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Women veterans (WV) are the fastest growing veteran subpopulation and recognized to be at increased risk for suicide compared with civilians. Improving engagement (e.g., response rates) of WV in survey research is critical to ensuring valid and generalizable findings, which can inform suicide prevention programs tailored for this population. Many factors are known to influence response rates, yet little is known about ways to optimize survey response rates among WV. Three recruitment cohorts (Waves 1 [W1], 2a [W2a], and 2b [W2b]) of WV were invited to participate in an online survey for a national, mixed‐methods study examining suicide risk among WV using reproductive health care services paid for or provided by the Veterans Health Administration. To examine the effects of enhanced recruitment efforts, standard recruitment materials were mailed to all three cohorts, with the additions of: a study flyer aiming to build trust between participants and researchers (W2a, W2b) and a paper survey (W2b). Characteristics of responders and non‐responders were compared by wave and across survey modalities. Response rates were significantly higher for groups receiving enhanced (W2a = 17.1%; W2b = 24.6%) versus standard (W1 = 12.2%) recruitment materials. WV residing in rural areas were significantly more likely to respond by paper (37.1%) than online (19.8%). Non‐respondents were disproportionately racial and ethnic minorities. Disclosure of sensitive information (e.g., military sexual trauma) did not differ by survey modality. Findings suggest that enhanced recruitment materials improve survey response rates among WV, an important consideration for future research with this population. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. Methods: A cross‐sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann‐Whitney and independent t‐tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. Results: Sixty‐two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. Conclusions: There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG. Implications for physiotherapy practice: Current knowledge Maximum Effort Tests provide detailed information on physiological health and enable exercise prescription.Exercise performance could be limited in children with cystic fibrosis (CF).Exercise performance is usually associated with obstruction to expiratory airflow in CF. What this paper contributes to our knowledgeChildren with CF show preserved respiratory muscles strengthPulmonary function and respiratory muscles strength were related to exercise performance by modified shuttle walk test (MSWT).Child collaboration influences test performance. [ABSTRACT FROM AUTHOR]

Objective: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. Design: A quantitative, descriptive design was used. Sample: We surveyed foreign residents in the greater Tokyo area (N = 209). Measurements: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. Results: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p =.000). Conclusions: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them. [ABSTRACT FROM AUTHOR]

Background: Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people's health expectations and potentially behaviour during the COVID‐19 pandemic. Objectives: Data were collected through an international survey (N = 6485) exploring people's thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Methods: Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. Findings: Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P <.001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year. Discussion: This is one of the first ever studies to report compelling comparative biases in UK adults' thinking about COVID‐19. [ABSTRACT FROM AUTHOR]

Are pregnancy and birth‐related parameters important risk factors in the development of urinary incontinence (UI)? The aim of this study is to examine the prevalence of UI and associated risk factors in Turkish women in the third postpartum month. Incontinence after childbirth is a common problem. A cross‐sectional study that included 370 women in third postpartum month in Çanakkale is presented in this paper. Wagner's quality of life scale questionnaire exploring the risk factors for UI was used as the principle data collection tool. All women gave consent prior to inclusion in the study. Chi‐square, t test, Mann‐Whitney U test and Binary logistic regression were used for comparison. The prevalence of self‐reported postpartum UI was 35.9%. In this study; age, educational level, parity, number of normal birth, nocturia and constipation were determined to be the associated risk factors for postpartum UI in univariate analysis. When examining these risk factors by using logistic regression, it was found that the number of birth being 2 increased UI 2.7 times (P = 0.002, 95% CI:1.434‐5.324), the number of birth being 3 or more increased UI 20.3 times (P = 0.001, 95% CI:7.130‐58.332) and nocturia being 3 times and more increased UI 2.6 times (P = 0.041, 95% CI:1.042‐6.790). Pregnancy and birth‐related parameters are important risk factors in development of UI. It would be useful to increase the awareness in women in pregnancy and the postpartum period, by providing health training and consultancy services about UI protection and the reduction of risk factors. [ABSTRACT FROM AUTHOR]

Objective Despite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice. Design Cross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience. Participants and Setting GP Registrars ( N = 452) training in either the general or rural pathways of three Registered Training Providers in three states, or training through the Australian College of Rural and Remote Medicine's independent pathway. Main outcome measure Ordinal logistic regression tested the impact of key variables on the likelihood that Registrars would settle in rural practice. Univariate analysis explored differences between groups and effects of variables. Results A significantly increased interest in rural practice was to found to exist among registrars who were male, identified themselves as being rural, had a partner who identified as being rural, were enrolled in a rural training pathway and had high levels of Cooperativeness. Conclusion We present a discriminating model combining socio-demographics, prior training and personality variables which challenges Australia to rethink Registrar attributes when training for rural general practice. With significant changes about to occur to GP training in Australia, this paper highlights the need for a more holistic approach which considers personal attributes such as Cooperativeness, rural identity and provision of geographically focused rural training pipelines to encourage Registrars to bond to individual rural communities and further develop their personal connectedness to country life and rural medical practice. [ABSTRACT FROM AUTHOR]

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub-elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score ( HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1-4) were included. Players completed in the beginning of the new season (July-Sept 2011) a self-reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45-52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26-36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub-elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season. [ABSTRACT FROM AUTHOR]

Aims The purpose of this paper is to discover patterns of drug use initiations over time through a multiple event process survival mixture model (MEPSUM model), a novel approach for substance use and prevention research. Design The MEPSUM model combines survival analysis and mixture modeling-specifically latent class analysis-to examine individual differences in the timing of initiation and cumulative risk of substance use over time, and is applied to cross-sectional survey data on drug initiations. Setting Data are drawn from the 2009 National Survey on Drug Use and Health. Participants The survey includes responses from 55 772 individuals (52.05% female). Measurements The age of first use of nine different types of substances are examined, including alcohol, tobacco, cocaine and non-medical use of prescription drugs. Findings It is argued that six patterns parsimoniously describe the population's risk of initiating different substances over time, described colloquially as general abstainers; early, late and progressive soft drug users; and early and late hard drug users. Both gender and ethnicity significantly predict the patterns, with Caucasians and males having a higher risk for the hard drug-using patterns. The MEPSUM model produced stable results in this application, as the patterns are validated in a split-sample design. Conclusions The MEPSUM model provides a statistical framework from which to evaluate patterns of risk for drug initiations over time and predict substance use trajectories relevant to public health interventions. The patterns that result from the model can be used as outcomes for subsequent investigations of etiological and mediating mechanisms. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between self‐efficacy, resilience and healthy ageing among older people who have an acute hospital admission. Design: A cross‐sectional study. Method s : Survey and medical record data were collected from older people on discharge from hospital. The survey measured self‐efficacy with the 6‐item General Self‐Efficacy scale (GSE‐6), resilience with the Brief Resilience Scale (BRS), and healthy ageing with the Selfie Ageing Index (SAI). Medical record data included potential confounders: co‐morbidities, frailty items, previous falls and previous admission in the last 28 days. Multi‐linear regression and Spearman's rank correlation coefficient were used to examine the independent associations between self‐efficacy, resilience and healthy ageing. Results: Responses were received from 143 older people (mean age 79). After adjusting for potential confounders, co‐morbidities (ß = ‐0.08, p = 0.001) remained negatively associated with healthy ageing, while self‐efficacy (ß = 0.03, p = 0.005) and resilience (ß = 0.05, p < 0.001) remained positively associated with healthy ageing (R2 = 0.243). Positive correlations were found between self‐efficacy (ρ = 0.33, p < 0.01), resilience (ρ = 0.38, p < 0.001) and healthy ageing. Positive correlations were also found between self‐efficacy and resilience (ρ = 0.38, p < 0.01). Those with lower self‐efficacy and resilience were more likely to report reduced activities of daily living, mobility, physical activity and mood. Conclusion: Findings indicate that while the number of co‐morbidities have negative consequences for healthy ageing among older people who are hospitalised, the promotion of self‐efficacy and resilience can potentially contribute to healthy ageing within the physical and psychological domains. Implications for Patient Care: Nurses can promote self‐efficacy, which can potentially increase resilience and help to improve self‐management of chronic conditions, functional ability in daily activities, mobility and physical activity and reduce both anxiety and depressive symptoms. Patient Contribution: Participant feedback throughout the data collection process assisted in the evaluation of study methods and data interpretation. This included processes such as assessing selected tools and clarifying the meanings of healthy ageing factors. [ABSTRACT FROM AUTHOR]

