventing depression and anxiety symptoms in adolescents. [ABSTRACT FROM AUTHOR]

Background: Communication via social networks has different norms than in the "offline" world and broadens the sphere of student-teacher interactions. Facebook is mainly used for social interaction and information sharing. However, it also serves as an education and learning platform. This risks boundary-blurred behaviors between students and their academic teachers in the virtual space. The current study examines the differences in perceived subjective norms, attitudes, and reported behaviors of academic teachers and nursing students' boundary-blurred behaviors with each other on Facebook. Methods: A cross-sectional study was utilized, guided by the Theory of Reasoned Action (TRA), examining attitudes, subjective norms, and reported virtual behaviors that signify blurred student-teacher boundaries. Data were collected among 223 nursing students and 78 academic teachers. The university's ethics committee approved the research (#21.9.19). Results: Consistent with the TRA, a significant correlation was found between virtual boundary-blurred behaviors and attitudes (r =.55, P <.001), university subjective norms (r =.48, p <.001), and peers' subjective norms (r =.47, p <.001). Nursing students' attitudes were significantly (t = 5.81; p <.001) more favorable towards boundary-blurred behaviors (M = 2.40, SD = 0.91) than those of academic-teachers (M = 1.71, SD = 0.83), and so were the perceived subjective norms of their student peers (M = 2.72, SD = 1.15) compared to those of their teachers (M = 2.09, SD = 1.14). Interestingly, the difference in reports of boundary-blurred Facebook behaviors between teachers (M = 1.36, SD = 0.52) and students (M = 1.49, SD = 0.70) was not significant. Boundary-blurred behaviors for teachers were best predicted by attitudes and perceived subjective norms of the university [R2 = 0.62; F(5,72) = 23.31], and for students by attitudes and perceived subjective norms of their peers [R2 = 0.45; F)5,216) = 28.88]. Conclusions: The differences demonstrated between students and teachers may emanate from the perception of the teacher's role and generational gaps. These may lead to miscommunication and the crossing of boundaries. The findings indicate the importance of setting more explicit guidelines for using social media in the context of student-teacher communication. [ABSTRACT FROM AUTHOR]

Background and purpose: Fear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation. Methods: Our study involved 600 individuals aged 70.8–96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high). Results: Falls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12–4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified. Conclusion: Fear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the reliability and validity of the Turkish version of the Nursing Activities Score. Methods: To validate the Turkish version of the Nursing Activities Score, a sample comprising 30 adult intensive care patients and 30 nurses was employed. After a pilot study, the internal consistency, Cronbach's alpha coefficient, was found to be p = 0.718. Following the significant internal consistency obtained in the pilot study, the correlation between Nursing Activities Score internal consistency and Critical Nursing Situation Index scores was examined in 150 adult intensive care patients and 150 nurses. Results: The assessment of inter-rater reliability showed a high level of agreement (99%) and an average Kappa index of 0.598 (p < 0.001). Concurrent validity was demonstrated through a statistically significant correlation between Nursing Activities Score and the Critical Nursing Situation Index (r = 0.71, p < 0.001) and multivariate regression analysis (R2 = 83%, p < 0.001). The validity is supported by the statistically significant relationship between Nursing Activities Score and Critical Nursing Situation Index. Conclusion: These results demonstrate that Nursing Activities Score is a valid and reliable tool for measuring nursing workload in Turkish intensive care units. Trial registration: Samsun University Samsun Training and Research Hospital, following ethics committee approval (Samsun University clinical research ethics committee (KAEK) 202312/2) and Clinical Trials (NCT04928040) registration. [ABSTRACT FROM AUTHOR]

Objective: The study was to survey the current situation and explore the relationship between pain assessment ability, palliative care core competence and palliative care practice ability among oncology nurses in mainland China. Methods: A multicenter cross-sectional study design was employed. Study data were collected in 26 tertiary hospitals among 1198 registered oncology nurses in the oncology department in Hubei province, China. A web-based survey was conducted using a stratified random integral sampling method to obtain data. All variables were measured using standardized instruments. Data was analyzed using SPSS 26.0 and AMOS 26.0 statistical software. All statistical tests were two-sided, with the significance level set at P < 0.05. The structural equation model was utilized to test the mediation effect of pain assessment ability on the pathway from palliative care core competence to palliative care practice ability. Results: The mean scores for pain assessment, core competence and practice ability were 125.68 (SD = 31.16), 76.67 (SD = 19.59) and 67.17(SD = 12.57), respectively. Pearson correlation analysis revealed significant positive correlations among the PCPS, EPCS, and Self-PAC scores of the oncology nurses (P < 0.01). The association between core competence and palliative care practice ability was mediated by pain assessment ability (ES = 0.125, 95%CI: 0.090–0.168). Conclusions: To enhance the effectiveness of palliative care practice, managers need to strengthen the core competencies of palliative care nurses and their ability to assess patients' pain, as these two factors will promote the practical abilities of oncology nurses. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a common condition that increases the risk of fracture and mortality. In Taiwan, clinical guidelines recommend pharmaceutical therapy for patients with a T-score of ≤ − 2.5; however, Taiwan's National Health Insurance (NHI) only covers these medications for those with a history of fragility fractures. This gap in coverage necessitates a discussion of out-of-pocket treatment options. To address this, we provided an integrated care program with patient education and shared decision-making by nurse case managers specializing in osteoporosis. We evaluated whether education by nurse case managers influences patients with a T-score ≤ − 2.5, who are not covered by the NHI, to choose out-of-pocket pharmaceutical therapy. Methods: We retrospectively reviewed medical records of patients who underwent bone density scanning at our hospital between January 2014 and December 2021. We identified 4,462 patients with a T-score of ≤ − 2.5 who were ineligible for NHI-covered anti-osteoporotic therapy and analyzed trends in out-of-pocket medication use. Since the integrated care program began in 2018, we evaluated whether education by nurse case managers between 2018 and 2021 influenced patients' decisions to pay out-of-pocket for therapy. After the implementation of the integrated care program, we identified 2,910 patients with a T-score ≤ -2.5 who were ineligible for NHI-covered anti-osteoporotic therapy. Of these, 640 opted for out-of-pocket treatment, while 2,270 chose conservative care. After a 1:1 propensity score match based on age and sex, logistic regression was used to analyze the impact of nurse case manager education on these decisions. Results: Between 2014 and 2021, 888 of the 4,462 patients chose out-of-pocket pharmaceutical therapy. Before the implementation of the integrated care program and patient education by nurse case managers (2014–2017), 16% of the patients opted to pay out-of-pocket for anti-osteoporotic therapy. After the program was implemented (2018–2021), the rate increased significantly to 22% (P < 0.001). A multivariate logistic regression model showed that a history of osteoarthritis (adjusted odds ratio = 1.576; P = 0.009) and education provided by the nurse case managers (adjusted odds ratio = 5.044; P < 0.001) were significantly associated with choosing out-of-pocket therapy. Conclusions: Education from nurse case managers significantly increased the likelihood of patients choosing out-of-pocket anti-osteoporotic therapy in our hospital, thereby bridging the gap between clinical guidelines and NHI reimbursement criteria. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to assess the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and past 12-month suicidal behaviour (PSB) among adolescents in Mozambique. Methods: Data from 3,109 females (aged 15–19 years) and 1,439 males (aged 15–19 years) that participated in the 2022-23 Mozambique Demographic and health Survey were analysed. MDD was assessed with the PHQ-9 and GAD with the GAD-7. Results: Results indicate that among girls the prevalence of PSB was 4.3% (attempt 1.0%, plan 1.9% and/or ideation 3.6%) and among boys 2.5% (attempt 0.3%, plan 0.7% and/or ideation 2.4%). Among girls and boys, the prevalence of MDD (≥ 8 scores) was 15.5% and 3.7%, respectively, and the prevalence of GAD (≥ 5 scores) was 25.0% and 10.3%, respectively. In adjusted logistic regression analysis, among girls, GAD was positively and solid fuel use was negatively associated with PSB, while among boys MDD and urban residence were positively associated with PSB. Among female adolescents, currently being pregnant and "big problem to get money for medical treatment" increased the odds of MDD. While among male adolescents, urban residence, having a genital sore or ulcer, has living children, and early sexual debut were positively associated with MDD. Urban residence, current alcohol use, and early sexual debut were positively associated with GAD in male adolescents, while poorer wealth status, being pregnant, and having a "big problem to get money for medical treatment" were positively associated with GAD in female adolescents. Conclusion: About 3% of participants had PSB, among girls one in five had MDD or GAD and among boys more than 5% had MDD or GAD. Public health interventions can be guided by several associated factors that have been identified. [ABSTRACT FROM AUTHOR]

