Search

Objective: The aim of this study was to compare the 30-day emergency department (ED) return rate between patients given a Take Home Medication pack (THM) versus a standard paper prescription (SPP) prior to discharge. Methods: This was an observational, prospective cohort study in an urban, university-affiliated, level I trauma center. Patients were identified through daily pharmacy reports. Consecutive adult patients discharged from the ED with either a THM or equivalent SPP were included. For each patient, baseline characteristics including age, gender, primary care provider (PCP), primary language, ethnicity, marital status, and insurance status were recorded from the electronic medical record (EMR). Review of the EMR was used to determine whether patients returned to the ED within 30 days and whether the return visit was for all-causes or for the same complaint targeted by the THM or SPP from the index visit. Similarly, visits to other providers in the health system within 30 days were recorded. Results: A total of 711 patients were included in the study, with 268 receiving a THM and 443 receiving a SPP. In comparison with the SPP group, the THM group was more likely to have an all-cause return (Relative Risk [RR] = 1.7, P < .01). Variables associated with increased odds of returning to the ED within 30 days included study group (adjusted Odds Ratio [aOR]: 1.7), male gender (aOR: 1.6), African American ethnicity (aOR: 3.0), public insurance (aOR: 3.3), and institutional financial assistance (aOR: 5.0). The difference between study groups for index visit complaint-specific returns was not significant. Conclusions: Patients receiving a THM demonstrated a higher all-cause return rate than patients receiving a SPP. A randomized study is needed evaluating the effect of THM on return ED visits. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco use is the major preventable cause of premature death worldwide, responsible for about 8 million deaths per year, mostly in low- and middle-income countries, such as Morocco. Adolescents' tobacco use is a matter of concern, because early initiation increases the risk of becoming a lifelong user. There exists a notable gap in the synthesis of evidence concerning tobacco use among Moroccan adolescents. Thus, the purpose of this study was to provide a comprehensive view of the prevalence of tobacco products' use and associated factors among adolescents in Morocco. Methods: We systematically searched PubMed, Scopus, Web of Science and ScienceDirect for relevant studies reporting prevalence rates of tobacco products' use among Moroccan adolescents, published until June 2024, using inclusion and exclusion criteria in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Additional searches were completed on other sources to reach unpublished reports. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of included studies. Results: After the final screening, 22 papers met the inclusion criteria. Life-time prevalence of tobacco use ranged from 7.8% to 20.4% for cigarettes smoking, from 10.6% to 21.9% for waterpipe, from 7.9% to 9.1% for chewing tobacco and from 9.2% to 12.4% for snuff. The last 12-month prevalence of cigarette smoking was comprised between 6.9% and 10.8%. As for the prevalence of current use, ranges of (1.8%-16.4%) and (4.9%-8.4%) were noted for cigarettes and waterpipe, respectively. The most commonly highlighted risk factors for tobacco use included male sex, older age, having friends or family members who use tobacco and low perception of risk associated with tobacco use. Conclusion: Our findings reveal an alarming situation of tobacco use among Moroccan adolescents. Therefore, it is crucial that all stakeholders engage in concerted efforts to develop and implement evidence-based preventive interventions among early adolescents. [ABSTRACT FROM AUTHOR]

Objectives: As people remain physically active later in life, there is an increased incidence of anterior cruciate ligament (ACL) injuries in patients 50 years of age and older. Historically, ACL reconstructions have not been recommended for patients over 50 years of age. While there is abundant literature on the outcomes of ACL reconstruciton in patients under 40 years of age, little has been published on the outcomes in this age group. The purpose of this study was to investigate whether ACL reconstruction in patients fifty years of age and older rwill esult in an improvement in function, stability, and quality of life at 5-year follow up. We also study the indications, outcomes, and tips for success. Methods: A retrospective review was performed of patients fifty years or older with a minimum follow up of two years who underwent an ACL reconstruction using a bone patellar tendon bone (BPTB) allograft by a single fellowship trained orthopedic sports medicine surgeon over a sixyear period. Patients were excluded from the study if they had significant radiographic osteoarthritic changes, or concurrent ligamentous or bony procedures performed. Patients were asked to return for an evaluation, including physical examination and KT-2000 instrumented stability measurements. Both the operative and non-operative knees were evaluated for range of motion, tenderness, stability on anterior drawer, Lachman, and pivot shift testing. Bilateral KT-2000 measurements which were taken at 10, 20, and 30 pounds as well as maximum manual testing. Each measurement was taken three times and averaged. The following scores were used pre- and post-operatively to assess function and pain: Lysholm, International Knee documentation Committee (IKDC), Tegner Activity, and SF-12. A physical examine including KT-2000 measurements was performed in a subset of these patients. Results: Fifty patients with an average follow-up of 5 years (range 2-8 years) underwent an ACL reconstruction using BPTB allograft. The average age at surgery was 55 years (range 50-68 years). Tegner scores improved from a pre-operative score of 3.3 to a post-operative score of 5.3 (p =.0001, 95% CI 2.2-3.5). The average post-operative IKDC score was 81.3 (SD 16.4), Lysholm score 88.5 (SD 16.3), SF-12 physical 54.3 (SD 6.6) and SF-12 mental 51.8 (SD 8.3). Forty (80%) patients reported good to excellent results, six (12%) patients reported fair results and four (8%) patients reported poor results. The patients that returned for a physical examinaiton had a range of motion that averaged flexion to 135 (SD 5.4), and all achieved full extension. There was one patient (2%) that had greater than 4mm translation on Lachman testing, and no patients had a positive pivot shift. There were no identified surgical complications. Conclusions: An anterior cruciate ligament reconstruction using BTB allograft successfully restores stability and allows return to pre-injury level of activity with few complications in patients 50 years or older at an average of 5 years follow-up. Our data set represents the largest case series of ACL reconstructions for this age demographic in the literature, using validated outcome tools, and complimented with a physical examination in a sub-set of the cohort. We have found no comparison that yields a clinically significant difference (based on MCID of 10 on theLysholm scale). Thus, older patients can be counseled to expect a functional return close to their pre-injury level, similar to younger patient cohorts. [ABSTRACT FROM AUTHOR]

Background and Objectives: Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. Methods: Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. Results: Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. Conclusions: This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD. [ABSTRACT FROM AUTHOR]

The article focuses on using age to screen cardiovascular disease and its implications. A Monte Carlo simulation with 500,000 people aged 0-89 was used for the study. The simple assessment of detecting 86 percent of cardiovascular events with a 24 percent false-positive rate taking 55 or over was done and compared with screening everybody from age 40 at five-yearly intervals using the standard Framingham risk score.

Background: Shoulder and elbow overuse injuries are the most common problems in baseball players. No scoping review has compared the findings from different types of evidence. Purpose: To map the broad evidence from 3 types of evidence (epidemiological, biomechanical, and narrative) on potential risk factors for shoulder and elbow injuries in baseball and identify gaps in the existing literature to guide future research. Study Design: Scoping review. Methods: Eight electronic databases were searched from inception to May 14, 2020. Any peer-reviewed papers that investigated or discussed potential risk factors for shoulder and elbow injuries in baseball were included. Results: A total of 302 studies (107 epidemiological studies, 85 biomechanical studies, and 110 narrative reviews) were included. Risk factors were categorized into 9 domains: sports profiles, physical characteristics/functions, pitching mechanics, performance, behavioral, psychosocial, biological and developmental, injury/sports profiles, and environmental factors. Studies were consistent in supporting limited shoulder range of motion (ROM) and player positions (pitchers or catchers) as risk factors for shoulder injuries. For elbow injuries, the majority of the included studies suggested that being pitchers or catchers and working with higher ball velocity can be risk factors. Conclusion: Findings were consistent in some risk factors, such as limited shoulder ROM and positions. However, findings were inconsistent or limited for most factors, and substantial research gaps were identified. Research assessing those factors with inconsistent or limited evidence in the current literature were recognized to be priorities for future studies. [ABSTRACT FROM AUTHOR]