This paper examines the prevalence of multiple symptoms and the relationships between future expectations and multiple symptoms in a cross-sectional study of 100 patients with chronic obstructive pulmonary disease. A questionnaire was used to examine the patients' symptoms of breathlessness, anxiety, depression, sleeplessness, fatigue, and pain, and their outlook for the future. All patients reported breathlessness, 64% anxiety, 69% depression, 28% sleeplessness, 72% fatigue, and 45% pain. Those with anxiety reported significant depression ( P < 0.001), and those with fatigue reported significant depression ( P = 0.004). Patients who reported pain also reported significant sleeplessness ( P = 0.022). A negative outlook for the future was reported by 42% of patients who also reported significantly more anxiety, depression, sleeplessness, fatigue, and pain ( P ≤ 0.049). Multiple symptoms are common in chronic obstructive pulmonary disease, and patients with a pessimistic view of the future reported more symptoms. Those with multiple symptoms and a negative outlook toward the future may benefit from interventions to help them achieve a more positive outlook for the future, which may relieve symptom burden. [ABSTRACT FROM AUTHOR]

What is already known about this subject? Obesity is at epidemic levels and presents a serious global public health challenge., Portugal is one of the European countries with the highest prevalence of childhood obesity., Childhood Obesity Surveillance Initiative (COSI) is a robust monitoring system covering similar age groups, using standardized methods that allows comparability with other WHO European Region Member States., What this study adds? In Portugal, one in every three of 6- to 8-year-old children are overweight., Compared with other COSI national surveys, a similar trend was observed in other southern European countries, particularly Italy., The reference method used to define overweight and obesity is important as it provides different estimates., Introduction Previous studies place Portugal among the five countries with the highest prevalence of childhood obesity in Europe. This paper describes the prevalence of thinness, overweight and obesity in Portuguese children of 6-8 years of age, based on the first data collection from Childhood Obesity Surveillance Initiative Portugal, which took place during the 2007/2008 school year. Methods This study uses a semi-longitudinal design with repeated cross-sectional national representative samples. Specific prevalence of overweight (including obesity) and obesity was determined using three different diagnostic criteria. Across the seven geographic regions, 3765 children were enrolled from 181 schools; 50.3% of participants were males. Results Using the International Obesity Task Force reference, the prevalence of thinness, overweight and obesity were 4.8%, 28.1% and 8.9%, respectively; using the Center for Disease Control and Prevention reference they were 2.1%, 32.2% and 14.6%, respectively; and according to the World Health Organization reference, they were 1.0%, 37.9% and 15.3%, respectively. Univariate analysis showed a higher risk of obesity in older children, in boys and in the Azores region. The islands of Madeira and the Azores were the regions with the highest prevalence of overweight at 39.4% and 46.6%, respectively, and Algarve was the one with the lowest (21.4%). Conclusion These findings demonstrate the need for urgent action in Portugal and provide policy-makers with comprehensive and detailed information to assist with this. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mississippi (MS) Delta adults and youth report obesity rates far exceeding those of the state and nation. State law requires in-school physical activity and nutrition practices to address childhood obesity but does not require evaluation of outcomes, specifically the impact on weight-related outcomes. This paper offers 3 things: (1) describes the weight status of elementary school-age children in the MS Delta; (2) explains the importance of including waist-to-height ratio (WHtR) values when reporting body mass index (BMI); and (3) provides impetus for policy that requires weight-related health risk, as measured by WHtR, to be assessed regularly as a means to evaluate school health policy. METHODS: We took anthropometric measures in a cross-sectional investigation of 1136 children from 11 public elementary schools in the MS Delta. Measures included BMI, waist circumference (WC) and WHtR. RESULTS: The prevalence of overweight and obesity (BMI ≥85th percentile) was 47.1% (18.3% overweight and 28.8% obese). In this sample, 59.9% and 42.0% were 'at risk' for weight-related chronic disease based on WC (≥75th percentile) and WHtR (>0.5), respectively. The differences in these proportions were statistically significant. The predominantly black districts reported higher on all of the weight-related measures. CONCLUSIONS: Investigators recommend the assessment of health policy include measures of health risk in addition to BMI, namely WHtR as it accounts for growth in both WC and height over age. Furthermore, WHtR is a more accurate indicator of fat distribution and health risk than WC alone. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Design Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree. [ABSTRACT FROM AUTHOR]

Aims The burden of diabetes is considerable for racial and ethnic minority populations in many places in the USA and worldwide, often disproportionately affecting immigrant communities. This paper reports findings from a community-based participatory research study that described diabetes risk and awareness, assessed the association between perceived and actual risk (high, two or more diabetes risk factors; low, fewer than two risk factors) and identified factors associated with disease risk among Chinese and Hispanic / Latino immigrant populations in Portland, OR, USA. Methods Cross-sectional, self-reported data were collected from a purposive sample of 324 Chinese (n = 159) and Hispanic / Latino (n = 165) adults, aged 18-86 years [mean (SD) age, 45.2(17.9) years; 50.7% women). Analyses described differences in variable distributions. Logistic regression estimated odds ratios and 95%confidence intervals in pooled and ethnic group-specific samples. Results Approximately 43% of participants were at high risk for diabetes, regardless of ethnicity or age. Of those unaware of their risk, or who perceived themselves not to be at risk, 25-53%had two or more risk factors (high risk); these patterns varied by ethnicity. The proportion of participants who reported two or more risk factors and were unaware of their risk status (31.8% Hispanic / Latino; 17% Chinese) or self-identified as not at risk (12.5% Hispanic / Latino; 13.0% Chinese) was substantial. Factors associated with diabetes risk also varied by ethnicity. Conclusions This study assessed the degree and determinants of diabetes risk and awareness among local Hispanic / Latino and Chinese communities and identified significant variation between groups. The results are important because they highlight substantial diabetes risk among persons who misestimate or are unaware of their risk status, regardless of ethnicity, and, in the USA, the Chinese immigrant population commonly is not considered a high-risk group for Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies. [ABSTRACT FROM AUTHOR]