Background: Calcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs). Methods: This study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery. Results: Functional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group. Conclusion: Compared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the flexion angle of a femoral prosthesis on the postoperative clinical outcome of patients with knee osteoarthritis who are undergoing unicompartmental knee arthroplasty. Methods: Patients were divided into three groups according to the flexion angle of the femoral prosthesis following unicompartmental knee arthroplasty. Group A comprised patients with a flexion angle of the femur prosthesis of less than 5°, Group B included those with a flexion angle of 5° to 10°, and Group C consisted of patients with a flexion angle of the femur prosthesis greater than 10°. The basic clinical data, visual analog scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM) were subjected to statistical analysis and comparison between the groups. Results: No significant differences were observed in the basic data of the patients in each group. The ROM and VAS scores for the knee in the first month following unicompartmental knee arthroplasty in groups B and C were significantly greater than those in group A. The HSS scores for the knee joint in Group B indicated superior outcomes in the initial postoperative month and the third postoperative month, as evidenced by the WOMAC scores, which demonstrated a statistically significant difference between Group B and the other two groups within the six-month postoperative period. Conclusion: The short-term recovery of patients in Group B was the fastest. These results provide a new reference for the installation of femoral prostheses in unicompartmental knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic generated or accelerated healthcare changes, some of which persist thereafter (e.g., healthcare reorganisation, remote consultation). Such changes entail novel risks for patient safety. Methods: Aim To compare the characteristics of patient safety incidents with harm (PSIH) in primary care before the pandemic and at present. Design and setting Cross-sectional, comparative, observational study conducted within the entire Primary Care Service of the Madrid region with observations at two time points (2018 and 2021/2022). Participants Patients > 18 years of age with at least one consultation in the previous year. The necessary sample size was established at N1 = 2,000 for the first time point and N2 = 2,700 for the second. Sampling was performed by simple randomisation for the first group and by clusters followed by simple randomisation for the second. Main measurements Age, gender, presence of PSIH in the medical record, and characteristics of the PSIH, specifically avoidability, severity, place of occurrence, nature, and contributory factors. Triggers validated in primary care were employed to screen the patients' medical records and those containing any trigger were reviewed by three nurse-physician teams who underwent previous training. Analysis Comparative analysis using Fisher's exact test. Results: A total of 63 PSIHs and 25 PSIHs were found for the first and second samples, respectively. The comparison of the characteristics of PSIH before the pandemic and currently was: avoidable 62% vs. 52% (p = 0.47), mild 51% vs. 48% (p = 0.57), in the primary care setting 73% vs. 64% (p = 0.47), respectively. Although no statistically significant differences were observed globally in the nature of the incidents (p = 0.13), statistically significant differences were found for diagnostic errors, with pre-pandemic rates of 6% vs. 20% at present (p < 0.05). Finally, no significant differences were found in the contributory factors. Conclusions: No differences were found in the avoidability, severity, place of occurrence, or contributory factors of PSIHs before the pandemic and currently. In terms of the nature of these incidents, the outcomes revealed an increase in diagnostic errors (excluding diagnostic tests), which could be attributed to a greater frequency of remote consultations and a decrease in the longitudinality of care resulting from the shortage of professionals. [ABSTRACT FROM AUTHOR]

Background: Pit and fissure sealant is a micro-invasive modality for treating deep and retentive pits and fissures to prevent and/or stop occlusal caries. Every effort needs to be done to enhance sealant retention and survival. The aim of this research is to assess the retention rate of giomer S-PRG filler containing pit and fissure sealant applied with or without etching. Methods: Overall, 52 patients were included in this trial and they were allocated randomly in 2 groups (n = 26). Group 1 (control group) received giomer sealant (Beautisealant, Shofu, Kyoto, Japan) without an etching step, and group 2 (intervention group) received the same but with a separate preparatory etching step before the sealant application. The retention rate of the sealant was assessed over one year at 3 months, 6 months, and 12 months. Intergroup comparison between categorical variables was done using the chi square test, while intragroup comparison was done using Cochran's q test followed by multiple comparisons. Relative risk was used to evaluate the clinical significance. Survival rate was analyzed using Kaplan-meier and Log-rank test. Results: Intergroup comparison between both techniques revealed statistically significant difference within different follow up periods (P < 0.05). Intragroup comparison within both giomer sealant with etching group and giomer sealant without etching group revealed statistically significant difference between different follow-up periods (P < 0.001). There was 69% less risk for total loss or partial loss of giomer sealant with etching when compared to giomer sealant without etching after 12 months. Conclusion: An initial preparatory step of etching to the enamel surface is crucial before giomer sealant application to enhance its bonding, increase its retention and promote its survival. Trial registration: Trial registration ClinicalTrials.gov, NCT04929782. Registered 14 July 2024 - Retrospectively registered, https://clinicaltrials.gov/study/NCT06509451 [ABSTRACT FROM AUTHOR]

Background: A recent phase 2A clinical study of Atractylodes lancea (Thunb.) DC. (AL) in patients with advanced-stage intrahepatic cholangiocarcinoma (iCCA) demonstrated significant reduction of the risk of tumor progression and mortality with a dose ranging from 1,000 to 2,000 mg. The present study aimed to determine the potential dosage regimen of AL for further phase 2B clinical study. Methods: Plasma-concentration time profiles of total AL bioactivity and clinical efficacy in patients with advanced-stage iCCA were obtained from Phase 2 A study. The population pharmacokinetic (pop-PK) model was developed. The pop-PK model and Monte-Carlo (MC) simulation, in conjunction with maximum concentration of AL (Cmax) as a cut-off criterion, was performed and validated with clinical data. The optimal model was used to simulate further dosage regimens and clinical efficacy of AL. Results: The pop-PK properties of total AL bioactivity were best described by a compartmental model with zero-order absorption (without delay) and linear clearance. None of the investigated covariates improved model accuracy.The developed pop-PK with MC simulations following once-daily dosing of 1,000 mg and 2,000 mg adequately predicted the clinical efficacy (tumor progression and mortality). The once-daily dose of 2,500 mg is recommended for further phase 2B clinical study due to its relatively high efficacy on tumor progression inhibition (73%) and mortality rate reduction (71%) without excessive number of the administered capsules (23 capsules) and low risk of toxicities (<5%). Conclusions: The applied pop-PK model with MC simulation, along with the appropriate cut-off pharmacokinetic parameters, can be used as a potential tool for supporting dosage prediction and selection for clinical studies, and thus reducing the rate of drug development failures. Trial registration: www.thaiclinicaltrials.org, WHO ICTRP search, TCTR20210129007, Registed 29 January 2021. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature. Method: Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram. Results: The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors. Conclusion: This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice. [ABSTRACT FROM AUTHOR]

Background: This study aims to examine the association for paternal care and father-child screen use with early childhood development and children's temper tantrums. Method: Study file included questions about paternal characteristics, child care, father-child screen habits, and utilized the UNICEF Early Childhood Development Index (ECDI). Factors influencing ECDI-on-track status and children's responses when screen use was restricted were investigated with Chi-square test and multiple logistic regression. Results: The study included 464 fathers having children aged 3–4 years. The findings showed that 89.7% of the children were on track in three out of the four ECDI subgroups. When screen use was restricted, 55.6% of the children engaged in another activity, while 44.4% reacted by crying. Multiple logistic regression analysis revealed that the father's education level, the child's age and gender, the starting age for screen usage, the child's reaction to screen restriction, and having three or more books were associated with ECDI. Furthermore, the child's reaction to screen restriction was related to the child's and father's screen time, the presence of three or more books, the adequacy of care, and being on track in the literacy-numeracy ECDI subgroup. Conclusion: Screen usage habits significantly impact early childhood development and children's reactions to screen restrictions. These findings underscore the importance of educating fathers about the effects of their own and their child's media habits, the quality of fatherly caregiving, and the presence of books in fostering positive child development. [ABSTRACT FROM AUTHOR]

Background: Fertility rates have been decreasing both worldwide and in China. Although current policies have been aimed at raising the birth rate in China, their overall effects have been unclear. Therefore, exploration of fertility intention and related influencing factors is crucial. Methods: This study used a convergent parallel mixed methods combining descriptive and cross-sectional designs with a framework analysis. Convenience sampling was used to select mothers of childbearing age with two children (n = 603), living in Guangdong Province, China. Participants completed an online questionnaire investigating sociodemographic characteristics, as well as determinants and attitudes regarding the third-child fertility intention. Correlation coefficients and multivariate regression analyses were used to present quantitative findings. Eleven interviews were conducted, and a framework analysis method was used for data analysis. The results for the qualitative and quantitative study components were analyzed separately and were subsequently integrated through side-by-side comparison and joint display. Result: Attitudes toward fertility intention were negative, and the rate of fertility intention was 10.4% in Guangdong Province. In the quantitative component, women's age, perceived value of having a third child, and attitudes were found to be factors promoting the intention to have a third child, whereas monthly family income, grandparents' health status, and policy support were found to be factors hindering the intention to have a third child. Four major themes emerged regarding the perceptions and experiences regarding fertility intention in the qualitative component. After integrated analysis, younger age, knowledge regarding policy support, and access to childcare support were found to be factors significantly affecting the intentions of mothers with two children regarding having a third child. Conclusion: Fertility issues require continued attention. Our findings provide a reference for optimizing existing policies to increase fertility intentions. Providing policy support, such as public childcare support, flexible working hours for mothers, affordable childcare, and greater psychological support, would enable mothers to improve their parenting. In addition, increasing the dissemination of knowledge regarding policies is necessary to improve the level of public understanding and promote fertility intention. [ABSTRACT FROM AUTHOR]