Objective: To determine age-related risk factors for chronic rhinosinusitis (CRS) with asthma. Methods: Data were obtained from a national survey of non-hospitalized civilians conducted by the Korean Center for Disease Control and Prevention. CRS diagnosis was based on the guidelines of the European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Asthma was judged based on whether the patient had been diagnosed with asthma in the past. Of the 45,811 survey participants, 26,335 were included in the cross-sectional study. Participants included in the study were divided into the control, CRS, and CRS with asthma groups. Age-related risk factors were analyzed in patients aged < 60 or > 60 years. Univariate logistic analyses were performed to evaluate the relationship between groups. Risk factors included age, sex, household income, residence, education level, occupation, and body mass index (BMI). Results: Education level (Odds Ratio [OR]: 0.342, P =.0003), BMI (OR: 1.09, P =.0082), and total IgE (TIgE) levels (OR: 5.582, P =.003) were significantly different between the control and the CRS with asthma group. Education level (OR: 0.478, P =.0016) and TIgE levels (OR: 4, P =.0218) were significantly different between the CRS and CRS with asthma groups under 60 years of age. BMI (OR: 1.087, P =.0443; OR: 1.104, P =.0224) showed a significant difference between all three groups with age > 60 years. Conclusion: Progression to CRS with asthma is influenced by education level, occupation, and TIgE levels in patients under 60 years of age. BMI was the only influencing factor associated with the progression to CRS with asthma in those aged > 60 years. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked. Purpose: This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid. Research Design: Narrative. Study Sample and Data Collection: Not applicable. Results: We discuss the implications of each emerging issue for health systems policy and practice. Conclusion: Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement. [ABSTRACT FROM AUTHOR]

Background: Although recommended for all member states of World Health Organization, there is no national human papillomavirus vaccination program in Kazakhstan. Furthermore, there are no studies in Kazakhstan that evaluate the mothers' perception of human papillomavirus vaccines. Objectives: This study aims to assess the knowledge and attitudes toward human papillomavirus vaccination among mothers in Kazakhstan and the factors associated with their attitudes. Design: A cross-sectional study was performed during the period of December 2021—February 2022. The STROBE guideline for cross-sectional studies was applied. Methods: Paper-based structured questionnaires were filled out by 191 mothers, 141 of whom had daughters. The attitude score was assessed as per the Likert-type scale. The Chi-square and Fisher's exact tests, with a significance value of < 0.05 were used to analyze the relationships between the characteristics of mothers and their attitude scores. Results: The following factors were significantly associated with mothers' attitudes toward human papillomavirus vaccination: a place of residence, family income, number of children, and refusal of vaccination for themselves (p < 0.005). Of all participants, only 45% of all mothers, 41% of mothers with a female, and 46% of mothers with male children had positive attitudes toward human papillomavirus vaccination. The child's gender was not a significant determinant. Overall, the level of knowledge about human papillomavirus vaccination was found to be low. The median total score is 0 out of 12 for women who have negative and neutral attitudes toward human papillomavirus vaccines. Among women who have positive attitudes toward HPV vaccines, the median score is around 3 points. Conclusion: Before the implementation of the human papillomavirus vaccination program into the Kazakhstani national vaccination calendar, comprehensive and adequate information and education campaigns are required on the national level for parents and the population in general. [ABSTRACT FROM AUTHOR]

Introduction: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. Methods: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. Results: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. Discussion: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term. [ABSTRACT FROM AUTHOR]

Background: Binge drinking among young adults aged 18-21 years has declined over the past decade, but binge drinking rates among people 22-25 years old have remained largely the same. This steady trend in later years represents a departure from the traditional course of maturing out of risky alcohol use, perhaps because young adults are delaying the transition into adulthood. Aims: This paper explores the relationship between binge drinking and aspects of the transition into adulthood that could inform interventions targeting these two distinct groups of young adults. Methods: We use survey data on 1,081 young adults aged 18-25 living in 10 Indiana counties. Our dataset is unique because it contains both college-attending and non-college attending young adults. We ran weighted logistic regressions to determine the association between college enrollment, living situation, roles common in adulthood, and stressors common during the transition to adulthood (e.g., relationships, economic conditions, job stability) and binge drinking. Results: Our data indicate that different factors are associated with binge drinking based on whether subjects who are in the earlier (18-21 years old) or later (22-25 years old) years of young adulthood. For example, within the 18-21 years old group, college enrollment is associated with higher rates of binge drinking, but it is not associated with increased binge drinking in the older age group. The type of stress related to binge drinking also varies by age group. Conclusion: Our results emphasize the need to disaggregate "young adulthood" into two separate periods when defining target populations and settings for binge drinking interventions. [ABSTRACT FROM AUTHOR]

Background: Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population. Objectives: To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care. Design: Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention. Methods: The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study. Results: Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%). Conclusion: Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo (MC-BPPV). Methods: We performed a retrospective analysis of 927 patients with BPPV who were admitted to our hospital between January 1, 2016 and December 31, 2019. The clinical data of all patients were collected. The Dix-Hallpike, straight head-hanging, and supine Roll tests were performed in all patients. The nystagmus was recorded using videonystagmography. The clinical characteristics of patients with MC-BPPV and single canal BPPV (SC-BPPV) was analyzed and compared. Results: Among 927 patients included, 49 (5.29%) patients had MC-BPPV, 878 (94.71%) patients had SC-BPPV. There were significant differences in the male to female ratio (1:3.90 vs 1:1.81, P <.05), mean age (62.47±12.51 vs 59.04±13.72, P <.05), as well as the ratio of cupulolithiasis to canalithiasis (1:1.45 vs 1:4.78, P <.01) between patients with MC-BPPV and SC-BPPV. The frequency of involvement of PC, HC, and AC were involved for 66 (67.35%), 23 (23.47%), and 9 (9.18%) times, respectively, in patients with MC-BPPV, which were involved in 581 (66.17%), 281 (32.0%), and 16 (1.82%) patients, respectively, in patients with SC-BPPV. No significant difference was found in the frequency of involvement of PC and HC between patients with MC-BPPV and SC-BPPV, while there was significant difference in the frequency of AC involvement between 2 groups (P <.01). Ipsilateral PC-HC-BPPV (n = 18) and bilateral PC-BPPV (n=19) were the most common among patients with MC-BPPV. Twenty-six (53.06%) patients had ipsilateral MC-BPPV, 23 (46.94%) had bilateral MC-BPPV. Of the 26 patients with ipsilateral MC-BPPV, 7 patients combined with unilateral peripheral vestibular disorder. Conclusion: Patients with MC-BPPV had a significantly older mean age at disease onset and a higher proportion of females compared with patients with SC-BPPV. Cupulolithiasis was more common in MC-BPPV. AC involvement was also much more common in MC-BPPV than in SC-BPPV. [ABSTRACT FROM AUTHOR]