Some women who breastfeed will experience complex ongoing difficulties, such as breastfeeding aversion response (BAR). This recently named breastfeeding challenge is defined as feelings of aversion while breastfeeding for the entire time that the child is latched. This study provides the first prevalence data for the experience of BAR in Australian breastfeeding women. A national online survey investigated the breastfeeding experience of Australian women including data on (1) participant demographics, (2) breastfeeding experience with up to four children, (3) breastfeeding challenges and prevalence of BAR, and (4) the value of available breastfeeding support. This study found that of the Australian breastfeeding women who participated (n = 5511), just over one in five self‐identified as having experienced a BAR (n = 1227, 22.6%). Most reported experiencing some breastfeeding challenges, with only 4.5% (n = 247) having had no breastfeeding complications. Importantly, despite these difficulties, 86.9% of the total women in this study rated their overall breastfeeding experience as good (n = 2052, 37.6%), or very good (n = 2690, 49.3%), and 82.5% of those who experience BAR as good (n = 471, 38.7%) or very good (n = 533, 43.8%). BAR reporting was decreased in higher education and income groups. Women who are breastfeeding for the first time are more likely to encounter difficulties with breastfeeding such as BAR. Complications with breastfeeding are pervasive, but women who can overcome breastfeeding issues often report a positive overall breastfeeding experience. Key messages: This national survey of 5511 breastfeeding women in Australia found that one in five reported having experienced a breastfeeding aversion response.There is limited evidence to guide stakeholders in supporting women who experience complex breastfeeding challenges such as breastfeeding aversion responses.Breastfeeding challenges are common for those who breastfeed however women who are supported to manage breastfeeding aversion response report a positive overall breastfeeding experience. [ABSTRACT FROM AUTHOR]

Nutritional support often focuses on cooking and food skills such as food selection, recipe planning and meal preparation. Individuals with greater cooking and food skills confidence have previously displayed higher diet quality scores and lower intakes of overall calories, saturated fat and sugar. Despite this, the cooking and food skills of team sport athletes have yet to be investigated. This study aimed to evaluate the relationship between cooking and food skills confidence and athletes' demographic characteristics. A validated measure for the assessment of cooking and food skills confidence was distributed via an online survey. Participants were required to rate their confidence on a Likert scale (1 "very poor" – 7 "very good") for 14 items related to cooking skills and 19 items for food skills. Food engagement, general health interest and self‐reported fruit and vegetable consumption as a measure of diet quality were also measured. The survey was completed by 266 team sport athletes (male: 150, female: 116, age: 24.8 ± 6.1 years). Group differences were explored using t‐tests and ANOVA and associations were evaluated using Spearman's correlation and hierarchical multiple regressions. Athletes' total cooking and food skills confidence was 62.7 ± 17.4 (64.0 ± 17.8%) and 83.8 ± 20.1 (63.0 ± 15.1%), respectively. Females reported greater confidence in both cooking (+20.3%, p < 0.01) and food skills (+9.2%, p < 0.01). Hierarchical multiple regressions explained 48.8% of the variance in cooking skills confidence and 44% of the variance in food skills confidence with gender, previous culinary training, cooking learning stage, general health interest and food engagement all remaining significant in the cooking skills confidence model and cooking frequency, previous culinary training, general health interest and food engagement remaining significant in the food skills confidence model. Male team sport athletes may benefit the most from educational interventions designed to increase cooking and food skills confidence. [ABSTRACT FROM AUTHOR]

Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low‐income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top‐up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at‐risk households. Transaction and redemption records from 150 loyalty card‐holding households, living in northern England, who had engaged with the top‐up scheme, were analysed to assess the potential overall population impact. Using a pre‐post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched‐pairs sign‐ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top‐up redeeming baskets compared to non‐top‐up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top‐up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low‐income households. These results yield important insights to inform public policy aimed at levelling up health inequalities. [ABSTRACT FROM AUTHOR]

The southeastern region of Kenya is prone to aflatoxin outbreaks, yet maternal and infant aflatoxin intake levels remain unclear. We determined dietary aflatoxin exposure of 170 lactating mothers breastfeeding children aged 6 months and below in a descriptive cross‐sectional study involving aflatoxin analysis of maize‐based cooked food samples (n = 48). Their socioeconomic characteristics, food consumption patterns and postharvest handling of maize were determined. Aflatoxins were determined using high‐performance liquid chromatography and enzyme‐linked immunosorbent assay. Statistical analysis was conducted using Statistical Package Software for Social Sciences (SPSS version 27) and Palisade's @Risk software. About 46% of the mothers were from low‐income households, and 48.2% had not attained the basic level of education. A generally low dietary diversity was reported among 54.1% of lactating mothers. Food consumption pattern was skewed towards starchy staples. Approximately 50% never treated their maize, and at least 20% stored their maize in containers that promote aflatoxin contamination. Aflatoxin was detected in 85.4% of food samples. The mean of total aflatoxin was 97.8 μg/kg (standard deviation [SD], 57.7), while aflatoxin B1 was 9.0 μg/kg (SD, 7.7). The mean dietary intake of total aflatoxin and aflatoxin B1 was 7.6 μg/kg/b.w.t/day (SD, 7.5) and 0.6 (SD, 0.6), respectively. Dietary aflatoxin exposure of lactating mothers was high (margin of exposure < 10,000). Sociodemographic characteristics, food consumption patterns and postharvest handling of maize variably influenced dietary aflatoxin exposure of the mothers. The high prevalence and presence of aflatoxin in foods of lactating mothers are a public health concern and calls for the need to devise easy‐to‐use household food safety and monitoring measures in the study area. Key messages: A high prevalence of aflatoxin (84.4%) and high dietary aflatoxin exposure were reported among lactating mothers in the study.The mean concentration of 90% of maize‐based cooked food samples exceeded the 2 and 10 µg/kg set limits for aflatoxin B1 and total aflatoxin, respectively.Household size, education, socioeconomic status and limited food consumption patterns were potential determinants of dietary aflatoxin exposure in lactating mothers. Within dietary diversity, the type of food constituting a diverse diet played an important role.Postharvest handling of maize could be one of the factors contributing to dietary aflatoxin exposure in the study area.The reported results call for the need to devise easy‐to‐use household food safety and monitoring measures in the study area. [ABSTRACT FROM AUTHOR]