Background: Asthma, a chronic respiratory disease, has been steadily increasing in prevalence and significantly impacts global health. In Bangladesh, it remains a major public health concern. The relationship between asthma and body mass index (BMI) is complex, with higher rates observed among overweight individuals. This study aims to explore the association between BMI, respiratory symptoms, and asthma in Khulna City, Bangladesh, addressing the lack of comprehensive data for this region. Methods: This study was a cross-sectional study. For data collection purposes, we considered Khulna Medical College and Hospital (KMC). Data collection involved a well-structured questionnaire during in-person meetings held from September 18 to November 6, 2022. We selected a total of 310 participants through simple random sampling and performed statistical analyses, including chi-square tests and logistic regression, to examine associations. Results: The majority of participants were aged above 60 years (36.5%), with most having a normal BMI (74.8%) and being male (69.0%). We found significant associations between the prevalence of asthma, age, BMI categories, and respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Overweight individuals showed a higher likelihood of developing asthma (AOR 7.01; 95% CI 5.04–7.11), as did those with primary education (AOR 1.51; 95% CI 1.11–2.95) and smokers (AOR 2.80; 95% CI 1.27–6.15). Conclusion: This study identifies a higher asthma prevalence in Khulna City, associated with older age, overweight status, primary education level, and respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Smoking further exacerbates the severity of the condition. We recommend public health strategies such as promoting healthier lifestyles, improving healthcare access, raising awareness about smoking risks, enhancing air quality, and establishing specialised asthma clinics for effective management and improved quality of life. [ABSTRACT FROM AUTHOR]

Background: To assess the adverse food reactions (AFR) prevalence in children with autism spectrum disorder (ASD) and in non-ASD healthy controls (NASD). Nutritional status alterations, food selectivity and adherence to Mediterranean Diet (MD) were also evaluated. Methods: The NAFRA (Nutritional status and Adverse Food Reactions in children with Autism Spectrum Disorder) project was an observational, case-control, comparative study conducted at a tertriary center for pediatrics involving Caucasian patients of both sexes, aged 18 months-7 years, with a diagnosis of ASD, and matched NASD controls. Results: From October 2017 to December 2023, 100 ASD patients [79 male, mean (± SD) age 49.9 months (± 15.4)] and 100 NASD controls [75 male, mean (± SD) age 49.8 months (± 17.7)] were enrolled at the Pediatric Section of the Department of Translational Medical Science of the University of Naples Federico II. A significantly higher prevalence of AFR was observed in ASD patients if compared with NASD (16% vs. 2%, p = 0.001), mainly due to a higher prevalence of food allergy (7% vs. 1%, p = 0.03). A significantly higher prevalence of food intolerance and celiac disease was also observed in ASD children. The rate of obesity was significantly higher in ASD patients compared to NASD. Food selectivity and low MD-adherence were more frequent in ASD children (26% vs. 2%, p < 0.0001 and 28% vs. 16%, p = 0.041, respectively). Conclusions: The high rate of AFR, obesity and unhealthy dietary habits observed in ASD children strongly suggest the importance of a multidisciplinary approach, providing early diagnosis of AFR and appropriate nutritional management to improve core and associated ASD-related conditions. Trial registration: The NAFRA Project was registered on https://clinicaltrials.gov/ with the identifier NCT04719923. Registered 18 January 2021. https://clinicaltrials.gov/study/NCT04719923. [ABSTRACT FROM AUTHOR]

Background: This study seeks to elucidate the expressions of lncRNA TSIX in Osteoarthritis (OA) and to explore its mechanisms in regulating OA progression. Methods: RT-qPCR was employed to analyze the expression of TSIX in OA patients classified by Kellgren-Lawrence (K-L) grades. Receiver operator characteristic (ROC) was conducted to evaluate the diagnostic value of TSIX. Correlation between TSIX levels and clinical scores such as Lysholm and visual analogue scale (VAS) score was evaluated using Pearson method. IL-1β-induced SW1353 cells served as an in vitro model. The cell function were assessed by flow cytometry and cell counting kit-8 (CCK-8) assay. The relationship between TSIX and miR-320a was verified by luciferase reporting system, while bioinformatics approaches were utilized to predict the downstream target genes of miR-320a. Results: The findings revealed that TSIX level in OA patients was elevated compared to that of the control group, with a notable progressive increase in TSIX expression correlated with higher K-L grades. In OA patients, the Lysholm score showed a negative correlation with TSIX expression, while the VAS score displayed a positive correlation with TSIX levels. Cell studies demonstrated that inhibition of TSIX enhanced cell viability and mitigated IL-1β-induced apoptosis by targeting miR-320a, in addition to promoting Aggrecan and Collagen II secretion. Luciferase reporter assay further validated the targeting interaction among TSIX, miR-320a, and PTEN. Conclusions: This study demonstrated an increased expression of TSIX in OA patients. It suggests that TSIX may play a role in chondrocyte dysfunction during OA by modulating the miR-320a/PTEN axis. [ABSTRACT FROM AUTHOR]

Background: Turnover intention (TI) indicates an employee's intention to depart from their current role within a defined timeframe. In China, the Targeted Admission Medical Education (TAME) program, initiated in 2010, offers tuition-free education to cultivate rural doctors. Despite continuous professional development (CPD) being considered a viable retention strategy, TI of alumni doctors from the TAME program remains high in recent years. This study aims to describe the prevalence of "turnover intention" among alumni doctors of the TAME program doctors in rural placements, and associated factors that predict high turnover intention. Methods: A snowball sampling method was adopted to collect survey responses from 1,369 alumni doctors of the TAME program in Jiangxi Province, China. Based on the survey data, a binary variable was constructed to measure the turnover intention, and multivariate binary logistic regression models were used to investigate the relationship between doctors' turnover intention and demographic characteristics, work environment characteristics, and CPD activities. Results were presented using adjusted odds ratios with 95% confidence intervals. Results: Among the 1,369 alumni doctors of the TAME program surveyed in this study, 392 (28.6%) expressed intentions to leave their current positions. Of the respondents, 620 (45.3%) were female, and 930 (67.9%) were married. Additionally, 1,232 respondents (90%) indicated that their fathers were engaged in farm work. Strong associations with turnover intention were notably found among individuals who had undergone training at a higher-level healthcare institution for more than three months (aOR = 6.810, 95% CI: 3.333 to 13.909, p-value < 0.001), particularly those who had participated in CPD through a graduate degree program (aOR = 1.818, 95% CI: 1.272 to 2.597, p-value < 0.001). Conclusion: Rural doctors in China from the tuition-free medical education program exhibit high turnover intention, especially those in graduate degree programs as CPD. To retain these highly qualified rural doctors, it is vital to offer competitive efficiency wages aligned with their skills and provide ample long-term career growth opportunities within the rural healthcare system. Highlights: Retaining rural doctors in China who graduated from the tuition-free medical education program continues to pose a significant challenge. High turnover intention is particularly prevalent among those enrolled in CPD graduate degree programs. Offering competitive efficiency wages and creating abundant long-term career growth opportunities within the rural healthcare system are essential measures. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this systematic review and meta-analysis was to assess the association between iron deficiency anemia (IDA) and retinal changes via optical coherence tomography (OCT). Methods: The search was conducted in MEDLINE, Scopus, Embase, Web of Science, and Google Scholar until February 1, 2024. Two independent researchers included the articles based on the inclusion and exclusion criteria. Data regarding the study design, patient characteristics, number of patients with and without IDA, mean and SD of the retinal nerve fiber layer (RNFL), C/D ratio, foveal avascular zone (FAZ) area and perimeter, foveal density and superficial and deep capillary plexus (SCP and DCP) vascular density (VD) were collected. STATA version 17.0 was used to compute pooled measures of the standardized mean difference. I2 and chi-square tests were used to assess heterogeneity between studies. Results: We found 1378 nonduplicate studies, 35 of which were potentially relevant. 19 articles met the inclusion criteria and were included in the review. The meta-analysis confirmed that there was a statistically significant association between IDA and RNFL thickness reduction (SMD = -0.76, 95% CI: -1.09 to -0.44 ; p-value = 0.001, I2 = 86.88%), FAZ area (SMD =-0.35, 95% CI: -0.67 to -0.02; p value = 0.04, I2 = 59.76%) and SCP VD (SMD = -1.12, 95% CI: -1.85 to -0.39; p-value = 0.001, I2 = 83.15%). The associations between IDA and the C/D ratio (SMD = 0.07, 95% CI: -0.13 to 0.28; p value = 0.49, I2 = 0.0%) and DCP VD (SMD = -0.30, 95% CI: -0.89 to 0.29; ,p-value = 0.32 ,I2 = 77.20%) were not significant. There was no considerable publication bias. Conclusion: The results of this meta-analysis demonstrated that, compared with healthy controls, individuals with IDA presented a thinner RNFL, a smaller FAZ, and lower SCP and DCP vascular densities. However, further studies are needed to reach more conclusive results. [ABSTRACT FROM AUTHOR]