This paper presents a new study based on a machine learning technique, specifically an artificial neural network, for predicting systolic blood pressure through the correlation of variables (age, BMI, exercise level, alcohol consumption level, smoking status, stress level, and salt intake level). The study was carried out using a database containing a variety of variables/factors. Each database of raw data was split into two parts: one part for training the neural network and the remaining part for testing the performance of the network. Two neural network algorithms, back-propagation and radial basis function, were used to construct and validate the prediction system. According to the experiment, the accuracy of our predictions of systolic blood pressure values exceeded 90%. Our experimental results show that artificial neural networks are suitable for modeling and predicting systolic blood pressure. This new method of predicting systolic blood pressure helps to give an early warning to adults, who may not get regular blood pressure measurements that their blood pressure might be at an unhealthy level. Also, because an isolated measurement of blood pressure is not always very accurate due to daily fluctuations, our predictor can provide the predicted value as another figure for medical staff to refer to. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is a serious public health issue. It is a significant but controllable factor in the emergence of cardiovascular disease. Controlling hypertension is a main target for individuals to prevent further illness. Objective: This study aims to explore the level of self-care behaviors, motivation, and self-efficacy among individuals with hypertension. Methods: A cross-sectional, descriptive, correlational design was used to recruit (n = 121) participants utilizing the Hypertension Self-Care Profile (HTN-SCP) questionnaire. Results: The analysis revealed that the mean score of self-care behavior was 49.7 (SD = 10.0) out of 20–80, which indicates that they are likely to have good self-care behavior. The mean score of motivation for self-care was 59.7 (SD = 11.8) out of 20–80, reflecting that individuals with hypertension have a good level of motivation for self-care, and the mean score of self-efficacy was 70.0 (SD = 9.8) out of 20–80, which means that individuals with hypertension have a high level of self-efficacy. Also, there was a significant positive correlation between self-care behavior and motivation for self-care (r =.527, p <.001), between motivation for self-care and self-efficacy (r =.554, p <.001), and between self-efficacy and self-care behavior (r =.572, p <.001). Conclusion: The study revealed that Jordanian patients with hypertension have good self-care practices, motivation, and high self-efficacy. Patients should therefore be strongly recommended to be compliant with self-care practices. The government should prioritize hypertensive patients by making it easier for them to receive information about self-management practices to improve their quality of care. [ABSTRACT FROM AUTHOR]

Background: Glenoid bone loss (GBL) is common in patients with shoulder instability and plays a major role in surgical decision-making. While a plethora of GBL estimation methods exist, all of which present specific challenges, recent studies have developed simple linear formulas estimating GBL based on glenoid height. Purpose: To assess the correlation between glenoid height and width, and to develop specific formulas based on age and sex to calculate the native glenoid width in the Lebanese population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans for 202 normal shoulders were extracted from our database. The glenoids were reconstructed in 3 dimensions and their width and height were measured. Glenoid width and height were compared between male and female groups. Correlation analysis was also performed on the width, height, age, and body mass index. Formulas estimating glenoid width were developed using regression analysis including all variables significantly influencing the model. Results were then compared with the values calculated using previously published formulas to determine the external validity when using linear formulas to estimate GBL. Results: Significant differences were found between men and women. Regression analysis found that glenoid height and width strongly influenced the model, and that age showed a weak but significant correlation; therefore, the following 2 sex-specific formulas were developed: width (mm) = 6.1 + 0.51 × height + 0.03 × age, and width (mm) = 4.55 + 0.51 × height + 0.03 × age, in men and women, respectively. The values yielded from the formulas developed in this study and the true width significantly differed from those calculated from previous reports. Conclusion: A strong correlation was found between glenoid height and width in a the Lebanese population and demonstrated that glenoid width can be accurately calculated based on the glenoid height and patient's age and sex using the following simplified formulas: width (mm) = 6 + 0.5 × height + 0.03 × age, and width (mm) = 4.5 + 0.5 × height + 0.03 × age, in men and women, respectively. [ABSTRACT FROM AUTHOR]

Background: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. Objective: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. Design: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. Methods: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Results: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03–1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Conclusion: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance. Plain Language Summary: A study found more women were unaware of pregnancy soon after birth before menses Unplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity. [ABSTRACT FROM AUTHOR]

Background: The anatomy of the trochlea plays a significant role in patellar stability. The developmental anatomy of the trochlea and its relationship to patellar stability remains poorly understood. Purpose: To describe the developmental changes of the osseous and cartilaginous trochlear morphology in skeletally immature specimens. Study Design: Descriptive laboratory study. Methods: A total of 65 skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using computed tomography scans. The measurements in the axial plane of both cartilage and bone include medial, central, and lateral trochlear height; sulcus height; medial and later trochlear facet length; trochlear sulcus angle; patellar sulcus angle; condylar height asymmetry; and trochlear facet asymmetry. Additional measurements included trochlear depth and lateral trochlear inclination angle. In the sagittal plane, measurements included curvilinear trochlear length, direct trochlear length, condylar height, and patellar sulcus angle. Results: Analysis of trochlear morphology using condylar height, condylar height asymmetry, and trochlear depth all increased with increasing age. The osseous and cartilaginous sulcus angles became deeper with age until age 8 and then plateaued. This corresponded with an increase in trochlear depth that also plateaued around age 8. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. The continued growth of the trochlea with age was further demonstrated in all measures in the sagittal view. Conclusion: This cadaveric analysis demonstrated that there is an increase in condylar height as age increased by all measurements analyzed. These changes in condylar height continued to be seen through age 11, suggesting a still-developing trochlea past this age. By age 8, a plateau in sulcus angle, and sulcus depth suggests more proportionate growth after this point. Similar changes in trochlear and patellar shape with age suggests that the 2 structures may affect each other during development. Clinical Relevance: This information can help design, develop, and determine timing of procedures that may alter the anatomy and stabilize the trochlear and patellofemoral joint. [ABSTRACT FROM AUTHOR]

Objectives The NHS bowel screening programme offers people aged 60-69 screening by faecal occult blood (FOB) testing, with colonoscopy as the diagnostic test. This paper describes the calculation of targets for the purpose of monitoring screening performance in the programme. Methods Targets were calculated for the prevalent round of screening in people aged 60-69, and for the 'steady state' of the programme when people will be offered their first screen at age 60 and subsequent screens at ages 62-69. Targets for the cancer and adenoma detection rates per 1000 people screened and per 100 colonoscopies were calculated using information from the English bowel cancer screening pilot. Results For the prevalent round, prevalent screen and incident screens the calculated targets for the cancer detection rate are 2.3, 1.3 and 1.7 per 1000 people respectively. For the adenoma detection rate the targets are 6.7, 5.2 and 5.5 per 1000 respectively. Targets for the cancer detection rate per 100 colonoscopies are 11.3, 7.5 and 8.4 and those for the adenoma detection rate are 32.0, 30.4 and 32.5 respectively. Conclusions The purpose of these targets is to ensure that the national bowel cancer screening programme is effective with a high quality of screening. The cancer detection and adenoma detection rates per 1000 people are those estimated to be necessary to achieve the expected mortality reduction. Rates per 100 colonoscopies (equivalent to the positive predictive value of referral to colonoscopy) are designed to maintain a high quality of screening by minimizing the number of false-positive referrals. [ABSTRACT FROM AUTHOR]

Background: Aflatoxins are common contaminants of staple foods in sub-Saharan Africa. These toxins are human liver carcinogens, especially in combination with chronic infection with hepatitis B virus. However, in an agricultural setting, the effects on growth, immune status, and susceptibility to infectious disease in farm animals are also well recognized. These latter effects have been far less explored in human populations.Objectives: To review some of the more recent work on aflatoxins where the health outcomes seen in the agricultural setting, including growth impairment and immune suppression, have been investigated in human populations. The paper draws largely on examples from West Africa. The paper also sets out how knowledge gained about aflatoxins in the agricultural setting can be used to design intervention studies in human populations.Methods: A review of the relevant literature.Results: Human exposure to aflatoxins begins early in life, and recent studies in West Africa have demonstrated an association between exposure and growth faltering, particularly stunting, in young children. At present the underlying mechanisms for the latter effects are unknown but may include impairment of immunity and increased susceptibility to infections. Simple postharvest intervention strategies were successful in reducing aflatoxin exposure in a subsistence farm setting, providing a rationale for prevention of aflatoxin-related disease.Conclusions: There are potential benefits to public health from intervention strategies combining expertise in the agricultural and health settings to address the aflatoxin problem. [ABSTRACT FROM AUTHOR]