Aim: The COVID‐19 pandemic has led to a rapid raise of work‐related stress among nurses, affecting their emotional well‐being. This study examined how nurses appraise job demands (i.e. time pressure, emotional demands and physical demands) during the pandemic, and how primary (i.e. challenge and threat) and secondary appraisals (i.e. coping potential) of job demands predict nurses' affective states (i.e. positive affect, anger and anxiety). Design: A cross‐sectional online survey. Methods: 419 nurses completed self‐report measures of job demands and related appraisals. Data analyses comprised correlation analysis, factor analysis, hierarchical linear regression analysis and dominance analysis. Results: Emotional and physical demands correlated exclusively with threat appraisal, while time pressure correlated with challenge and threat appraisal. Time pressure, emotional demands and threat appraisals of job demands predicted negative affective states, while challenge appraisals of emotional and physical demands predicted positive affect. Coping potential was identified as the most important predictor variable of nurses' affective states. Public Contribution: The current study identified statistically significant risk and protective factors in view of nurses' affective states experienced during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). Aim: This study aims to examine the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan. Methods: A cross‐sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self‐structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle. Results: The unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient‐to‐nurse and patient‐to‐doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21–28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19–26) and 28 (IQR = 23–30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score (rs = 0.654, p value =.011). Similarly, 24‐h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care (rs = 0.676, p value =.008) while routine subglottic aspiration was correlated with the number of doctors (rs = 0.636, p value =.014). Conclusion: Our study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels. Relevance to clinical practice: Critical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non‐compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically ventilated patients. Lastly, nurse staffing of ICUs in Pakistan must be increased to enable high quality care and more doctors should be trained in critical care. [ABSTRACT FROM AUTHOR]

Background: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). Methods: An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. Results: One hundred and thirty‐five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return‐to‐learn protocol in place and 90% reported having a return‐to‐play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty‐seven percent of respondents believed that PPM158 improves student well‐being. Conclusions: Identified implementation barriers and facilitators can inform concussion policy practices to improve student well‐being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools. [ABSTRACT FROM AUTHOR]

Background: eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health‐related quality of life (HRQoL) among older persons. Methods: A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short‐form health survey (SF‐36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors. Results: The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy. Conclusions: The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing. [ABSTRACT FROM AUTHOR]

Objectives: To assess (i) paediatric fever management practices among New Zealand ED doctors and nurses, including adherence to best practice guidelines; and (ii) the acceptability of a randomised controlled trial (RCT) of antipyretics for relief of discomfort in young children. Methods: A cross‐sectional survey of doctors and nurses across 11 New Zealand EDs. The primary outcome of adherence to paediatric fever management best practice guidelines was assessed with clinical vignettes and defined as single antipyretic use for the relief of fever‐related discomfort. Results: Out of 602 participants (243 doctors, 353 nurses and six unknown; response rate 47.5%), only 64 (10.6%, 95% confidence interval [CI] 8.3–13.4%) demonstrated adherence to best practice guidelines. In a febrile settled child with normal fluid intake, the percentage of participants that would use antipyretics doubled with abnormal vital signs (33.7% vs 72.9%, difference −39.2%, 95% CI –44.4% to −34.0%). Most participants would use antipyretics for reduced fluid intake (n = 494, 82.1%, 95% CI 78.8–85.0%) in a febrile settled child. Over half (n = 339, 57.1%, 95% CI 53.0–61.1%) would advise giving antipyretics to prevent febrile convulsions. Most (n = 467, 80.0%, 95% CI 76.5–83.1%) participants agreed that a RCT of antipyretics in febrile children <2 years of age with relief of discomfort as a primary outcome is needed. Conclusions: Just over 10% of New Zealand ED doctors and nurses demonstrated adherence to paediatric fever management best practice guidelines. A RCT of antipyretics in febrile children <2 years of age specifically addressing relief of discomfort as a primary outcome is strongly supported. [ABSTRACT FROM AUTHOR]

Aim: Australian children consume 35% of energy from discretionary food and beverages which increases their risk of non‐communicable diseases like type 2 diabetes. Despite this concerning statistic, broad analysis of the profile of discretionary food intake has not been fully undertaken. This study asks: what is the discretionary food and beverage intake profile, contribution to nutrient intakes, and associations with demographic and health characteristics? Methods: Cross‐sectional data from the 2011–12 National Nutrition and Physical Activity Survey (n = 2812, 2–18 years) were used to profile discretionary food consumption. Dietary intake was assessed by 24‐h recall. General linear models tested the difference in respondent characteristics by age group, sex, and quartiles of discretionary food energy contribution. Results: Ninety‐nine percent of respondents consumed discretionary foods, 74% exceeded the maximum discretionary food recommended serves. Among 10 eating occasions available to select: snack, dinner, lunch and morning tea appeared to contribute 76% of discretionary food energy, with snack and dinner contributing 24% each. Age and frequency of discretionary food consumption were positively associated with energy intake from discretionary foods (p < 0.001); while sex, socio‐economic status, physical activity and body composition had no association. High discretionary food consumers chose specific discretionary food items in a large quantity (1.0–3.5‐serves/discretionary food) compared to low discretionary food consumers (0.4–1.4‐serves/discretionary food). Conclusions: Nearly all Australian children and adolescents consumed discretionary food daily. No demographic or anthropometric characteristics beyond increasing age were associated with higher discretionary food. Targeted public health policy and community interventions are required to focus on addressing the largest contributors to discretionary food intake in terms of equivalent serve sizes, popularity, and eating occasion. [ABSTRACT FROM AUTHOR]

Emotional eating (EE; defined as overeating irrespective of satiety and in response to emotional states) develops within childhood, persists into adulthood, and is linked with obesity. The origins of EE remain unclear, but parental behaviours (e.g., controlling feeding practices and modelling) and child characteristics (e.g., temperament) are often implicated. To date, the interaction between these influences has not been well investigated. This study explores whether the relationship between parent and child EE is shaped by parental feeding practices, and if the magnitude of this relationship varies as a function of child temperament. Mothers (N = 244) of 3–5‐year‐olds completed questionnaires about their EE, feeding practices, their children's EE and temperament. Results showed that parental use of food to regulate children's emotions fully mediated the relationship between parent and child EE, and using food as a reward and restricting food for health reasons partially mediated this relationship. Analyses demonstrated that the mediated relationship between parent and child EE via use of food as a reward and restriction of food for health reasons varied as a function of child negative affect, where high child negative affect moderated these mediations. These findings suggest child EE may result from interrelationships between greater parent EE, use of food as a reward, restriction of food for health reasons and negative affective temperaments, but that greater use of food for emotion regulation may predict greater child EE irrespective of child temperament. Key messages: Child temperament moderates the significant mediating relationships between parent EE, certain parental feeding practices and child EE.Parental use of food as a reward significantly mediates the relationship between parent and child EE only for children who are medium or high in negative affect.Parental restriction of food for health reasons significantly mediates the relationship between parent and child EE only for children who are high in negative affect.In children who are low in negative affect, parental rewarding and restrictive feeding practices do not mediate the relationships between parent and child EE.Models of eating behaviour should consider how child characteristics can shape the expression and influence of behaviours that are known to place children at greater risk of obesogenic eating behaviours. [ABSTRACT FROM AUTHOR]