Purpose: Although many factors were suggested to affect acetabular cup positioning during primary total hip arthroplasty, the effect of surgeon handedness was rarely evaluated. We aimed primarily to assess the difference in cup positioning (inclination and anteversion) between the right and left sides during primary THA. Secondly, to check the difference in the percentages of cups positioned in the safe zone for inclination and anteversion and if there will be a difference in cup positioning according to the type of cup fixation (cemented vs. cementless). Methods: Cup inclination and anteversion of 420 THAs were radiographically evaluated retrospectively. THAs were performed by a senior right-handed surgeon, who operated through a direct lateral approach in a lateral decubitus position using manual instruments and freehand technique for cup placement. Patients were assigned to two groups: Group A (right, or dominant side), and Group B (left, or non-dominant side), with equal cases of THAs (n = 210) in each group. Results: No difference was found in patients' basic characteristics, preoperative diagnosis, and cup fixation (54.3% cemented and 45.7% cementless) between the two groups. There was a significant difference in cup inclination between Groups A and Group B (40.1° ± 6.3° vs. 38.2° ± 6.1°) (P = 0.002). No significant difference was revealed in anteversion between the two groups (11.7° ± 4.4° vs. 11.8° ± 4.7°) (P = 0.95). The percentage of cups located within the safe zone in terms of both inclination and anteversion was 85.2% vs. 83.8% and 69% vs. 73.3% for Group A and Group B, according to Lewinnek and Callahan's safe zones, respectively. There existed a significant difference in the cemented cup inclination between Group A and Group B (40.8° ± 6.4° vs. 38.3° ± 6.3°) (P = 0.004). Conclusion: Cup inclination is affected by the surgeon's handedness when operating through a direct lateral approach and using a freehand technique, while anteversion is less affected. Furthermore, the difference is greater with cemented cups. [ABSTRACT FROM AUTHOR]

Background: We set out to assess the appropriateness of current placement of mentally disordered offenders allocated by the courts in Italy to REMS or to forensic community residences. We hypothesised that as in other countries, the match between a standardised assessment and the decision of the court would be imperfect. Methods: The DUNDRUM Toolkit was translated into Italian. The translation had good psychometric properties. In order to compare the current level of therapeutic security with a calculated safest current placement, we compared the DUNDRUM-1 triage security assessment of need for therapeutic security prior to treatment, with evidence for progress made in treatment (DUNDRUM-3) and forensic recovery (DUNDRUM-4). The more conservative of these two would be taken as the safe current level of need for therapeutic security. Results: The Italian translation of the DUNDRUM Toolkit had good internal consistency and mean scores had a Reliable Change Index less than one unit. 3.7% of those in REMS (medium security) were assessed as needing high security and 38% were ready to move to a less secure place. In low secure places, 56% were assessed as needing a higher level of therapeutic security and 6% could have moved to open non-secure places. Conclusions: The Italian translation of the DUNDRUM Toolkit allows an assessment of the current working of the model of care for forensic psychiatry following the reforms of 2015. Most patients are safely placed. A small but important proportion needed high secure places that are not currently available. (3.7% of 604 nationally, 95% Confidence Interval 1.2% to 8.4%, 7 to 50). A greater use of such measures would enable better health gains and safer outcomes. Trial registration ClinicalTrials.gov ID: NCT06018298 Unique Protocol ID: ITAL-EE-REMS. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin c can relieve the pain after other diseases, but there are no studies on whether vitamin C can relieve the pain after hip replacement. The purpose of this paper is to study whether vitamin C can relieve the pain after total hip replacement. Purpose: In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients receiving THA at our hospital were randomly assigned to vitamin c or control groups. During the operation, the vitamin C group will receive intravenous injection of 3 g vitamin C, and the control group will receive 3 g placebo. If the patient has postoperative pain, 10 ml subcutaneous injection of morphine will be required as a rescue analgesic. The primary outcome was the amount of postoperative injection of morphine as a rescue analgesic and expression of inflammatory factors, and the secondary outcome was postoperative pain and hip recovery as assessed by visual analog scale (VAS). Results: The dosage of subcutaneous injection of morphine was significantly reduced in vitamin C group. VAS pain scores at rest and exercise were lower in the vitamin C group 24 h after surgery, and hip motion was better 24 h after surgery, but there was no significant difference between the two groups 24 h after surgery.Nonetheless, the overall changes in morphine usage and VAS scores did not surpass the established minimal clinically important differences (10 mg for morphine consumption; 1.5 at rest and 1.8 during movement for VAS scores). Conclusion: Adding intravenous vitamin c to multimodal analgesia significantly improved morphine consumption, VAS pain score, and functional recovery. However, it is recommended that single intravenous administration of vitamin C during the perioperative period may achieve better pain relief for patients after THA. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to assess the efficacy of surgical treatment in children with drug-refractory infantile epileptic spasms syndrome (IESS) and examine the factors influencing the post-surgical outcomes. Methods: The clinical data of 30 children (18 males and 12 females) with epileptic spasms (ES) who underwent surgery at the Epilepsy Center of Shenzhen Children's Hospital between June 2018 and June 2020 were retrospectively analyzed. Post-surgical outcomes were evaluated using the Engel Epilepsy Surgery Outcome Scale. Scalp electroencephalography and developmental quotient were assessed preoperatively and postoperatively. Univariate analysis and exact logistic regression analyses were used to identify the factors affecting the postoperative efficacy. Results: Of the 30 patients who underwent surgical resection, 22 (73.3%) achieved Engel's class I–II outcomes. Additionally, motor and cognitive functions improved in 14 patients (46.7%). The development of 12 (40%) patients remained at the preoperative development level. The median number of antiseizure medications taken preoperatively was 5.27 (range 2–10), which decreased to 1.90 (range 0–4) at the last follow-up. Seizure duration, etiology, positive positron emission tomography-magnetic resonance imaging (PET-MRI), surgery type, and lesion location were significantly correlated with the postoperative efficacy (P < 0.05). Positive PET/MRI findings and lesion location predicted independently the postoperative outcomes. Permanent impairments of motor or language function were rare, with only two cases reporting hydrocephalus and one reporting hemiplegia. Conclusions: Surgery is an effective treatment option for children with IESS. Early referral and comprehensive preoperative evaluation are essential for identification of surgically treatable structural lesions. The primary surgically treatable cause is cortical malformation, followed by perinatal brain injury. Hemispheric disconnection is a preferred surgical approach. Positive PET/MRI findings and lesion location predicted the postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity. Methods: This was a cross-sectional study of 400 adults aged 20–70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis. Results: The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03–1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01–1.10). Conclusions: Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity. [ABSTRACT FROM AUTHOR]

Objective: This study compared parental distress in 166 couples, using the Parenting Stress Index–Short Form (PSI-SF), in the Italian NASCITA cohort at the two-year well-child visits. The study explored the concordance of distress levels within couples (aim 1) and their correlation with child-related stressors (aim 2). Background: Previous studies focused on maternal distress or considered maternal and paternal experiences separately, without addressing differences within couples. Method: Data on parental distress were collected from the PSI-SF completed separately by parents. The total score was derived from three subscales, with high distress defined by a score above 85. The Wilcoxon signed-rank test compared the total PSI-SF scores of mothers and fathers. The prevalence of high distress was assessed using chi-square tests, and concordance between parents within the same couple was estimated using Cohen's K statistic. Chi-square tests were also used to compare distress levels in parents exposed to potential child-related stressors versus those not exposed. Results: A slightly higher total score (z = -2.45; p = 0.01) was observed in mothers versus fathers, although the prevalence of distress was similar (15.1% vs. 13.9%, respectively; p = 0.76). Nine children (5.4%) had both parents distressed. Agreement in the high level of distress was observed for 81.9% of the couples, with a fair agreement on the total score (Cohen's K = 0.27).The percentage of children with both distressed parents was slightly higher in the group exposed to potential stressors (6.6% vs. 4%, p = 0.49). Conclusions: It is essential to evaluate distress in parents exposed to potential stressors related to child characteristics early. This assessment should be part of the pediatric family practice to prevent adverse outcomes in both child and parental wellbeing. [ABSTRACT FROM AUTHOR]