Background: Poor nutrition during childhood impedes physical and mental development of children, which propagate the vicious cycle of intergenerational under nutrition. This paper is aimed at understanding the determinants of stunting among children aged 0 to 59 months in Bangladesh.Methods: The study used Bangladesh Demographic and Health Survey 2011 data and a multistage stratified cluster-sampling design. Anthropometric data (for height and weight) were collected and analysis was limited to 7647 children. Multiple binary logistic regression analysis was performed to assess the association of stunting with potential socioeconomic and demographic factors.Results: The prevalence of stunting has been found to be about 41% among children aged less than 60 months and higher in rural setting than in urban areas (43% vs 36%). Adjusted model revealed that several factors were influencing stunting. The children living in moderately food-insecure households had higher odds of becoming stunted (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.05-1.54, P = .01) compared to the children living in food-secure households. The derived ORs of stunting for children delivered at institutions facilitated particularly by public (OR = 0.80, 95% CI: 0.67-0.96; P = .02) or private (OR = 0.81, 95% CI: 0.67-0.97; P = .02) sectors were less than for children delivered at home. Similarly, wealth index, exposure of mother to the mass media, age of child, size of child at birth, and parents' education were significantly associated with stunting.Conclusions: Moreover, the demographic characteristics and other indicators appeared to have significant influence in the prevalence of stunting. Public health programs are needed to avert the risk factors of stunting among children in Bangladesh. [ABSTRACT FROM AUTHOR]

Transcranial Magnetic Stimulation (TMS), a form of Non-Invasive Brain Stimulation (NIBS), has gained popularity in the last couple of decades. It is approved for treating depression in adults and is under investigation in pediatric depression. This paper aims to evaluate Transcranial Magnetic Stimulation (TMS) studies in pediatric depression and provide a narrative overview by reviewing the research databases (PubMed, Science Direct, and Cochrane Library). Recent evidence suggests that in pediatric patients of treatment-resistant depression, repetitive Transcranial Magnetic Stimulation (rTMS) of the frequency of 10 Hz when applied to the left dorsolateral prefrontal cortex (DLPFC), can lead to remission, improvement in depressive symptoms, or decrease in recurrence of episodes. Existing literature also suggests that TMS's adverse effects in the pediatric population are minimal and comparable to those in the adult population. However, the limitations of existing studies, including lack of double-blind sham-controlled randomized trials or RCTs (only one RCT exists to date), small sample sizes, absence of long term follow-ups, and lack of homogenous age distribution, render the evidence insufficient for approval of TMS use in pediatric depression. This review suggests that although there is a scope of TMS use in pediatric depression, more proof is required to establish and quantify its efficacy and standardize its dosing regimens. [ABSTRACT FROM AUTHOR]

University students are experiencing a mental health crisis. COVID-19 has exacerbated this situation. We have surveyed students in 2 universities in Lebanon to gauge their mental health challenges. We have constructed a machine learning (ML) approach to predict symptoms of depression, anxiety, and stress based on demographics and self-rated health measures. Our approach involved developing 8 ML predictive models, including Logistic Regression (LR), multi-layer perceptron (MLP) neural network, support vector machine (SVM), random forest (RF) and XGBoost, AdaBoost, Naïve Bayes (NB), and K-Nearest neighbors (KNN). Following their construction, we compared their respective performances. Our evaluation shows that RF (AUC = 78.27%), NB (AUC = 76.37%), and AdaBoost (AUC = 72.96%) have provided the highest-performing AUC scores for depression, anxiety, and stress, respectively. Self-rated health is found to be the top feature in predicting depression, while age was the top feature in predicting anxiety and stress, followed by self-rated health. Future work will focus on using data augmentation approaches and extending to multi-class anxiety predictions. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: To assess the utility of the computerized cognitive function assessment tool, CogEvo, as a screening tool for mild cognitive impairment in primary care, we explored the relationship between CogEvo performance, age, and the severity of cognitive dysfunction evaluated by the Mini-Mental State Examination (MMSE). Methods: The observational cross-sectional study included 209 individuals' data (mean age 79.4 ± 8.9 years). We conducted a correlation analysis between CogEvo and MMSE scores, compared the performance among the 3 cognitive function groups (MMSE ≥ 28 group; MMSE24-27 group; MMSE ≤ 23 group) using the MMSE cut-off, and evaluated CogEvo's predictive accuracy for cognitive dysfunction through ROC analysis. Results: Both total CogEvo and MMSE scores significantly decreased with age. A significant positive correlation was observed between total CogEvo and MMSE scores, but a ceiling effect was detected in MMSE performance. Significant differences were observed in the total CogEvo score, including orientation and spatial cognitive function scores, among the 3 groups. CogEvo showed no educational bias. ROC analyses indicated moderate discrimination between the MMSE ≥ 28 group and the MMSE24-27 and MMSE ≤ 23 groups. Conclusions: The computer-administered CogEvo has the advantage of not exhibiting ceiling effects or educational bias like the MMSE, and was found to be able to detect age-related cognitive decline and impairment. [ABSTRACT FROM AUTHOR]

Background: There are multiple recommended protocols for Vitamin D (VitD) supplementation in elderly; however, only a few studies achieved to examine the role of VitD supplements before intertrochanteric fracture surgery on mortality and complications after surgery. Methods: This single-center block-randomized double-blinded trial was conducted on 80 patients with intertrochanteric fractures and a sufficient level of 25 (OH) VitD. The intervention group received an intramuscular 300,000 IU VitD ampule before surgery. The primary outcome was a 6-month mortality rate, and the secondary outcomes were 1- and 2-year mortality rates and Harris Hip Score (HHS) in 6, 12, and 24 months after surgery. Chi-square, t-test, repeated measure ANOVA, and Cox regression survival model was used for statistical analysis. Results: 40 patients were allocated to each group. Demographic, clinical characteristics, and preoperative evaluations were not significantly different between the groups. Mortality rate 6-month after the surgery was 7.5% and 10% for the intervention and placebo groups respectively (P value =.71), 15% and 12.5% at 1-year (P value =.83), and 25% and 27.5% at 2-year (P value =.98). Based on the Cox regression model, only age was significantly associated with mortality (HR = 1.229, P value <.001). Significant HHS changes from baseline through 24 months after surgery were observed within both groups; however, mean differences were not significantly different between groups. Conclusions: A single preoperative 300,000 IU VitD did not significantly impact 2-year survival and HHS in patients with intertrochanteric fractures and sufficient serum VitD level. [ABSTRACT FROM AUTHOR]

Aims: Children of parents with substance use and/or other mental health (SU/MH) diagnoses are at increased risk for health problems. It is unknown whether these children benefit from receiving primary care at the same clinic as their parents. Thus, among children of parents with >1 SU/MH diagnosis, we examined the association of parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations. Design: Retrospective cohort study using electronic health record (EHR) data from the OCHIN network of community health organizations (CHOs), 2010-2018. Setting: 280 CHOs across 17 states. Participants/Cases: 41,413 parents with >1 SU/MH diagnosis, linked to 65,417 children aged 0 to 17 years, each with >1 visit to an OCHIN clinic during the study period. Measurements: Dependent variables: rates of WCCs during (1) the first 15 months of life, and (2) ages 3 to 17 years; vaccine completeness (3) by the age of 2, and (4) before the age of 18. Estimates were attained using generalized estimating equations Poisson or logistic regression. Findings: Among children utilizing the same clinic as their parent versus children using a different clinic (reference group), we observed greater WCC rates in the first 15 months of life [adjusted rate ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02-1.10]; no difference in WCC rates in ages 3 to 17; higher odds for vaccine completion before age 2 [adjusted odds ratio (aOR) = 1.12; 95% CI = 1.03-1.21]; and lower odds for vaccine completion before age 18 (aOR = 0.88; 95% CI = 0.81-0.95). Conclusion: Among children whose parents have at least one SU/MH diagnosis, parent-child clinic concordance was associated with greater rates of WCCs and higher odds of completed vaccinations for children in the youngest age groups, but not the older children. This suggests the need for greater emphasis on family-oriented healthcare for young children of parents with SU/MH diagnoses; this may be less important for older children. [ABSTRACT FROM AUTHOR]