BACKGROUND: School‐based health centers (SBHCs) provide health care to vulnerable youth. The purpose of the study was to identify characteristics of youth who use SBHCs with the highest frequency to understand their health needs and receipt of health services. METHODS: This study examined cross‐sectional survey data from adolescents in 3 urban school districts (n = 2641) to identify the characteristics of youth who use SBHCs with high frequency (10+ visits). Analyses included calculations of simple frequencies and percentages, chi‐square tests of significance and multivariate regression. RESULTS: High‐frequency SBHC users were more likely to have seriously considered attempting suicide (adjusted odds ratio [AOR]: 3.2), be sexually active (AOR: 6.8), and have been victimized at school (AOR: 2.2) compared to their peers who did not use the SBHC. High‐frequency SBHC users were also significantly more likely than their peers to report "always" getting mental health (AOR: 7.0) and sexual health (AOR: 6.6) care when needed, and having talked with a health care provider about their moods/feelings (AOR: 3.1) and how school is going (AOR: 3.2) in the past year. CONCLUSIONS: These findings hold important relevance to demonstrating the value of SBHCs in increasing vulnerable youth's access to health care, particularly in urban settings. [ABSTRACT FROM AUTHOR]

Introduction: The increasing population of older adults and rapid increases in co‐morbidities globally has necessitated the need for a healthcare delivery system that meets the multifaceted needs of the growing population of older adults. Concurrent with these rising complex health needs is the importance of positive, non‐judgmental attitudes of health services providers towards older adults. Moreover, this is particularly important in the nursing profession, given nurses' significant and crucial roles in healthcare settings. Aim: The study aimed to evaluate nurses' attitudes towards older adults in a tertiary hospital in Ghana. Design: It employed a descriptive cross‐sectional quantitative design. Method: Data were collected from 160 registered adult medical and surgical ward nurses using the Ageism Attitude Scale (AAS). Results: Findings indicated that more than half of the participants had a diploma in general nursing. None of the nurses surveyed specialized in the care of older adults, and the mean age of participants was 30.14 (3.75) (minimum 24 and maximum 42 years). Female nurses had more positive attitudes than their male counterparts. Although the surveyed nurses reported a somewhat positive attitude towards older adults, there was no correlation between nurses' education levels and positive attitudes. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID‐19 outbreak in Spain. Design: A cross‐sectional study reported in line with the STROBE guidelines. Methods: Nursing students were invited to complete an online questionnaire at the end of the 2019–2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID‐19, habits and lifestyle using the World Health Organization Five Well‐Being Index (WHO‐5) and the Generalized Anxiety disorder‐7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, Results: The prevalence of low psychological well‐being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID‐19 and having been afraid of getting infected. Conclusions: The levels of anxiety due to the COVID‐19 pandemic in nursing students have been high, and levels of psychological well‐being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID‐19 or being afraid of getting infected are associated with the highest scores for anxiety. Relevance to clinical practice: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic. [ABSTRACT FROM AUTHOR]

Aims The Ethnic Minority Meta-Analysis ( EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs ( PWID) across various countries. This is the first report of the data. Methods Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities. Results Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106 715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [ OR = 2.09, 95% confidence interval ( CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR = 2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs- I2 = 75.3%: interquartile range = 1.38-3.56-and an approximate Gaussian distribution of the log ORs. Conclusions Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions. [ABSTRACT FROM AUTHOR]

Reactions to caregiving and depression affect a carer's ability to continue in their caring role. This paper examines the relationship between reactions to caregiving and depression in carers of frail, older people and is a cross-sectional study of carers of community-living people ( ≥70 years), identified as frail, who completed a postal questionnaire. Reactions to caregiving were evaluated using the Caregiver Reaction Assessment. Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale. Borderline depressive symptoms were reported in 15% of carers, and 10% had abnormal depressive symptoms. Anxiety symptoms in the carers were slightly higher at 24% and 12%, respectively. Multiple regression indicated that the impact on carers' daily schedules (β = 1.419, P = 0.001; β = 1.162, P = 0.025) and their health (β = 1.509, P = 0.007; β = 1.850, P = 0.006) as a result of caregiving explained 49% of the variance in carers' depressive symptoms (P < 0.001) and 42% of the variance in their anxiety symptoms (P < 0.001). Specific reactions to caregiving are important predictors of depressive and anxiety symptoms in carers of frail, older people. Regular carer support services and targeted health-care initiatives could alleviate or lessen negative reactions associated with caregiving, such as depression. [ABSTRACT FROM AUTHOR]

Background: Physical and emotional conditions of patients treated in an intensive care unit (ICU) may be adversely affected by environmental stressors. Aims and objectives: The aim of this study was to investigate the relationship between patients' anxiety and depression levels and environmental stressors in the ICU. Design: This was a descriptive cross‐sectional study. Methods: The study was conducted between June 2018 and April 2019 with 150 patients treated in the ICUs of a training and research hospital. Patient information form and ICU environmental stressors and hospital anxiety and depression scales were used for data collection. Descriptive statistics, t‐test, one‐way analysis of variance, and Pearson's correlation coefficient were used to evaluate the data. Results: The mean hospital anxiety score of the patients in ICUs was 11.1 ± 2.7, and 77.3% of patients were at risk for anxiety (10‐point cut‐off). The mean hospital depression score was 10.6 ± 3.3, and 94% of patients were at risk for depression (7‐point cut‐off). The mean score of environmental stressors was 123.9 ± 13.1. A moderate positive correlation between hospital anxiety and hospital depression (r =.63, P <.001) and a weak negative correlation between environmental stressors and hospital anxiety (r = −.24, P =.003) were found. However, no significant correlation between environmental stressors and hospital depression was found (r = −.13, P =.12). Conclusion: According to this study, the environmental stressors in the ICU were high, and the patients were at risk of anxiety and depression. The depression levels of the patients increased along with their anxiety levels. As environmental stressors increased, hospital anxiety levels of the patients decreased. However, there was no significant relationship between environmental stressors and patients' hospital depression levels. Relevance to clinical practice: Environmental stressors in ICUs are high, and the patients in the ICUs are at risk of anxiety and depression. [ABSTRACT FROM AUTHOR]