Background: Several vaccines were introduced in Tanzania to combat the COVID-19 pandemic. While studies have explored the acceptability and hesitancy of COVID-19 vaccines within the general population, there is limited research focusing on the confidence and associated factors among People Living with HIV (PLHIV). This study aims to fill that gap by investigating vaccine confidence and its determinants in this demographic group. Methods: A cross-sectional study was conducted in centres for care and treatment in four regions of mainland Tanzania using structured questionnaires. A generalized linear mixed model was fitted to determine the factors associated with confidence in the COVID-19 vaccine. Results: A total of 1,100 participants were interviewed; 761 (69.2%) were female. The mean age and standard deviation were 41.6 ±12.1 years. The overall level of confidence in COVID-19 vaccines was 55.3%. Females were less likely to express confidence compared to males (aOR = 0.77; 95% CI: 0.72–0.84). Participants with primary (aOR = 1.79; 95% CI: 1.65–1.94), secondary (aOR = 1.81; 95% CI: 1.57–2.09), and university-level education (aOR = 2.14; 95% CI: 0.17–26.54) were more likely to report confidence in COVID-19 vaccines. Attending a dispensary-level health facility (aOR = 1.32; 95% CI: 1.27–1.38) and living in rural areas (aOR = 1.43; 95% CI: 1.23–1.66) were significantly associated with confidence in COVID-19 vaccines. Conclusion: Although COVID-19 is no longer a global public threat, these findings highlight the significance of being prepared in public health and the necessity of continuous efforts to comprehend and enhance vaccine acceptance and confidence among people living with HIV. By tackling the factors that impact vaccine attitudes in this group, we can improve our preparedness for future public health challenges where vaccine uptake may once again become crucial. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation is a growing epidemic in Africa. Anticoagulation, considered the backbone for non-valvular atrial fibrillation (NVAF) management, is limited to warfarin as the mainstay of available anticoagulation therapy in most low- and middle-income countries (LMIC). The optimal time in the therapeutic range (TTR) while on warfarin is essential to avoid bleeding and thromboembolic complications. This study assessed anticoagulation control in patients with NVAF on warfarin in Johannesburg, South Africa. Methods: We conducted a cross-sectional retrospective study on patients with NVAF managed in the Division of Cardiology, at a tertiary-level academic centre in Johannesburg, South Africa, between 1 January 2015 and 31 December 2019. Anticoagulation control for patients with NVAF was assessed by calculating the TTR using the Rosendaal method. Results: The study population comprised 177 patients diagnosed with NVAF. The mean age was 65.0 ± 13.1 years. The median TTR among patients with NVAF was 46% [interquartile range (IQR): 8.7–86.0], and 63 (35.6%) patients with NVAF had a TTR ≥ 70% (optimal anticoagulation control). Patients with poor anticoagulation control (TTR < 70%) were on warfarin for a shorter duration compared with those with optimal anticoagulation control [56 days (IQR: 43–84) vs. 70 days (IQR: 56–140), p = 0.0013]. The mean CHA2DS2-VASc score was 4 ± 1.5, and it did not differ between patients with poor or optimal anticoagulation control. Among the 175 patients with available HAS-BLED scores, 21 (12.0%), 112 (64.0%) and 42 (24.0%) were at a low, moderate, and high risk for bleeding, respectively. Of the 21 patients in the HAS BLED low-risk category, only 4 (19.0%) had a TTR < 70% (p < 0.001). Warfarin toxicity was documented in 13 (7.3%) patients. Conclusion: In our study, a TTR ≥ 70%, suggesting optimal anticoagulation control, was found in only 35.6% of patients with NVAF on warfarin. [ABSTRACT FROM AUTHOR]

The study aimed to assess the perception of a higher risk of COVID-19 infection among young people who used e-cigarettes, and its association with a change in the use of e-cigarettes during the pandemic in Nigeria. A secondary analysis of the Nigerian component of a multi-country online survey data, which was obtained from adolescents and young adults on e-cigarette use from November 1st to December 30th, 2021, was conducted. Multi-nominal regression analyses were done to determine the associations between the dependent (use of e-cigarettes) and independent (perception that e-cigarette users are more likely to be infected with COVID-19) variables after adjusting for confounders (health status, COVID-19 status, HIV status, anxiety level, age and sex). Of the 568 respondents (52.8% male), 122 (21.5%) perceived that e-cigarette users were more likely to be infected with COVID-19. In addition, 188 (33.1%) respondents increased e-cigarette smoking during the pandemic. A greater percentage of participants who perceived that e-cigarette use is associated with a greater risk of COVID-19 infection, and a significantly higher percentage of participants with high levels of anxiety reported decreased e-cigarette use (28.6% versus 13.3%, p = 0.029). The perception that e-cigarette use increased the risk for COVID-19 was associated with higher odds of an increase in e-cigarette use (AOR: 1.328) and lower odds of a decrease in e-cigarette use (AOR: 0.580) during the COVID-19 pandemic, though these associations were not statistically significant. The persistence of e-cigarette use among the youth in Nigeria despite awareness of COVID-19 risks highlights the need for stronger public health interventions. Simply providing information on risks is insufficient; targeted strategies addressing addiction, social factors, and accessibility are crucial for meaningful behavioural change. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the mechanisms influencing metacognitive awareness among nursing students, encompassing educational environment, learning motivation, emotional intelligence, and self-directed learning ability. These findings could be a theoretical reference for formulating metacognitive awareness intervention strategies specifically designed for nursing students. Method: Through stratified sampling, 600 nursing students were recruited from two universities in China. Data collection involved five self-report instruments: the Metacognitive Awareness Inventory, Medical Education Environment Evaluation Scale, Learning Motivation Scale, Emotional Intelligence Scale, and Self-Directed Learning Ability Scale. Confirmatory factor analysis was utilized to test the measurement model, while structural equation modeling utilized multiple indices to assess model fit. Bootstrapping was conducted to analyze total, direct, and indirect effects. Results: All study variables differed significantly according to age and year level (p < 0.01). Metacognitive awareness positively correlated with the educational environment, learning motivation, emotional intelligence, and self-directed learning ability (r = 0.493–0.729; all p < 0.01). The test of the measurement model shows good reliability and validity. The model depicting factors influencing metacognitive awareness demonstrated a good fit (χ2/df = 2.42, SRMR = 0.048, RMSEA = 0.049, CFI = 0.947, IFI = 0.935). Path analyses revealed that educational environment (EE), learning motivation (LM), and emotional intelligence (EI) directly impacted self-directed learning ability (SDLA) (βEE = 0.189, βLM = 0.436; βEI = 0.215; all p < 0.05). Moreover, educational environment and self-directed learning ability directly influenced metacognitive awareness (βEE = 0.224, βSDLA = 0.520; all p < 0.05). Lastly, the educational environment, learning motivation, and emotional intelligence influenced metacognitive awareness by self-directed learning ability. Conclusion: Metacognitive awareness in nursing students rises with age and year level. Females exhibit more potent self-directed learning abilities than males. Educational environment, motivation, and emotional intelligence indirectly influence metacognitive awareness via self-directed learning ability. This finding has enriched the ways and perspectives of metacognitive awareness training for nursing students. Highlights: This study profoundly explores the characteristics and interconnections between metacognitive awareness, self-directed learning ability, educational environment, emotional intelligence, and learning motivation in undergraduate nursing students in China. By examining the role of self-directed learning ability as a mediator, the research offers theoretical and practical insights that could guide the design of intervention strategies to enhance metacognitive awareness in nursing education. [ABSTRACT FROM AUTHOR]

Background: The opening up of the laws to medicinal cannabis in recent years is a key factor in the growth of this therapy, but there is little information about what nurses know and think about it. The present paper seeks to analyze the knowledge, opinions, and experiences of nurses and nursing students in Portugal regarding the use of cannabis and to understand gender differences. Methods: A self-completion questionnaire was drawn up and published online. It received face and content validity and was approved by the Ethics Committee. The instrument includes socio-demographic data, questions about knowledge, opinions, experiences, and training in cannabis. The data was collected and processed by applying descriptive and inferential statistics using the chi-square test and Fisher's exact test on the SPSS platform. Results: The majority of the 610 participants were women. The therapeutic benefits of medical cannabis were appreciated by 79,6% of nurses and 84,3% of students. When asked about the functions of the endocannabinoid system, 71,7% of nurses and 79,5% of students had never heard of it. There is a statistically significant gender difference concerning personal experience of cannabis use to treat symptoms or illnesses. Conclusions: As the levels of knowledge were low and a minority had education on medical cannabis, there is a need for further education of nurses and for this emerging area to be included in the curricula. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is commonly assessed with diagnostic imaging prior to intervention. The study objective was to describe practice patterns of diagnostic imaging for appendicitis and the associations with surgical delays, hospital costs, and complications. Methods: This was a population-based cohort study of patients with appendicitis between 2009 and 2015. Imaging was categorized into none, ultrasound, computed tomography (CT), or both. The outcomes were: 1) time from triage to surgery, 2) complication rate and 3) hospital costs. Logistic regression and hierarchical linear regression were used to estimate associations between imaging and outcomes. Results: There were 50,369 study patients. Time to surgery was highest in patients requiring both CT and ultrasound (mean difference 5.0 h 95%CI 4.6–5.4) followed by patients requiring CT (2.7 h 95%CI 2.4–3.0) and ultrasound (mean difference 0.7 h, 95%CI 0.5–1.0), compared to no imaging. Hospital costs were highest in those with both ultrasound and CT ($256 95%CI $28–483) and CT alone ($234 95%CI $75–394), compared with no imaging. Complications were associated with the use of CT (OR 1.08 95%CI 1.00–1.17) and both CT and ultrasound (OR 1.21 95%CI 1.09–1.35) compared with no imaging, but not with ultrasound alone (OR 1.01 95%CI 0.93–1.09). Conclusions: This study demonstrated that type of diagnostic imaging is associated with delays to surgery, especially in those requiring CT scan. In addition, complications and hospital costs are increased in this group. Clinicians could consider ultrasound as the first imaging modality to facilitate more timely surgery and reduced costs. [ABSTRACT FROM AUTHOR]

