Search

Background: Texture‐modified foods (TMF) is a common intervention for improving swallowing safety and efficiency for people with dysphagia. Non‐standardized texture classification (NSTC) of foods is used worldwide. However, as this study documents, it can introduce a lack of clarity and confusion over definitions that can potentially harm patients' safety. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework offers international terminology and standardized methods for texture testing that can address this issue Aims: To document differences between NSTC and standardized texture classification (STC) of the IDDSI, to document changes in the STC in the 30 min following meal delivery, and to explore the relationship between food intake and texture level. Methods & Procedures: In this observational study, data were collected from 24 long‐term care departments during five meals served to 624 residents, including at least one breakfast, lunch and dinner. To document differences between NSTC and STC, all NSTC food textures used in the LTC facilities were reclassified to match the IDDSI texture level at the time food left the kitchen (n = 1276). To document time‐related changes in texture, the STC texture as food left the kitchen was compared with texture 30 min later (n = 1276). Finally, to explore the relationship between texture and consumption, estimates were made of single‐item food consumption (n = 3820) using a subjective evaluation of consumption percentage Outcomes & Results: A total of 1276 food items were classified over the course of five meal services (with at least one each from breakfast, lunch and dinner). Statistically significant differences in NSTC and STC texture levels were found that revealed that residents were consuming food that was more difficult to eat than intended by the TMF prescription. In addition, significant changes in food texture were found over time, with texture levels significantly increasing 30 min after food left the kitchen. Finally, greater consumption was found for softer textures in comparison with regular foods; moreover, food consumption was greatest during breakfast and lowest during lunch. Conclusions & Implications: Residents requiring TMF received harder textures than intended which required complex swallowing ability, thus introducing a choking risk. Using the STC as proposed by the IDDSI could improve patient safety, oral intake and nutritional status. Time‐related changes should also be considered in circumstances where patients do not consume food soon after service. Lastly, reduced food consumption during lunch might negatively impact overall nutrient intake, particularly in cultures where lunch is the main meal of the day. What this paper adds: What is already known on the subject: Despite widespread agreement on the importance of STC, institutional care providers widely use NSTC. The IDDSI framework offers international terminology and standardized methods for texture testing. The clinical importance of using STC is not well understood. What this paper adds to existing knowledge: This study found that residents who required texture‐modified foods were eating food textures that were more challenging to swallow than intended. Differences were found in food texture between when it left the kitchen compared with texture 30 min later. Pureed texture had greater consumption than regular textured food. Food consumption was found to be the highest during breakfast, and reduced during lunch, which might negatively impact overall nutrient intake. What are the potential or actual clinical implications of this work?: Accurate food texture prescription is the first step towards increasing patients' safety. However, food preparation and handling are also very important steps, not to be disregarded. Time‐related changes in food texture are remarkable and should be considered in circumstances where patients do not consume food soon after service, as these can compromise patients' safety. [ABSTRACT FROM AUTHOR]

Introduction: Media comparison studies examining the effectiveness of immersive virtual reality in education have yielded inconclusive findings, leaving the question of its impact on learning compared to conventional media unanswered. To address this issue, our study employs a novel approach that combines media comparison with an investigation on the influence of broader educational context. Methods: In the experiment, 262 students from two distinct types of lower secondary schools—comprehensive school and multi‐year gymnasium (a selective academic school)—participated. The students received a lesson on topography and contour line interpretation, using either an immersive virtual environment or a PowerPoint slideshow. A transfer test was carried out before, immediately after, and 1 month after the lesson to measure knowledge application. Results: The impact of the media (immersive virtual reality vs. PowerPoint slideshow) on learning outcomes was found to be minimal, with no clear advantage of one over the other in any experimental condition. In contrast, a significant influence on learning gains was observed due to school type. Multi‐year gymnasium students consistently outperformed comprehensive school students in the pre‐test and demonstrated greater learning gains, regardless of the learning media. Conclusion: The present study employs an innovative approach by integrating a comparative analysis of different media types with an investigation into the impact of learner characteristics. By including students from distinct types of schools, the study provides insights into the differential effects of immersive virtual reality in varied educational contexts. Lay Description: What is already known about this topic: Media comparison studies typically assess the effectiveness of immersive virtual reality as a learning medium in comparison to other instructional methods in education.The findings of these studies differ markedly.Numerous factors impact learning outcomes in an immersive virtual environment. What this paper adds: Recommendation that research in the field should explore not only if but also when and how IVR learning is effective.Evidence that learning achievements may not be affected by the medium used.Evidence that the type of school can significantly influence learning gains.Evidence that cognitive dispositions, such as spatial abilities, can be another factor that influence learning outcomes. Implications for practice: A technology‐centred approach alone does not allow for a proper evaluation of the learning gain potential of IVR, learner characteristics and broader educational context should also be taken into account.IVR as a learning medium may not be appropriate for all students and every educational setting.To ensure reliable evaluation of learning gains, it is necessary to align the content and format of the intervention in both learning mediums as closely as possible.Measuring learning gains not only immediately after the intervention but also with a significant time delay can contribute to a more comprehensive understanding. [ABSTRACT FROM AUTHOR]