Background: Reduced graft failure rates have been reported after anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex (ALC) augmentation. However, the preoperative diagnosis of concomitant ALC injury remains a clinical challenge. Purpose: To identify the altered rotational tibiofemoral position on magnetic resonance imaging (MRI) in ACL-injured patients with concomitant ALC injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Based on the evaluation of ALC abnormalities on MRI scans by experienced surgeons, 123 patients with nonchronic (<3 months) ACL injury confirmed by arthroscopy were included. The patients were divided into 2 groups—an ALC-injured group (n = 57) and an ALC-intact group (n = 66). The altered rotational tibiofemoral position was evaluated and compared by quantitatively measuring internal rotational tibial subluxation (IRTS) and axial internal tibial rotation (ITRa) on MRI. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify the factors associated with concomitant MRI-determined ALC injury. Results: The ALC-injured group showed significantly increased IRTS (P <.001), ITRa (P <.001), lateral anterior tibial subluxation (ATS) (P <.001), and global ATS (GATS) (P =.002) compared with the ALC-intact group, while no significant difference in medial ATS (P =.810) was observed. A strong positive correlation was identified between IRTS and ITRa (r P = 0.809; P <.001). Multivariate analyses revealed that IRTS (P <.001) and GATS (P =.016) were associated factors for the presence of concomitant MRI-determined ALC injury. IRTS (area under the curve [AUC] = 0.734) was more strongly associated with the outcome than GATS (AUC = 0.658) in ROC analyses, suggesting a more significant internal rotational subluxation than anterior subluxation of the tibia. An IRTS threshold of 3.1 mm demonstrated a specificity of 84.2% for indicating the presence of concomitant MRI-determined ALC injury. Conclusion: The presence of concomitant MRI-determined ALC injury in ACL-injured patients was associated with a significant increase in IRTS and ITRa compared with those with intact ALC, indicating that these MRI measurements of the altered rotational tibiofemoral position could serve as potential quantifiable indicators for identifying concomitant ALC injury in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the efficacy of different doses and forms of corticosteroids in the treatment of postinfectious olfactory dysfunction and to specify the factors related to the curative effects. Methods: The medical records of patients diagnosed with postinfectious olfactory dysfunction from January 2018 to May 2019 were reviewed. All patients received different doses of oral corticosteroids for 12 days or inhaled corticosteroids for 1 month. Results: A review of the records of 43 patients showed that the mean follow-up time was 6.66 months, and the overall effective rate of treatment was 48.8%. Postinfectious olfactory dysfunction exhibited distinct seasonality, with the highest incidence in March. The curative effect was significantly related to the olfactory discrimination threshold at the first consultation (P =.022), but not significantly associated with age (P =.325), sex (P =.924), duration of disease (P =.526), follow-up time (P =.489), or treatment program (P =.330). Conclusions: Different doses and forms of corticosteroids showed no significant difference in the therapeutic effect on postinfectious olfactory dysfunction. The olfactory discrimination threshold at the first consultation was the most important factor influencing the prognosis. [ABSTRACT FROM AUTHOR]

Background: Culturally appropriate communication training programs for a wide range of professions that can be used during infection epidemics are crucial for advance care planning implementation. Starting in 2018, the Japanese Ministry of Health, Labour and Welfare made a major policy change, and doctors, nurses, and social workers, and care managers were identified in the guidelines as the professions that promote advance care planning. Motivated by the lack of online programs for Japanese care managers, we proposed a new one-day program. Objectives: This study aimed to determine the changes in the positive attitude of care managers toward dying patients compared to that of nurses, which has been used in past literature as an outcome of advance care planning educational interventions, after administering the program in Japan. Design: Before-after comparison study. Methods: Care managers were recruited through our website, ACP-Piece, http://plaza.umin.ac.jp/~acp-piece/piece.html. A questionnaire survey concerning positive attitudes toward dying patients was administered before and after the program on 28 August 2021. Sixty-six subjects participated in the training and 60 participants, including 14 care managers, consented to the study and completed the questionnaire surveys before and after the program. Results: The Frommelt attitude toward care of the dying scores for care managers increased after the program (p -values, confidence intervals, and effect sizes: p < 0.001, −11.90 to −4.388, −1.252). After training, care managers had a significantly higher maximum score occurrence than nurses. Older care managers with advance care planning experience may have had a higher maximum score occurrence compared to younger, inexperienced participants. Conclusion: To our knowledge, this is the first to demonstrate the increased positive attitude scores toward dying patients after online communication training for Japanese care managers. The limitations of this study include the lack of evidence regarding reasons for score changes, long-term score changes, and effectiveness for patients and their families. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 has had an important effect on nursing students, with some having their clinical practice cancelled or suspended and others suffering from the virus. Objective: The purpose of this study was to assess the psychological status in terms of stress, anxiety, and depression of nursing students during COVID-19 pandemic. Methods: The study was cross-sectional, carried out by a convenience sample of 320 participants of nursing students between May and June 2020. Data collection was performed by "Depression Anxiety Stress-21 Scale" (DASS-21). Results: The results revealed that 78 (24.3%) of participants reported stress; 121 (37.8%) reported anxiety; and 72 (22.5%) reported depression. Also, grade and socioeconomic status had statistically significant effect on anxiety, stress, and depression. In addition, age had statistically significant effect on depression, place of residence had statistically significant effect on anxiety, and gender had statistically significant effect on stress. Conclusion: The study confirmed an alarming number of nursing students who experienced anxiety, stress, and depression. This study serves as an evidence concerning nursing students' mental health issues as a consequence of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease (CKD) often complain of taste dysfunction. The prevalent taste dysfunction among patients with CKD predisposes them to malnutrition, poor quality of life, and worsen disease prognoses. To appropriately treat the taste dysfunction in this group of patients, it's imperative that factors that predict taste dysfunction and its severity are identified for prompt treatment. Aim: To identify factors associated with taste dysfunction and its severity among patients with CKD. Materials and Methods: This was a hospital-based case–control study of adult patients with CKD at the University College Hospital, Ibadan, Nigeria. The control group was made up of age- and gender-matched healthy volunteers with no clinical and laboratory evidence of CKD. Relevant clinical and social data obtained include demographics, symptoms, and signs of taste dysfunction and its risk factors. The 4 basic taste modalities namely sweet, sour, bitter, and salt taste senses of the participants were tested with validated "taste strips." Factors that predict taste dysfunction were identified among the spectrum of the disease. Results: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± standard deviation [SD] = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P =.57). Hypogeusia was found in 27.0% of patients with CKD, while total taste function score of all the control was within normal range. Increasing duration of CKD was identified as a predictor of taste dysfunction among patients with CKD (odds ratio: 4.889, P =.038). The stages of CKD had no statistically significant relationship with the severity of taste dysfunction (P =.629). Conclusion: The prevalence of taste dysfunction among patients with CKD was high and this showed significant correlation with increasing duration of CKD; in contrast, the severity of CKD is not significant in the development of taste dysfunction. [ABSTRACT FROM AUTHOR]