Background: Long-term management of patients with hypothyroidism on thyroxine replacement requires thyroid function test (TFT) monitoring once every six–12 months as recommended by clinical practice guidelines. This study determined their thyroid function status during two-year follow-up visits in primary care, and the factors influencing their thyroid status, and assessed the optimal interval for TFTs. Methods: A retrospective cohort study was conducted on adults with a clinical diagnosis code for hypothyroidism in their electronic health records taken from a group of polyclinics in Singapore between July 2017 and June 2020. The follow-up thyroid status was categorized as under-replacement (TSH ≥ 3.70mIU/L), over-replacement (TSH ≤ 0.65mIU/L) or euthyroid (TSH 0.65–3.70mIU/L). The patients' demographic, clinical and TFT data were analyzed using appropriate statistical tests during the two-year follow-up. Stepwise logistic regression analysis identified the factors associated with suboptimal thyroid control. Kaplan–Meier analysis was used to compare their thyroid function status in association with the interval between TFT monitoring. Results: Data from 5,749 eligible subjects (mean age 62.1 ± 13.29 years; 79% female; 79.7% Chinese) were analyzed. After a two-year follow-up, 61.9% (n = 3558) of all subjects were euthyroid, with 29.5% (n = 1694) being under-replaced and 8.6% (n = 497) over-replaced. However, thyroid status did not differ significantly with the various dose regimen (daily, segmented, or alternate days) (p = 0.193). Stepwise logistic regression showed that thyroxine under-replacement was significantly associated with the male gender (AOR = 1.25,95%CI = 1.03–1.51,p = 0.02) and obesity (AOR = 1.34,95%CI = 1.08–1.66,p = 0.008). Every unit (μg/kg body weight) increase in the mean daily thyroxine dose was associated with 2.72 times greater odds of over-replacement. When comparing thyroid function monitoring at intervals of 13-24 months, monitoring at shorter intervals (≤ 12 months) was less likely to detect thyroxine under-replacement (AOR = 0.57,95%CI = 0.44–0.74,p < 0.001) and over-replacement (AOR = 0.62,95%CI = 0.41–0.97,p = 0.033). Among the 3,312 adults who were euthyroid at baseline, 22.2%, 41.7% and 59.6% had suboptimal thyroid control at 6, 12 and 24 months respectively (Kaplan–Meier analysis). Conclusion: Around six in ten patients were euthyroid with thyroxine replacement for hypothyroidism in primary care over two years. Thyroxine under-replacement was associated with male gender and obesity. The proportion of euthyroid patients developing abnormal thyroid function doubled with TFTs at six, 12 and 24-month intervals. [ABSTRACT FROM AUTHOR]

Background: The current outbreak of war in Palestine on the 7th of October 2023, heightened concerns about mental health and well-being of individuals, particularly undergraduate students in Palestine. Such traumatic experiences and political conflict did affect the social, economic, psychological, and academic status of university students in Palestine, in particular, nursing students. However, resilience is one of the moderators which may positively decrease the severity of those negative war-related symptoms. Aim: The study aimed to examine the moderation effect of resilience on the relationship between sociodemographic and personal characteristics and depression, anxiety, and stress among undergraduate nursing students in Palestine. Design and methods: A quantitative, descriptive-correlational design utilized to investigate anxiety, depression, stress, and resilience among nursing students. A convenience sample of 325 nursing students recruited from Al-Quds University were asked to respond to a self-administered questionnaire. Results: A total of 325 nursing students participated in this study. The analysis showed that the majority of the participants were experiencing extremely severe anxiety levels (43.7%, n = 142), while 25.5% (n = 83) were experiencing extremely severe depression and 14.5% (n = 47) were experiencing high-stress levels compared to 60% (n = 195) of the students were at their normal resilience level. There were statistically significant differences in the resilience based on sex (t323 = 2.994, p =.003). Knowing that males have higher resilience mean scores (M = 3.06, SD = 0.35) than females (M = 2.93, SD = 0.41) indicates higher resilience in males than females. After performing two steps of hierarchical regression, the results revealed that resilience negatively moderated the relationship between sociodemographics and depression, and anxiety. Conclusion: This study offers valuable insights into the mental health status of undergraduate nursing students in Palestine during the war. The results indicated that resilience is one of the pivotal moderators that may buffer anxiety and depression. The findings underscore the need for targeted interventions to address the diverse mental health needs of this population, considering the complex interplay of individual, demographic, and contextual factors. Future research should continue to explore these dynamics and evaluate the effectiveness of interventions promoting mental well-being during conflict. [ABSTRACT FROM AUTHOR]

Objective: Hepatitis B virus (HBV) infection is associated with the incidence and prognosis of diffuse large B-cell lymphoma (DLBCL), and previous studies differ in terms of clinical characteristics and prognostic factors. In this study, we explored the clinical features and prognostic characteristics of real-world DLBCL patients infected with HBV. Methods: Patients with pathologically diagnosed primary DLBCL at West China Hospital of Sichuan University were enrolled. Patients with follicular lymphoma-transformed DLBCL, primary central nervous system DLBCL, and hepatitis C virus, hepatitis E virus, human immunodeficiency virus, or syphilis infections were excluded. Ultimately, a total of 941 patients were included in this study. All patients included in the study underwent HBV serum marker testing before treatment. The demographic features, clinical characteristics and treatments of patients with different HBV infection states were collected and analyzed comprehensively to identify prognostic factors for OS and PFS. Results: Statistical analysis of the data revealed that hepatitis B surface antigen positive (HBsAg +) DLBCL patients were younger and more likely to present with advanced disease, germinal center B cell-like subtype, B symptoms and splenic involvement. There were no significant differences in OS or PFS among patients with different HBV infection statuses (χ 2 = 0.139, P = 0.933; χ2 = 0.787, P = 0.675); R-CHOP/R-CHOP-like regimens improved prognosis in HBsAg + DLBCL patients (OS: χ2 = 7.679, P = 0.006; PFS: χ2 = 9.042, P = 0.003); antiviral prophylaxis for HBsAg + DLBCL patients improved OS and PFS (HR: 0.336, P = 0.012, 95% CI [0.143, 0.788]; HR: 0.397, P = 0.032, 95% CI [0.171, 0.925]), with tenofovir treatment being particularly effective (χ2 = 4.644, P = 0.031; χ2 = 4.554, P = 0.033). Conclusions: HBsAg + DLBCL patients have unique clinical characteristics, and the use of CD20 monoclonal antibody based regimens significantly improves the outcome and prognosis of patients with HBsAg + DLBCL. Anti-HBV therapy, especially tenofovir, improves the prognosis of DLBCL patients with HBV presenting infection. Timely and sustained antiviral prophylaxis should be the standard strategy for treating DLBCL patients with HBV infection to optimize the efficacy of chemotherapy and immunotherapy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the knowledge, awareness, and practice of intraoral scanners (IOS) and the factors affecting their accuracy amongst dental interns and practitioners. Methods: This was an observational cross-sectional study in which data was collected from a representative population in Saudi Arabia, with the help of online questionnaires. The forms were distributed to 500 dental interns and practitioners and the questionnaire's validity and reliability were evaluated for vetting and remarks. The questionnaire consisted of three parts: the participants' demographic details, questions on the awareness and knowledge of participants regarding IOS, and the factors affecting the accuracy in clinical use of IOS. Questions were to be answered with 'yes', 'no' and 'I don't know'. Descriptive statistical analysis was performed using the control chart technique and the chi-squared test, with statistical significance set at p < 0.05. Results: Most of the participants (58%) knew about the IOS and its applications (47.5%), but the majority of the participants did not use IOS in their clinics (43.5%). The majority of males (57.39%) and females (50.86%) strongly agreed that cost was a barrier to purchasing an IOS. To better get more knowledge on IOS, the specialists 66 (16.5%) and interns 54 (13.5%) chose continuing dental education programs and workshops. There was a significant association (p < 0.05) of knowledge and awareness, perception, and factors affecting parameters with different categories and years of experience. Conclusion: Within the limitations of this study, most participants had a positive stance towards IOS but due to inadequate knowledge and understanding, its use and applications were minimal. IOS was well-received regardless of operator training and experience. There is a significant need to increase awareness of this concept, as it may increase treatment efficiency and effectiveness. [ABSTRACT FROM AUTHOR]