Objectives: To translate, cross‐cultural adapt and psychometrically validate the Children's Environmental Health Knowledge Questionnaire (ChEHK‐Q) and the Children's Environmental Health Skills Questionnaire (ChEHS‐Q) for community nurses in China. Design: This was an observational, cross‐sectional study undertaken in two phases: (1) translation and cultural adaptation process; (2) psychometric evaluation. Sample: A total of 294 nurses from 23 community health service centers in cities of Henan province participated in the study. Methods: These two questionnaires were analysed psychometrically based on IRT. ChEHK‐Q was analyzed based on basic Rasch Model, and ChEHS‐Q based on Rating Scale Model (RSM). EFA, expert validity, threshold analysis, retest reliability, item and individual reliability were used to evaluate the psychometric attributes of these two questionnaires. Results: The Infit and Outfit values for most items are within reasonable limits. The person reliability of ChEHK‐Q was 0.85 and the item reliability was 0.97. The person reliability of ChEHS‐Q was 0.94 and the item reliability was 0.93. The test‐retest reliability of the ChEHK‐Q was 0.85 and the ChEHS‐Q was 0.87. Conclusions: ChEHK‐Q and ChEHS‐Q are reliable and valid instruments with satisfactory psychometric properties for nurses in China. Future studies should recruit a more representative sample to verify the applicability of these two questionnaires. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between a number of prevalent foot problems in older people and their history of falls and quality of life. To examine the relationship between timed up and go (TUG) test time and ankle muscles' strength. Method: In this cross‐sectional observational study on a convenient sample of 350 people 65 years and older, direct logistic and hierarchical regressions were used to assess the relation of self‐reported falls and quality of life with hallux valgus, oedema, sensory loss and callus. The correlation coefficients were calculated to measure the relationship between TUG test time and ankle muscle strength. Results: Moderate negative correlations were measured between ankle muscles' strength and TUG time (rDorsiflexors = −0.42 p = 0.000, rPlantar flexors = −0.45 p = 0.000). The odds ratio extracted from logistic regression for foot pain was 3.05 (p = 0.000, 95% CI: 1.8–5.1). The results of the hierarchical regression showed that oedema had the highest contribution to depicting the quality of life (standardised B = −0.22, p = 0.001), followed by foot pain (beta = −0.178, p = 0.004) and plantar sensory loss (beta = −0.143, p = 0.019). Conclusion: The results of this study highlight the importance of foot problems in older people. Foot pain showed relationship with self‐reported fall experience. Oedema and foot pain had negative impact on quality of life. Ankle muscles' strength may affect balance in older people. However, because of the small effects sizes and wide confidence intervals, the results should be interpreted cautiously. [ABSTRACT FROM AUTHOR]

Aim: To assess whether expatriate‐specific factors were associated with nurses' overall job dissatisfaction after controlling for known factors. Background: Current evidence about job dissatisfaction among nurses in Saudi Arabia is not specific to expatriate nurses. Specific aspects such as job insecurity, fear of litigation, and language barriers have not been assessed in the context of job dissatisfaction. Introduction: The majority of nurses in the Arab Gulf countries are expatriate. The motive for employment here is purely financial because there is no path to permanent residency. Methods: This was a cross‐sectional electronic survey of 977 expatriate nurses in Al‐Qassim, Saudi Arabia. The survey included questions on demography, job dissatisfaction (overall and related to salary, workload, and teamwork), job characteristics, job duration as an expatriate, communication issues with patients and doctors, fear of litigation, and job insecurity. We used a hierarchical logistic regression to evaluate whether unique factors were associated with overall job dissatisfaction either as a group, or individually. Results: The mean age of the nurses was 32 years, and 19% reported overall job dissatisfaction. The unique expatriate factors as a group contributed significantly to the model. Job insecurity, patient communication problems, and shorter job duration were significantly associated with higher overall job dissatisfaction. Conclusions: Job insecurity, job duration, and patient communication were significant correlates of overall job dissatisfaction among expatriate nurses. Implications for nursing policy: A longer job contract and organizational initiatives to help new expatriate nurses acculturate will likely decrease feelings of job insecurity and increase job satisfaction. [ABSTRACT FROM AUTHOR]

Background: Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require. Methods: Data were collected using mixed methods in a cross‐sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open‐ended questions. Quantitative data acquired were analysed statistically, and responses to the open‐ended question were analysed using content analysis methodology. Results: Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self‐management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia. Conclusion: Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore the association between diabetes‐related distress as a dependent variable and fear of hypoglycaemia as a independent variable in Chinese individuals with type 2 diabetes, which can provide a basis for the development of effective nursing interventions. Design: A cross‐sectional descriptive study. Methods: Pre‐piloted scales were used to determine whether they experienced fear of hypoglycaemia and whether this impacted upon their management of the disease. From June–October 2019, participants were asked to complete the "hypoglycaemia fear survey" and "diabetes distress scales" to assess levels of fear and distress. Stepwise multivariate regression analysis was applied to reveal relationship between distress as a dependent variable and fear as a independent variable. Covariates included demographic, clinical or lifestyle factors. Results: A total of 258 participants were recruited for the survey, and they were characterized by little or no distress (39.53%), moderate distress (45.35%) and high distress (15.12%). The prevalence of moderate to severe distress in patients was 60.47%. Increased diabetes‐related distress was strongly correlated with increased fear of hypoglycaemia and closely associated with the scores of the worry and behaviour subscales. These results indicated that 62.3% of diabetes‐related distress may be explained by fear of hypoglycaemia. Conclusion: Increased diabetes‐related distress is associated with increased fear of hypoglycaemia in individuals with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Patients need medication and medical condition‐related information to better self‐manage their health. Health‐care professionals (HCPs) should be able to actively provide information outside of one‐on‐one consultations; however, patient consent may be required. Objective: To investigate the Australian public's preferences, and factors that may influence their preferences, towards an opt‐in versus an opt‐out approach to health communication. Design: A cross‐sectional study using a structured questionnaire administered via Computer‐Assisted Telephone Interviewing. Setting and participants: Participants across Australia who were adults, English‐speaking and had a long‐term medical condition. Main outcome measures: Preferences for opt‐in vs opt‐out approach to receiving follow‐up tailored information. Results: A total of 8683 calls were made to achieve the required sample size of 589 completed surveys. Many (346/589; 58.7%) indicated that they were interested in receiving tailored, ongoing follow‐up information from their HCP. Nearly half (n = 281; 47.7%) preferred an opt‐in service and 293/589 (49.7%) an opt‐out service for receiving follow‐up information. Reasons for preferring an opt‐in service were being in control of the information received (n = 254); able to make a decision that is best for them (n = 245); opt‐in service would save time for HCPs (n = 217); they may not want or need the information (n = 240). Many (n = 255) felt that an opt‐out service should be part of the normal duty of care of their HCP and believed (n = 267) that this approach would ensure that everyone has access to information. Conclusions: Respondents were interested in receiving tailored information outside of consultation times. However, preferences for an opt‐in or opt‐out approach were divided. [ABSTRACT FROM AUTHOR]

Objective: Examine secondary school students' knowledge and attitude about mental health, mental health problems, and interacting with people with mental health problems. Methods: A survey was carried out with 500 students in secondary schools in the northern area of Jordan. Results: A variance in knowledge and attitude was predicted by the regression model. Family income, having a family member with a mental disorder, and experience with people with mental health problems were the major predictors of knowledge about and attitude toward interacting with people with mental health problems. Conclusion: The results indicate that secondary school students have low knowledge about mental health problems and people with mental health problems. Moreover, they have a negative attitude toward interacting with people with mental health problems. Hence, there is a strong need to better educate young people about mental health and the diverse types of mental health problems that exist, as well as to help them to develop a more constructive and appropriate attitude. Implications for Practice: Improving the scope of the school curriculum on topics relating to people with mental health problems would help students to make more objective evaluations of people with mental health problems. [ABSTRACT FROM AUTHOR]