Background/objectives: There is limited research on the associated immediate and long-term outcomes of postpartum hemorrhage. Mothers with a pre-existing psychiatric disease prior to delivery may be especially vulnerable to postpartum hemorrhage outcomes but little is known on this topic. Barriers to studying this population exist and add to knowledge gaps. The goal of this study is to determine the clinical characteristics and frequency of complications within 1 year of a postpartum hemorrhage diagnosis and the psychiatric sequelae within 7 days of a postpartum hemorrhage diagnosis in mothers with a pre-existing mental health diagnosis prior to delivery versus those without. Methods/design: This is a multicenter retrospective observational cohort study using TriNetX, a de-identified electronic health record database. The following electronic health record data were collected and evaluated in postpartum females who were billed for either a vaginal or cesarean delivery: age, race, ethnicity, diagnostic codes, medication codes, and number of deaths. Results: We included 10,649 subjects (6994 (65.7%) no mental health diagnosis and 3655 (34.3%) pre-existing mental health diagnosis). Haloperidol administration (118 (3.2%) versus 129 (1.8%), p < 0.001) was more prevalent in subjects with a pre-existing mental health diagnosis. Adjusting for demographics, pre-existing mental health diagnoses were associated with complications within 1 year after postpartum hemorrhage diagnosis (OR = 1.39, 95% CI: 1.26–1.52, p < 0.001). Conclusion: Having a mental health disorder history is associated with a higher odds of developing subsequent complications within 1 year of postpartum hemorrhage diagnosis. Mothers with a pre-existing mental health disorder have a significantly higher frequency of certain severe postpartum hemorrhage sequelae, including acute respiratory distress syndrome, retained placenta, sickle cell crisis, and need for mechanical ventilation/tracheostomy up to 1 year after delivery. Medications such as haloperidol were ordered more frequently within 7 days of a postpartum hemorrhage diagnosis in these mothers as well. Further research is needed to understand and manage the unique consequences of postpartum hemorrhage in this vulnerable maternal population. [ABSTRACT FROM AUTHOR]

Introduction: Evidence and clinical experience suggest that there are a range of signs of health issues that affect patients who have recovered from acute COVID-19 infection. This condition is commonly referred to as "persistent COVID-19," which is not connected with the severity of the disease. We have identified the prevalence and clinical-epidemiological characteristics of patients with COVID-19 and persistent symptoms treated in primary care centers. This is a descriptive observational study conducted between December 2020 and May 2022, the data were collected from digitized medical records and interviewing 1542 individuals with laboratory-confirmed SARS-CoV-2 infection. These patients were clinically followed for up to 1 year, based on the prevalence of symptoms. When stratifying by the risk of developing persistent COVID-19, 37.09% of the patients exhibited risk factors, with age (over 60 years) and cardiovascular risk factors predominating. The obtained prevalence of persistent COVID-19 at 90 days was 12.39%, with a slight predominance in females (55%) and a mean age of 45.8 years. The most affected systems were the cardiovascular, respiratory, and psychoneurological systems, with predominant symptoms of fatigue (41.88%), dyspnea (32.46%), and headache (14.66%), among others. The average duration of persistent symptoms was 178 days, equivalent to 6 months. In conclusion, over 10% of patients who recover from acute SARS-CoV-2 infection developed long-term consequences. Objective: To measure the prevalence and clinical-epidemiological characteristics of individuals diagnosed with COVID-19 and persistent symptoms treated in primary care centers in Área Sanitaria Sur de Córdoba (Spain) between December 2020 and May 2022. Methods: A retrospective observational study of the population of Área Sanitaria Sur de Córdoba was developed between December 2020 and May 2022. The scope of the study was 1542 individuals, and the prevalence of patients diagnosed with COVID-19 and persistent symptoms was determined based on laboratory-confirmed cases, randomly selected from adults who had progressed beyond the acute phase of the disease. All data were managed by the Área Sanitaria Sur de Córdoba (Spain). Results: The risk factor of exhibiting one or more risk factors associated with developing persistent COVID-19 is 37.09%. The obtained prevalence of persistent COVID-19 at 90 days is 12.39%, it is higher in females (55%) than males and the mean age was 45.8 years. The most affected systems were the cardiovascular, respiratory, and psychoneurological systems, with predominant symptoms of fatigue (41.88%), dyspnea (32.46%), and headache (14.66%), among others. Conclusions: Results confirm that more than 10% of individuals recovering from acute SARS-CoV-2 infection showed long-term consequences and the observed persistent symptom duration was 178 days on average. [ABSTRACT FROM AUTHOR]

Objective: Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept. Methods: Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures. Results: Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p <.001), but this association was not found among younger adolescents (B = -0.29, p =.680). A similar effect was found for SPPC among older (B = -0.48, p =.001) and younger adolescents (B = 0.03, p =.842). Adolescent sex was not found to be a moderator. Conclusions: Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age—differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services. [ABSTRACT FROM AUTHOR]

Background: The incidence of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in children and adolescents has increased over the past decade, with increasing numbers of ACL and PCL reconstructions in this patient population. Purpose: To evaluate the size and morphology of both the ACL and the PCL by magnetic resonance imaging (MRI) in different pediatric age groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: MRI examinations of 127 knees (67 female, 60 male; aged 0-18 years) were analyzed retrospectively. The cohort was split into 6 age subgroups, 1 subgroup for every 3 years (minimum 8 patients per subgroup). The following parameters were measured by 2 independent raters at 2 different time points: ACL length, anteroposterior and mediolateral ACL width, sagittal and coronal ACL inclination, inclination of the intercondylar notch, bicondylar width, notch width, coronal ACL and PCL width, PCL length, and sagittal width of the lateral femoral condyle. The following indices, areas, and volumes were calculated: sagittal width of the lateral femoral condyle/PCL length, ACL area and volume, notch width index, ACL width/notch width, PCL width/notch width, ACL width/bicondylar width, and PCL width/bicondylar width. A correlation analysis was performed for patient age, height, weight, and body mass index (BMI). Results: ACL length was between 18 and 37 mm, and ACL width was between 4 and 6 mm. PCL length ranged between 27 and 43 mm, while PCL width was between 7 and 9 mm. Growth of the cruciate ligaments was the most pronounced between the ages of 4 and 12 years. Correlations with size and weight were strong, while BMI correlated slightly with the measurements. Measurements in female patients were slightly larger than in their male counterparts between the ages of 0 and 6 years, while male patients tended to have larger values starting from ages 7 to 9 years. These values were significantly larger in male patients from the ages of 16 to 18 years (P <.05). Conclusion: This study provides normative data on the morphology of pediatric anatomic features in the knee as a basis for age-appropriate and individualized surgical care of ACL and PCL injuries in children and adolescents. [ABSTRACT FROM AUTHOR]

Objectives In August 2008 the British reality TV star Jade Goody made public her diagnosis of cervical cancer. In February 2009 it was announced that she was terminally ill and she died a few weeks later. A surge in cervical screening attendances associated with these events was widely reported. This paper aims to quantify the size of that effect across England, its duration, and whether it affected some groups of women more than others. Setting The Cervical Screening Programme in England. Methods Routinely collected statistics for the months around Jade Goody's diagnosis and death were compared with those for other periods. Results About half a million extra cervical screening attendances occurred in England between mid-2008 and mid-2009, the period during which Jade Goody was diagnosed and died; among these were 370 attendances where the test result was suspected neoplasia. At its peak in March 2009, attendance was 70% higher than expected. Increases were seen in both initial and follow-up screening attendances and in colposcopy attendances, and at all ages, though the magnitude was greater for women aged under 50. A substantially greater proportion of the extra attendances of women aged 25-49 on routine recall occurred in women whose attendance was overdue (28% occurred at 60 months or more) and relatively little represented over-screening (8% had been screened within the last 30 months). Conclusions The pattern of increased attendance mirrored the pattern of media coverage of Jade Goody's diagnosis and death. It is likely that the increased screening resulted in a number of lives saved. [ABSTRACT FROM AUTHOR]