Background: To investigate the current status of health information-seeking behavior (HISB) of periodontitis patients, and to identity its main influencing factors using the Comprehensive Model of Information Seeking (CMIS). Methods: In total, 274 periodontitis patients were recruited from a specialized dental hospital in Hangzhou by purposive sampling method for a cross-sectional study. Demographics, direct experience, salience, beliefs, characteristics and utility were 6 variables of CMIS. Data were collected from the patients by using the general information questionnaire, the Health Information Seeking Behavior Scale, the Self-Efficacy Scale for Self-care (SESS) for measuring belief, the Short Form of Health Literacy Dental Scale (HeLD⁃14) for measuring direct experience, and the Brief Illness Perception Questionnaire (BIPQ) for measuring salience. Univariate analysis and regression analysis were utilized to determine the factors influencing the HISB. Results: The HISB score of periodontitis patients in this study was 3.68 ± 0.40. The low level of HISB was negatively associated with multiple factors, including age of 40 ~ 59 (odds ratio [OR] 0.041, 95% confidence interval [CI] 0.006–0.299), age of 18 ~ 39 (OR 0.053, 95%CI 0.008–0.364), low level of understandability of information (characteristic) [OR 0.317, 95%CI 0.119–0.840] and low level of satisfaction of information (utility) [OR 0.027, 95%CI 0.008–0.089]. However, low level of HISB was positively correlated with medium self-efficacy level [OR 3.112, 95% CI 1.463–6.747] and low self-efficacy level [OR 8.061, 95% CI 1.981–32.807]. Conclusions: According to the CMIS model, we identified several factors influencing health-seeking behaviors (HISB). Lower levels of HISB are closely associated with older age and lower level of understandability and satisfaction of information. Conversely, higher self-efficacy may encourage patients to seek health information more actively. Therefore, it is essential to focus on elderly patients and assess their information expectations and needs in a timely manner, while also working to enhance their self-efficacy to promote more effective access to health information. [ABSTRACT FROM AUTHOR]

Background: Tanzania has been promoting community participation in health, either directly or through health facility governing committees (HFGCs), as part of its wider, ongoing health system reforms since the 1990s. Although some studies have assessed the functioning of the HFGCs, little is known about community knowledge and involvement in their activities. Methods: A cross-sectional survey assessing community awareness and participation in HFGCs was conducted between July and October 2022, involving two rural districts of Tanzania, which were selected based on their performance: Handeni, showing low performance and Mbarali, high performance. A total of 1,184 household heads living in the catchment areas of diverse facilities were involved. Frequencies and percentages were calculated overall and by district. The Chi-squared test was applied to assess statistically significant differences in knowledge, awareness, and participation between the districts. Results: The results revealed that 85.3% of the participants were unaware of the presence of the HFGCs and 91.7% did not know their roles. Additionally, 87% had neither heard nor seen any announcement about the selection of committee members. Only 14.5% considered that HFGCs were accountable to the community. While 96.7% of the respondents said they had never received any feedback from the HFGCs, only 8.1% reported that HFGCs were collecting views from the community. Regarding participation, 79.9% believed that the community had not been supporting their activities; however, 44.7% believed that the committees were important in improving health service delivery. Feedback and support were more common in Handeni. Conclusion: The level of community awareness of and participation in HFGCs was very low in both districts. The Ministry of Health and the President's Office of Regional Administration and Local Government should implement an action plan to raise community awareness of the role of the HFGCs and their significance in promoting social accountability within the Tanzanian health system. [ABSTRACT FROM AUTHOR]

Background: Hypertension and type 2 diabetes mellitus (T2DM) are important contributors to noncommunicable disease related morbidity and mortality. Health systems could benefit from exploring the use of Faith-Based Centres (FBC) to screen and link suspected cases for further care in order to help achieve Sustainable Development Goal (SDG) 3. The study investigated the role of faith-based screening for T2DM and hypertension and the linkage of cases to the healthcare system and examined the care cascade in the Kassena Nankana Districts of Northern Ghana. Methods: We screened individuals from 6 FBCs for elevated blood pressure and hyperglycaemia. Suspected hypertension and T2DM cases were referred to health facilities for confirmation and subsequently followed them up for 3 months. We assessed the prevalence of behavioural and metabolic risk factors, including hypertension and T2DM, and the retention of referred cases in the healthcare system over follow up period. We further assessed levels of awareness, treatment and adequate control of hypertension and T2DM. Results: A total of 631 participants were screened, (mean age 49 ± 16years, 73% female) from 6 Faith based Centres. More males than females reported smoking tobacco (14.5% vs. 0.7%) and been physically active (64.5% vs. 52.7%) while more females were obese (29.6 kg/m2 vs. 14.5 kg/m2) and had a higher mean waist circumference (89.0 cm IQR 75-116 cm vs. 84.2 cm IQR 72–107 cm), hip circumference (101.5 ± 10.6 cm vs. 96.4 ± 8.6 cm) and waist-to-hip ratio (0.86 ± 0.1 cm vs. 0.87 ± 0.1 cm) than males. The prevalence of confirmed hypertension and T2DM was 27.9% and 3.5% respectively with no observed sex differences. We observed deficits in the hypertension and T2DM care cascade with reported low awareness, treatment and uncontrolled levels. A 3-month follow up showed a retention in care of 100% in month one and 94.9% in the third month. There was an increase in treatment (39.4% in month-1 and 82.8% in month-3) and control (26.3% in month-1 and 76.3% in month-3) of hypertension and T2DM combined. Conclusion: Faith-based centres have the potential to enhance the screening, linkage to the healthcare system, and management of hypertension and T2DM. This improvement over the routine system could lead to earlier diagnoses, a reduction in complications, and decreased premature mortality from cardiovascular diseases. Consequently, these efforts would contribute significantly to achieving SDG 3. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the impact of Mobile health (M-health) on medication time adherence among people living with HIV/AIDS (PLWHA). Methods: The study included all PLWHA who were receiving care at the Federal University Teaching Hospital Owerri (FUTH) and Imo State Specialist Hospital (ISSH) Umugumma during the study duration. The test group (FUTH) received a 2-way text message sent three times a week and a once-a-week phone call, while the control group (ISSH) received only the standard care. Findings: The result shows that the adherence was higher among PLWHA in the test group compared to those in the control group (P = 0.000, χ2 = 168.62, 95% confidence interval (CI): 7.22 to 16.19). Conclusion: M-health intervention significantly improved the medication time adherence among the participants in the test group compared to those in the control group. [ABSTRACT FROM AUTHOR]

Background: Foundry workers are occupationally exposed to a variety of inhalable chemical substances. Occupational exposure to vapors, gases, dusts, and fumes can lead to adverse health effects on the respiratory system and cause chronic respiratory diseases, such as interstitial lung diseases (ILDs), chronic obstructive lung disease (COPD), chronic bronchitis, and emphysema. Research on respiratory symptoms, diseases, and lung function in foundry workers over the past few decades has been limited. The aim of this cross-sectional study was to assess the prevalence of respiratory symptoms and diseases and declined lung function of current foundry workers, ex-foundry workers, and unexposed controls. Methods: We assessed respiratory symptoms, diseases, and lung function among 335 current foundry workers, 64 ex-foundry workers, and 161 unexposed controls. The cumulative dust exposure (mg-y) of each participant was calculated, and the median cumulative dust exposure according to the main places of exposure was determined. Results: A higher prevalence of chronic bronchitis, as reported in a questionnaire, was found among current and ex-foundry workers compared to unexposed controls, even after adjusting for pack-years of smoking (p = 0.009). Additionally, cough and wheezing in adulthood without respiratory infection, and chronic rhinitis symptoms were more common among current and ex-foundry workers compared to unexposed controls. These differences remained significant even after adjusting for pack-years of smoking and body mass index (BMI) (p = 0.007 and p < 0.001, respectively). Impaired lung function was more prevalent among both ex-foundry workers (29.7%) and current foundry workers (15.5%) compared to the unexposed controls (8.7%), with the difference remaining significant even after adjusting for the pack-years of smoking and BMI (p = 0.009). According to the questionnaire, the number of physician-diagnosed cases of chronic obstructive pulmonary disease (COPD) or chronic bronchitis was unexpectedly low compared to the indications from the symptom questionnaire and lung function test results, suggesting a potential underdiagnosis. The prevalence of silicosis was low (0.8%) among current and ex-foundry workers. Conclusions: Respiratory symptoms are common among foundry workers. Current and ex-foundry workers exhibited lower lung function in spirometry compared to unexposed controls. There is a potential underdiagnosis of COPD and chronic bronchitis among foundry workers. [ABSTRACT FROM AUTHOR]