BACKGROUND: New Jersey (NJ) Safe Schools Program, primarily funded by the NJ Department of Education, has aims concerning safety and health including helping to alleviate harassment, intimidation, and bullying (HIB) in secondary school because HIB can affect learning. We evaluated officially reported adolescent HIB total incidents and estimated rates in NJ public city and county school districts for the 2011‐2016 school years. METHODS: A cross‐sectional observational study using population‐based state‐reported public data. We calculated point prevalence and incidence rates for K‐12 students in 22 public city school districts, students in 21 career‐technical‐vocational education (CTE) school districts, and 8 special services school districts during 2011‐2016. RESULTS: HIB is prevalent in NJ school classrooms. HIB comprised ≥75% of total officially reported in‐school violence‐related incidents in a given school year. Rates per 100 enrollees of total officially reported incidents for the 5‐year period of 2011‐2016 was highest in special services school districts (5.00; 95% confidence interval [CI]: 4.67, 5.34) followed by CTE districts (1.94; 95% CI: 1.86, 2.01), and lowest in city districts (1.46; 95% CI: 1.44, 1.48). The special services school district also had the highest rates per year and the 5‐year period. CONCLUSIONS: Data analyses suggested ideas for further research and improvements for school HIB incident reports. Policies and programs could remedy issues observed in state secondary school classrooms. Best practices within districts and schools can help protect students from HIB and promote safety, health, learning, and maturation. [ABSTRACT FROM AUTHOR]

Objectives: A reason for the lack of interest in physical fitness testing in mental healthcare is limited time among existing staff. This cross‐sectional study investigated the test–retest reliability of the 2‐min walk test (2MWT) and its concurrent validity with the 6‐min walk test (6MWT) in Ugandan patients with depression. We also explored practice effects and assessed the minimal detectable change (MDC) and clinical correlates with the 2MWT. Methods: This is a cross‐sectional study executed in Butabika National Referral Hospital in Kampala, Uganda. Fifty Ugandan patients with depression (15 women; median age = 29.0 years) performed twice a 2MWT, once a 6MWT, and completed the Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory‐18 (BSI‐18). Results: The median (interquartile) 2MWT score on the first and second test were 125.5 (59.2) meters and 131.0 (57.0) meters (p =.28). The intraclass correlation was.96 (95% confidence interval [0.94, 0.98]). The MDC was 23.5 m for men and 23.4 m for women. There was no evidence of a practice effect. Scores on BSI‐18 depression, SIMPAQ walking, and SIMPAQ incidental physical activity explained 66.3% of 2MWT score variance. Conclusion: The 2MWT is a reliable test, which can be conducted without any special equipment or substantial time demands, to provide a valid assessment of the functional exercise capacity in outpatients with depression. [ABSTRACT FROM AUTHOR]

Background/aim: Demand for occupational therapy graduates able to work in complex and diverse workplaces is increasing. The threshold concepts framework has emerged as one pathway to assist in the development of work‐ready graduates. A previous Australian study identified 10 threshold concepts for occupational therapy; the aim of this study was to explore the acquisition of these. Method: A mixed‐methods study using observational, cross sectional design and a triangulation design convergence model was undertaken. A survey using Likert scales and open response questions was developed by the authors. Seventy‐three surveys were completed by 13 first and 20 final year Victorian occupational therapy students. Twenty recent graduates and 20 experienced clinicians from across Australia also participated. Seven first and 10 final year occupational therapy students, 10 recent graduates and 10 experienced clinicians also took part in in‐depth interviews. Likert scales were used by participants to rate confidence that they had acquired the threshold concepts, they also answered open‐response questions (via survey or interview) asking them to provide examples of how they would use threshold concepts in practice. Results: Fourth year students were statistically significantly less confident than experienced clinicians for the threshold concepts Understanding the models and theories of occupational therapy and Applying clinical reasoning (P < 0.05). When whole group data were analysed, participants were most confident for Occupation and Client centred practice (P < 0.05). These results resonated with the qualitative findings which demonstrated a shift from surface to deep knowledge with increased experience. Fourth year students reported responses that suggested some threshold concepts were still in development, while experienced clinicians used a web of threshold concepts. Conclusion: This exploratory study provides provisional data to suggest that students appear to still be acquiring some threshold concepts at graduation and experienced clinicians make use of a web of threshold concepts in their clinical practice. [ABSTRACT FROM AUTHOR]

In Portugal, cardiovascular diseases stand out among the main causes of morbidity, disability, and mortality, with an expectation of growth up to the year 2025. A descriptive, exploratory study was carried out with patients in a cardiac rehabilitation program from an institution in the northern region of Portugal; 103 participants were randomly selected for the study. The data collection took place from February to April 2017. The majority of respondents presented a low level of literacy (inadequate and problematic). The profiles of the participants were characterized by the predominance of married males, with a mean age of 69 years. The participants considered doctors and nurses as the professionals who contribute the most to the increase of their health literacy. These health professionals have the opportunity and the responsibility to increase the health literacy levels of patients. It is known that low levels of health literacy are a problem throughout the European Union. Portugal's general population reflects this reality, and this study contributed to the conclusion that cardiac rehabilitation patients also present worrying levels of health literacy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the controlled direct effect (CDE) of common mental disorders (CMD) on xerostomia which is not mediated by psychoactive medication intake. Methods: A population‐based cross‐sectional study was conducted with 1720 individuals aged 20‐59 years from Florianópolis, Brazil, in 2009. A two‐stage cluster sample design was adopted, with a systematic selection of census tracts, followed by a random selection of households. All inhabitants of the selected households belonging to the age group of interest were considered eligible to participate. CMD were assessed using the Self‐Reporting Questionnaire (SRQ > 7). Xerostomia was the outcome assessed by asking: "How often do you feel dry mouth?" with responses "often" and "always" taken as indicating xerostomia. Psychoactive medication intake was set as the mediator. Confounding factors included sex, age, per capita family income, educational attainment and smoking status. Marginal structural models were performed to quantify the CDE of CMD on xerostomia. Missing data were handled by multiple imputation by chained equations, and sensitivity analysis for unmeasured confounding was carried out. Results: The overall prevalence of xerostomia was 8.8% and 15.3% of the individuals presented with CMD. After adjustment, the prevalence of xerostomia among individuals with CMD was 3.2 times higher than that among individuals without CMD (PR = 3.2 [95% CI: 2.3; 4.5]). The CDE of CMD on xerostomia which is not mediated by the medication intake resulted in a three times greater prevalence of xerostomia (PR = 3.0 95% CI: 2.0; 4.5) among those individuals with CMD. Conclusions: Common mental disorders is directly and negatively associated with xerostomia. Clinicians should bear in mind the emotional state when investigating the underlying factors and managing patients with xerostomia. [ABSTRACT FROM AUTHOR]