Scholars and practitioners from multiple perspectives, including developmental science, sociology, business, medicine, and public health, have considered the implications of employment for young people. We summarize a series of meetings designed to synthesize information from these perspectives and derive recommendations to guide research, practice, and policy with a focus on young worker safety and health. During the first three meetings, participants from the United States and Canada considered invited white papers addressing developmental issues, public health data and findings, as well as programmatic advances and evaluation needs. At the final meeting, the participants recommended both research and policy directions to advance understanding and improve young worker safety. [ABSTRACT FROM AUTHOR]

The conventional method used to project a country's future health care expenditures is to assume that relative health spending by age remains constant. This method has been criticized as being too pessimistic, on the one hand, because of continued improvements in the health status of older people, and as too optimistic, on the other, because of the effects of technological innovations on increasing health spending on the elderly relative to the non-elderly. This paper uses cross-country data to shed light on this question. I find that, contrary to conventional wisdom, the theoretical effects of technology on health spending are to decrease the concentration of health spending on the elderly. Empirically, I find that relative health spending by age has been quite stable over time. I also find that countries with the most technologically intensive health sectors spend relatively less on the oldest old compared to the younger old. [ABSTRACT FROM AUTHOR]

The rapid adoption of software to simulate human reach motions in the design of vehicle interiors and manufacturing and office workstations has required a sophisticated understanding of human motions. This paper describes how more than 3,000 right-arm reaching motions of a diverse group of participants were captured and statistically modeled. The results demonstrate that stature and age have a larger effect than does gender on reach motion postures for motions chosen by the participants while reaching to targets placed throughout a typical automobile interior. We propose that these methods, models, and results can assist the further development of human motion simulation software for ergonomic purposes, such as for the design or evaluation of vehicle interiors or industrial workplaces, to ensure that various population groups are physically accommodated. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results. Objective: To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain. Design: Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain. Data sources and methods: A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood. Results: Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of r =.31 (95% confidence interval:.23–.40) p <.001. Heterogeneity was large and significant (I 2 = 84.5%, Q (24) = 155.16, p <.001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain. Conclusion: A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain. Registration: This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328. Plain Language Summary: Severity of period pain is associated with catastrophic thinking Dysmenorrhea, known as menstrual cramps or period pain, is a common symptom and condition for women of reproductive age. Medical and surgical treatments often do not effectively reduce dysmenorrhea. Understanding the psychological processes that reinforce dysmenorrhea may help in developing better treatments. One important psychological process is catastrophizing, a thinking style in which people "catastrophize" or engage in negative thinking about how bad pain is or might become. In this study, we reviewed 25 studies of women with menstrual pain and statistically combined their results. We found that pain severity was significantly associated with higher catastrophizing. We also found that the association between pain and catastrophizing was higher in the studies that assessed general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain. The relationship between pain and catastrophizing was not affected by diagnoses, age, or level of depression. Our results suggest a significant association between catastrophizing and menstrual pain ratings. Patients experiencing dysmenorrhea may benefit from interventions targeted at addressing catastrophizing. [ABSTRACT FROM AUTHOR]

Background: Despite a strong international standpoint against female genital mutilation, the prevalence of female genital mutilation in Somalia is extremely high. Objectives: This study assessed the knowledge, attitude, and practice of female genital mutilation among female health care service providers in order to formulate appropriate policies and programs to eliminate this harmful practice. Design: Facility-based cross-sectional survey conducted in 2019 among female doctors and nurses working in Banadir Hospital, Mogadishu, Somalia. Methods: A total of 144 female health care service providers were randomly selected, and data were collected through a pre-tested, semi-structured questionnaire. Quantitative data were analyzed by using the statistical software SPSS (Version 21), and qualitative data were analyzed thematically in accordance with the objectives of the study. Results: The study found that about three-fifths of the respondents had undergone some forms of female genital mutilation during their life. An overwhelming majority believed that female genital mutilation practices were medically harmful, and a majority of them expressed their opinion against the medicalization of the practice of female genital mutilation. The study also observed a significant association between participants' age and their negative attitudes regarding the legalization of female genital mutilation. Conclusion: Health care service providers' effort is critical to eliminating this harmful practice from the Somalian society. Strong policy commitment and a comprehensive health-promotion effort targeting the parents and community leaders are essential to avert the negative impact of female genital mutilation. [ABSTRACT FROM AUTHOR]

This Letter to Editor is a supplement to the previously published article in the Journal of Official Statistics (Wazir and Goujon 2021). In 2021, a reconstruction method using demographic analysis for assessing the quality and validity of the 2017 census data has been applied, by critically investigating the demographic changes in the intercensal period at national and provincial levels. However, at the time when the article was written, the age and sex structure of the population from the 2017 census had not yet been published, making it hard to fully appreciate the reconstruction of the national and subnational level populations. In the meantime, detailed data have become available and offer the possibility to assess the reconstruction's outcome more in detail. Therefore, this letter aims two-fold: (1) to analyze the quality of the age and sex distribution in the 2017 Population census of Pakistan, and (2) to compare the reconstruction by age and sex to the results of the 2017 population census. Our results reveal that the age and sex structure of the population as estimated by the 2017 census suffer from some irregularities. Our analysis by age and sex reinforces the main conclusion of previous article that the next census in Pakistan should increase in quality with an inbuild post-enumeration survey along with post-census demographic analysis. [ABSTRACT FROM AUTHOR]

Introduction: Depression is increasing worldwide. Some previous studies have explored the impact of work–family conflict on depressive symptoms of married working women. However, little is known about the moderating relationship underlying them. Objectives: This study aims to determine the moderating effects of marriage satisfaction and organizational gender discrimination climate in the relationship between work–family conflict and depressive symptoms of married working women in Korea. Methods: A cross-sectional study was conducted using the data of the 8th Korean Longitudinal Survey of Women and Families (KLoWF). The data of 1,816 married working women employed and paid by an individual or an enterprise were analyzed. Results: The work–family conflict had a significant effect on depressive symptoms of married working women. In the dynamics between work–family conflict and depressive symptoms, no significant moderating effect of marriage satisfaction was found. On the contrary, the organizational gender discrimination climate displayed a moderating effect on the relationship between work–family conflict and depressive symptoms. Conclusion: Nursing strategies in the workplace or community are needed so that married working women can cope positively and actively between work–family conflicts and maintain healthy mental health. To this end, gender role awareness education should be prioritized to improve awareness of gender discrimination in the workplace. In addition, nursing interventions such as linking local or government support and information delivery should be provided so that married working women can be consulted about situations related to work–family conflicts or gender discrimination climate. [ABSTRACT FROM AUTHOR]

Objectives: To study the effects of age on the olfactory function recovery of chronic rhinosinusitis patients after endoscopic sinus surgery and related risk factors. Methods: A total of 176 chronic rhinosinusitis (CRS) patients enrolled from February 2017 to October 2019 were divided into child, youth, middle-aged, and elderly groups. Their baseline data, T&T olfactory test score, visual analogue scale (VAS) olfactory score, sinus computed tomography (CT) Lund-Mackay score, and Lund-Kennedy score were compared. Based on postoperative olfactory function, they were divided into good and poor improvement groups. Results: Complication with nasal polyps, allergic rhinitis history, and sinus surgery history had significant differences among patients of different ages (P <.05). Three months after surgery, T&T olfactory, VAS olfactory, Lund-Mackay, and Lund-Kennedy scores all rose with increasing age, with significant differences between any 2 groups (P <.05). The improvement of postoperative olfactory function became poorer with aging (P <.05). T&T and VAS olfactory scores had significant positive correlations with Lund-Mackay and Lund-Kennedy scores (P <.001). Age, preoperative Lund-Mackay and Lund-Kennedy scores, complication with nasal polyps, allergic rhinitis history, sinus surgery history, and postoperative complications were risk factors for the poor improvement of postoperative olfactory function. Doctor-directed treatment was a protective factor for good improvement. Conclusions: The improvement of olfactory function of CRS patients after endoscopic sinus surgery declines with aging. Age, preoperative Lund-Mackay and Lund-Kennedy scores, complication with nasal polyps, allergic rhinitis history, sinus surgery history, and postoperative complications are risk factors for the poor improvement of postoperative olfactory function. Doctor-directed treatment is a protective factor for good improvement. [ABSTRACT FROM AUTHOR]