Background: Nurses' attitudes towards communication with patients influence the effectiveness of communication, which could reduce patients' negative emotions and improve their adherence to medication and treatment. The aim of this study was to develop a Chinese version of the nurses' attitudes towards communication with the patient (ACO) scale and examined its validity and reliability. Methods: The Chinese version ACO scale was generated using the translation-backward translation method and cross-cultural adaption.The psychometric properties of the scale, including item-to-total correlations, discriminative validity, content validity, structural validity, convergent validity, internal consistency reliability and test-retest reliability, were evaluated. Data were collected from a convenience sample of 610 clinical nurses from four hospitals and were analyzed using both exploratory factor analysis and second-order confirmatory factor analysis. Result: The reliability was demonstrated with item-to-total correlations of greater than 0.40, Cronbach's alpha of 0.946 and intraclass correlation coefficients of 0.879. Content validity was acceptable and discriminative validity showed a significant discriminative ability. Exploratory and confirmatory factor analyses revealed a three-factor model. Convergent validity was confirmed by a moderate relation with a measure for nurses' empathy (r = 0.375, P<0.01).The test-retest reliability was satisfactory within a 2-week interval. Conclusion: The ACO is a reliable and valid instrument to assess nurses' attitudes towards communication with patient in Chinese hospitals. [ABSTRACT FROM AUTHOR]

Study design: Retrospective analysis of difficult airway alerts in a major tertiary centre. Objective: To investigate the completeness, utility and efficacy of difficult airway alerts and their impact on future airway management episodes. Design, data sources and methods: Patients who had a "difficult airway" entry on electronic medical records (EMR) from 2011 to 2021 were included. Each alert was analyzed by a team of anesthetists with expertise in difficult airway management for its quality, appropriateness, and impact on future airway management episodes. Alert quality was defined as to whether the content of the alert contained pertinent information for emergent airway management. Alert appropriateness was defined as to whether the experts would be unhappy to perform a rapid sequence induction and intubation, if required, following review of all available documentation. Results: 141 patients were included for this study, with a mean age of 58.6 +/- 15.3 years. Ninety-three (66%) alerts were created by medical staff, of which 52 were recorded by consultant anesthetists. 117 alerts (83%) were deemed to be appropriate by the airway expert team, but only 40 alerts (28%) were found to have sufficient quality to be helpful in emergent airway management. Sixty-five patients (47%) had at least one subsequent airway management episode, of which 35 patients (56%) underwent a change of management following alert creation. We proceeded to modify 103 alerts (73%) to improve their quality to aid future encounters. Conclusion: Difficult Airway encounters are an uncommon event in anesthesia, but clear, comprehensive and effectively communicated documentation is required to minimize the risk in future encounters. In our institution, while most difficult airway alerts were appropriate, we found significant heterogeneity in the quality of this documentation, which limits the clinical utility of the alert system. We have taken measures to improve local processes of difficult airway documentation and considered the implications of our project for the broader airway management community. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Despite the well-documented benefits of breastfeeding, many first-time mothers encounter challenges. This study compares the efficacy of traditional face-to-face breastfeeding education (FtFE) versus video-based breastfeeding education (VBE) on improving breastfeeding practices and self-efficacy among primiparous mothers. Methods: Using a sequential, quasi-experimental design, 70 primiparous mothers were enrolled from a State Hospital in Turkey and systematically divided into two groups: FtFE (n = 35) and VBE (n = 35). The study spanned from January to June 2023 and the assessments of statuses of breastfeeding self-efficacy and skilles was performed in two distinct phases for each group. In the first phase, mothers were administered the scale of breastfeeding self-efficacy short (BSES) to measure baseline breastfeeding self-efficacy and the scale of LATCH tool to assess baseline breastfeeding skills. Subsequently, the research groups received FtFE and VBE interventions. In the second phase, 2 weeks later, mothers were interviewed again, and the BSES scale was re-administered to evaluate changes in their breastfeeding self-efficacy levels. Results: The pre-test scores of BSES and LATCH tools of the FtFE and VBE groups were found similar (p > 0.05). The post-test score of BSES of the FtFE was significantly higher than that of the VBE group (p > 0.05). In the FtFE group, the post-test score of BSES was significantly higher compared to the pre-test score of BSES (p < 0.05). In the VBE group, the post-test score of BSES was higher compared to the pre-test score of BSES but this difference did not reached statistical significance (p > 0.05). Conclusion and recommendations: FtFE is more effective in informing mothers compared to VBE. However, VBE also positively affectes breastfeeding success. Further research is needed to explore the long-term impacts of these educational approaches on breastfeeding compliance. [ABSTRACT FROM AUTHOR]

The prevalence of postpartum depression in teenage mothers is higher than that in adult mothers. The present study aimed to investigate the prevalence of depression, distress, and post-traumatic stress disorders (PTSD) following childbirth and its resultant risk factors among teenage mothers. Material and Methods. This cross-sectional study was carried out on 167 teenage women aged 11–19 years, 8-week after giving birth, in Tabriz, Iran. The data were collected using by socio-demographic characteristics questionnaire, Edinburgh Postnatal Depression Scale, Posttraumatic Stress Disorder Checklist and Postpartum Distress Measure scale. Results. The study results revealed that 12.6% and 7.2% of the participants had postpartum depression and PTSD, respectively. The results showed that the variables of the number of children, dissatisfaction with marriage, and history of preconception depression were among the risk factors associated with postpartum depression. The results indicated that unwanted pregnancy, lack of spousal support, insufficient income, and infant restlessness variables were predictors of PTSD. Conclusion. Based on our findings, it is crucial to identify teenage mothers with predisposing factors for postpartum depression and PTSD. Providing family planning counseling to reduce unwanted pregnancies, training fathers to support their spouses, and ensuring timely referral of high-risk individuals are essential interventions to address the mental health challenges faced by teenage mothers. [ABSTRACT FROM AUTHOR]

Background: At least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs' knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs' care for Long Covid patients at a cross-country level. Methods: A cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed. Results: A total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37–61). Concerning GPs' knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs' country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation. Conclusions: GPs frequently provide (multidisciplinary) care to Long Covid patients and GPs' care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid. [ABSTRACT FROM AUTHOR]

Background: Harsh parenting has been recognized as a risk factor for adolescent anxiety; however, the underlying mechanisms of this relationship remain unclear, and it is unknown whether this relationship is influenced by different parental roles and living arrangements. This study aimed to investigate the mediating mechanisms between harsh parenting and adolescent anxiety symptoms using a multiple mediation model and to further compare specific roles of harsh parenting and distinguish between the living arrangements. Methods: A total of 3505 adolescents completed this survey, and 3295 adolescents (54.7% girls, Mage = 14.97 years) were included in the study. Participants completed self-assessments measuring harsh parenting, self-efficacy, school connectedness, Internet addiction, sleep problems, and anxiety. They were categorized into three groups based on living arrangements: living with both parents, only with the mother, or only with the father. Results: Correlational analyses revealed that both maternal and paternal harsh parenting were associated with increased anxiety symptoms. Structural equation modeling (SEM) mediation analyses and multigroup analyses showed that the independent mediating effects of school connectedness, Internet addiction, and sleep problems, as well as the sequential mediating pathways involving self-efficacy → school connectedness, self-efficacy → Internet addiction, and self-efficacy → sleep problems, vary across the adolescents' living arrangements in the association between maternal and paternal harsh parenting and adolescent anxiety symptoms. Conclusions: This study elucidated the mechanisms linking harsh parenting to adolescent anxiety symptoms and validated the effects of different parental roles and living arrangements. The findings provide important insights for developing targeted interventions to address anxiety symptoms in adolescents exposed to harsh parenting. [ABSTRACT FROM AUTHOR]

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: Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods: Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results: Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions: PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration: This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021). [ABSTRACT FROM AUTHOR]

Purpose: To examine quality of life (QoL) and mental health among Asian Indians in Southwest and Central-west Florida by COVID-related lifestyle changes, and demographic characteristics. Methods: QoL was assessed using SF-12 questionnaire while mental health/healthcare was assessed using the household pulse survey. Face-to-face interviews and self-administered online surveys were conducted among 151 participants in 2021–22. F and Chi-square statistics were used to examine the differences in QoL scores and mental health/mental healthcare by sociodemographic factors and COVID-related lifestyle changes. Results: Mental Component Summary (MCS) scores were lower for those who experienced changes in work expectations (p 0.041), sleep (p 0.002), exercise (p < 0.001), meditation (p.004) and connecting with family (p 0.007) and among those with family testing COVID positive (p.012). Mean Physical Component Summary (PCS) scores were lower for caregivers (p.008). PCS scores were lower for certain income groups (p 0.006), retired (p 0.004), older age groups (p 0.002). Lower MCS scores with college education (p.005), those who were students (p <0.001), younger age groups (p < 0.001). Those who helped with homeschooling felt anxious (p 0.049), couldn't stop worrying (p 0.046) and took medications (p < 0.001). Participants' families who tested COVID positive were anxious (p = 0.019) and worried (p = 0.015). Those with greater work expectations sought counseling (p = 0.009) and those who connected more with their family were anxious (p = 0.008). Conclusion: The pandemic affected QoL, especially the mental component and increased anxiety and worrying. Mental health services for younger individuals, those with caregiving responsibilities and facing increased job demands must be prioritized. [ABSTRACT FROM AUTHOR]