Aim: Obesity is an emerging public health problem, with its incidence on the rise. An abnormal metabolic profile is a risk factor for developing obesity. Dietary factors play a central role in the regulation of inflammation and obesity. The aim of the present study was to determine the prevalence of metabolically healthy obese and metabolically unhealthy obese (MUO) phenotypes, and their association with dietary inflammatory index (DII) among obese Iranian people. Methods: A cross‐sectional study was conducted from July to October 2017 among 300 obese participants in southern Tehran. DII scores were computed based on the overall inflammatory properties of 32 dietary components using dietary intake assessed by food frequency questionnaire. MUO phenotype was defined as having three or more of these metabolic abnormalities: high blood glucose, high triglycerides, low high‐density lipoprotein cholesterol, elevated blood pressure or abdominal obesity. The association was determined using logistic regression analysis. Results: The MUO phenotype (n = 176) was found in 63.5% of obese participants. Compared with participants in the first quartile, those in the fourth quartile of DII score (more pro‐inflammatory diet) had higher odds of MUO phenotype (odds ratio, OR: 2.58 (95% CI: 1.19–5.59), P = 0.04), and there was a significant association between the continuous form of DII score and the odds of MUO phenotype (OR: 1.18 (95% CI: 1.01–1.37)) after adjusting for potential confounders. Conclusions: Higher DII scores were positively associated with the MUO phenotype. A more pro‐inflammatory diet is a potential risk factor for MUO phenotype. [ABSTRACT FROM AUTHOR]

Background: Family violence (FV) is a prevalent health issue around the world and health care services have an important role in both recognizing and treating the consequences of violence. However, FV experiences among health care professionals themselves have not been investigated much. We also lack specific knowledge on the associations between FV and mental health. Aim: The purpose of the study was to investigate the prevalence and effects of FV in a sample of Finnish health care professionals. In addition to analysing direct connections between different types of FV and mental health, the mediating effect of sleep quality was also taken into account. Methods: The study followed a cross‐sectional design. The sample comprised 1952 health care professionals from Central Finland, who participated in a survey measuring their health and well‐being. The dependent variables were perceived sleep quality and mental health as measured by depressive symptoms and the mental health continuum short form (MHC‐SF) questionnaire. Data were analysed using cross‐tabulations, anova and structural equation modelling. Results: Thirty‐eight per cent of the participants reported experiencing FV. The most common forms of abuse were 'psychological FV only' and 'psychological & physical abuse'. Participants with FV experiences scored significantly worse on depressive symptoms (p < 0.001), MHC‐SF classification (p = 0.008), sleep quality (p = 0.001) and emotional (p < 0.001), social (p < 0.001), and psychological (p = 0.008) well‐being. The mediation analyses indicated that the harmfulness of FV was at least partially explained by impaired sleep quality. Conclusion: The results indicate that FV experiences are common among Finnish health care professionals and that they can significantly affect their mental health. FV should thus be taken to account in seeking to promote the occupational well‐being of health care professionals. The results also suggest that the harmfulness of FV might be mediated by sleep quality. This finding prompts the need for further investigation and FV‐related interventions. [ABSTRACT FROM AUTHOR]

Changes in UK psychiatric wards have been difficult to implement. Specific areas of nursing staff resistance remain unclear. Previous healthcare research suggests that burnout is common and that managers' regard changes more positively than direct care staff. We will therefore examine whether burnout and workforce characteristics influence psychiatric nurses' perceptions of barriers to change. Psychiatric nurses (N = 125) completed perceptions measures of 'barriers to change' (VOCALISE: subscales included 'powerlessness, confidence and demotivation'); and 'burnout' (Maslach Burnout Inventory: subscales included 'emotional exhaustion, personal accomplishment and depersonalization '). Staff characteristics, such as length of employment, occupational status, education, ethnicity, gender and age, were also collected. Correlations between these measures informed random‐effects regression models, which were conducted to predict the barriers to change score and to explore differential effects in the subscales of VOCALISE. Perceptions of barriers to change (VOCALISE) were correlated with burnout (r = 0.39), occupational status (r = −0.18) and age (r = 0.22). Burnout (Coef. β: 10.52; P > 0.001) and occupational status (Coef. β: −4.58; P = 0.05) predicted VOCALISE. Emotional exhaustion (Coef. β: 0.18; P < 0.001) and low personal accomplishment (Coef. β: 0.21; P = 0.001) predicted powerlessness. Emotional exhaustion predicted low motivation regarding changes (Coef. β: 0.11; P = 0.005). Low confidence predicted high levels of depersonalization (Coef β: 0.23; P = 0.01). Direct care staff expressed significantly more powerlessness (Coef. β: −2.60; P = 0.02) and significantly less confidence (Coef. β: −3.07; P = 0.002) than managers. For changes to be successful in psychiatric wards, burnout will need to be addressed. Future change strategies may consider involving direct care staff to improve perceptions of barriers to change. [ABSTRACT FROM AUTHOR]

Objective: To assess the factors influencing the attitudes of Bachelor of Science in Nursing students toward climate change and environmental sustainability and the inclusion of these concepts in the nursing curricula of four Arab countries. Method: A convenience sample of 1,059 students from four Arab countries was surveyed using the Environmental Sustainability Attitudes in Nursing Survey‐2 (SANS‐2) questionnaire in this descriptive‐comparative study. Results: The majority of the respondents exhibited positive attitudes toward the five items of SANS‐2, with "Environmental sustainability is an important issue for nursing" receiving the lowest mean score and "Issues about climate change should be included in the nursing curriculum" receiving the highest mean score. Saudi students had more positive attitudes toward environmental sustainability in health care compared with students from Iraq, Egypt, and the Palestinian Territories. Country of residence, type of community, and knowledge about environmental issues and their impact on health in any nursing course were significant factors that influenced attitudes toward environmental sustainability. Conclusion: The inclusion of climate change and environmental sustainability in nursing curricula in the Arab region was emphasized by the findings. Including environmental sustainability practices in nursing education will help student nurses develop critical thinking and skills in the adaptive delivery of health care, especially when resources are scarce. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: The purpose of this study was to determine whether there was an association between dietary patterns and children's academic performance. METHODS: This cross‐sectional study involved 315 children aged 9‐11 years from 26 schools in Australia. Academic performance was measured in 4 domains (reading, writing, numeracy, and language—subdomains: spelling, grammarm and punctuation) using the National Assessment Program in Literacy and Numeracy (NAPLAN). A self‐reported child questionnaire collected dietary intake data. “Core” (healthy) and “noncore” (unhealthy) dietary patterns were derived using principal components analysis. RESULTS: The noncore pattern was associated with lower NAPLAN scores across all academic domains (mean: −12.6, 95% CI: −18.7 to −6.4, r2 = .073, p < .001) except writing, while the core foods pattern was not associated with NAPLAN scores across all domains. When the noncore model was adjusted for sociodemographic covariates (child body mass index, ethnicity, sex, parental education, household income, marital status, mother's employment hours, and number of siblings), the association was attenuated but remained statistically significant (NAPLAN summary score: −8.5, 95% CI −15.0 to −1.9, r2 = .123, p = .011). CONCLUSIONS: Academic performance was deleteriously associated with a nutrient‐poor, energy‐dense diet, yet not associated with a nutritious diet. [ABSTRACT FROM AUTHOR]