Introduction: One of the most important outcomes of diabetes care and treatment is an improvement in patients' health-related quality of life (HRQoL). Objective: This study aimed to review the empirical evidence regarding the predictors of HRQoL among adults with type 2 diabetes mellitus (T2DM). Methods: To find all English-language articles published between 2012 and 2022, a comprehensive literature search was conducted using ProQuest, Scopus, PubMed, Science Direct, and CORE. Cross-sectional studies were the focus of this analysis. Search terms included "type 2 diabetes" OR "T2DM" AND "health-related quality of life" OR "HRQoL" AND ("predicting factors" OR "influencing factors" OR "associated factors"). The original search yielded a total of 1,089 studies, from which 35 met the review's inclusion criteria. The systematic review protocol was registered with PROSPERO CRD42023431229. Results: The final analysis comprised 24,346 people with type 2 diabetes and used data from 35 cross-sectional studies conducted during the preceding decade. Socio-demographic factors (age, marital status, gender, monthly income, education, area of residence, and religiosity), patient-centered factors (diabetes knowledge and self-efficacy), disease characteristics (comorbidities, duration of diabetes, and insulin treatment), self-management behaviors (physical activity, medication adherence, and frequent glucose checks), and family support were found to be predictors of HRQoL. Conclusion: A diabetes program to enhance the HRQoL among people with T2DM is highly encouraged to address these factors, which can be focused on promoting self-management behaviors, diabetes distress management, and encourage family support. [ABSTRACT FROM AUTHOR]

Full details of the age-sex structure of the Soviet Union were published for 1926 and are now out-dated over a quarter of a century. From the 1939 All-Union Census only partial data were published, and the form in which this material was published suggests that the Soviet have been interested in suppressing factual information about certain aspects of the population structure. It is the purpose of the present paper to show in broad groupings the 1939 age-sex position of the USSR total, urban, and population. The method used in calculating the three age-sex compositions is described in the article. It is hoped that this material will not only increase the knowledge of the Soviet Union's population, but also, in view of the extensive use made by scholars of the 1939 partial data as a basis for making 1950-1970 population projections, contribute to a better understanding of the USSR's population at present and in the immediate future. In 1940 the Soviet government published a preliminary tabulation from the 1939 All-Union Census showing the distribution of 99.44 percent of the population among certain age classes, but with no indication of the sex ratios of the population within these age classes.

The conceptions individuals have of themselves as young, middle-aged, or old are, of course, related to their actual age. People in their sixties are certainly more likely than people in their thirties to think of themselves as old. But the variations in age identification between persons in the same age group and the similarities between those whose actual age differs indicate that chronological age is only a limiting condition and does not fully explain the changes in age identification that occur in the course of the individual's life span. In this paper, two topics will be discussed: first, the relative influence of chronological age and age identification on other aspects of the self-image of older persons, and second, some of the social factors that hasten or forestall changes in age identification among older people. Of course, the likelihood that people consider themselves old rather than middle-aged steadily increases as they grow older. Under 65, only 18 per cent define themselves as old, between 65 and 70, 37 per cent do so, but in the age group of 70 and over this proportion rises to 59 per cent.

Many previous studies have discussed an association between alcohol use disorder (AUD) and seizure incidents. There are also case reports of seizures during opioid withdrawals. Therefore, it is possible that AUD patients may have a higher risk of seizures if they also have opioid use disorder (OUD). However, it remains unproven whether AUD patients with a dual diagnosis of OUD have higher seizure incidents, to our knowledge. This study explored seizure incidents among the patients with a dual diagnosis of AUD and OUD as well as seizures among AUD only or OUD only patients. This study utilized de-identified data from 30 777 928 hospital inpatient encounters at 948 healthcare systems over 4 years (9/1/2018-8/31/2022) from the Vizient® Clinical Database for this study. Applying the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes, AUD (1 953 575), OUD (768 982), and seizure (1 209 471) encounters were retrieved from the database to examine the effects of OUD on seizure incidence among AUD patients. This study also stratified patient encounters for demographic factors such as gender, age, and race, as well as the Vizient-categorized primary payer. Greatest gender differences were identified among AUD followed by OUD, and seizure patient groups. The mean age for seizure incidents was 57.6 years, while that of AUD was 54.7 years, and OUD 48.9 years. The greatest proportion of patients in all 3 groups were White, followed by Black, with Medicare being the most common primary payer in all 3 categories. Seizure incidents were statistically more common (P <.001, chi-square) in patients with a dual diagnosis of AUD and OUD (8.07%) compared to those with AUD only (7.55%). The patients with the dual diagnosis had a higher odd ratio than those with AUD only or OUD only. These findings across more than 900 health systems provide a greater understanding of seizure risks. Consequently, this information may help in triaging AUD and OUD patients in certain higher-risk demographic groups. [ABSTRACT FROM AUTHOR]

Background: Successful return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) can be affected by a patient's physical and psychological state throughout the rehabilitation process. Purpose: To prospectively compare differences in patients at 6 months after primary ACLR with the ACL–Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee (IKDC) or pediatric (Pedi)-IKDC, Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and Patient-Reported Outcomes Measurement Information System–Psychological Stress Experiences (PROMIS-PSE) scores. Study Design: Prospective cohort study; Level of evidence, 2. Methods: Patients enrolled were 8 to 35 years old who underwent primary ACLR and had their 6-month follow-up appointments between December 2018 and March 2020. Patients were divided into 3 age groups as follows: (1) preadolescents (10-14 years); (2) adolescents (15-18 years); and (3) adults (>18 years). Outcomes on the ACL-RSI, IKDC/Pedi-IKDC, Pedi-FABS, and PROMIS-PSE were compared according to age group, graft type (hamstring, patellar tendon, quadriceps, or iliotibial band autograft), and sex. Results: A total of 176 patients (69 male, 107 female), with a mean age of 17.1 ± 3.1 years were included in the study. The mean ACL-RSI scores were significantly different among age groups (preadolescents, 75 ± 18.9; adolescents, 61.5 ± 20.4; and adults, 52.5 ± 19.8 [ P <.001]) and graft types (P =.024). The IKDC and PROMIS-PSE scores were also significantly different among age groups (P <.001 and P =.044, respectively) and graft types (P =.034 and P <.001, respectively), with the iliotibial graft and the younger age group performing the best. There was no significant difference in the Pedi-FABS either by age group (P =.127) or graft type (P =.198). Female patients had lower ACL-RSI scores and higher (worse) scores on PROMIS-PSE than their male counterparts (P =.019 and P <.001, respectively), with no sex-based differences on IKDC or Pedi-FABS scores. The ACL-RSI and IKDC were positively correlated (Spearman r = 0.57; P <.001), while the ACL-RSI and PROMIS-PSE were negatively correlated (Pearson r = –0.34; P <.001). Conclusion: This study suggests that psychological profiles and subjective perceptions of knee function 6 months after ACLR may vary in patients of different ages and between the sexes. Preadolescent patients had better scores on a majority of patient-reported outcomes compared with adolescent and adult patients. [ABSTRACT FROM AUTHOR]