Background: Skill integration is vital in students' mastery development and is especially prominent in developing code tracing skills which are foundational to programming, an increasingly important area in the current STEM education. However, instructional design to support skill integration in learning technologies has been limited. Objectives: The current work presents the development and empirical evaluation of instructional design targeting students' difficulties in code tracing particularly in integrating component skills in the Trace Table Tutor (T3), an intelligent tutoring system. Methods: Beyond the instructional features of active learning, step‐level support, and individualized problem selection of intelligent tutoring systems (ITS), the instructional design of T3 (e.g., hints, problem types, problem selection) was optimized to target skill integration based on a domain model where integrative skills were represented as combinations of component skills. We conducted an experimental study in a university‐level introductory Python programming course and obtained three findings. Results and Conclusions: First, the instructional features of the ITS technology support effective learning of code tracing, as evidenced by significant learning gains (medium‐to‐large effect sizes). Second, performance data supports the existence of integrative skills beyond component skills. Third, an instructional design focused on integrative skills yields learning benefits beyond a design without such focus, such as improving performance efficiency (medium‐to‐large effect sizes). Major Takeaways: Our work demonstrates the value of designing for skill integration in learning technologies and the effectiveness of the ITS technology for computing education, as well as provides general implications for designing learning technologies to foster robust learning. Lay Description: What is currently known about the subject matter?: Skill integration is vital in students' mastery development, and is especially prominent in developing coding tracing skills.Coding tracing skills are foundational to programming, an increasingly important area in the current STEM education, yet many novice students struggle with code tracing.Instructional design to support skill integration in learning technologies has been limited.One of the most effective technologies for skill mastery, intelligent tutoring systems (ITS), is underused or only used in a partial form in programming education. What our paper adds to this?: We present the development and empirical evaluation of instructional design targeting students' difficulties in code tracing particularly in integrating component skills in an ITS, the Trace Table Tutor.The instructional features of the ITS technology (e.g., active learning, step‐level support, individualized problem selection) support effective learning of code tracing.Students' performance data supports the existence of integrative skills beyond component skills.An instructional design that provides deliberate practice and focused practice on integrative skills yields learning benefits beyond a design without such features. The implications of study findings for practitioners: Designing for skill integration is valuable and should receive more attention in designing learning technologies to foster robust learning.The instructional features of full‐scale ITSs are effective in supporting learning and merit further application in learning technologies in computing education. [ABSTRACT FROM AUTHOR]

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]

Online search involves multitasking and may demand better working‐memory capacities (WMC) and additional cognitive aids. Given the constraints of human cognition, we tested the effectiveness of note‐taking strategies on university students' online search performance. Also examined were the profile configurations of WMC tests in silence and in irrelevant speech as well as its interaction effects with note‐taking strategies on online search performance. Among the participants of 60 university students, we found a four‐group WMC profile composition that differed significantly across WMC scores in both silence and irrelevant speech. Results showed that WMC profiles, note‐taking groups and their interaction effect were significant factors on online search performance. Both Free Note and Matrix Note were beneficial for the students in low silent WMC profile groups. Study results have both theoretical and practical implications, advancing our understanding of the interrelationship of WMC under different conditions and informing instructional practice of online search performance. Lay Description: What is already known about this topicWorking memory capacity is fundamental to multitasking ability.Online search is a typical multitasking behavior that requires constant switching between different information sources.Students who take note perform better than those who do not while reading materials with seductive but irrelevant information.What this paper addsStudents working memory capacity is examined under silent and irrelevant speech conditions.Students exhibited different profile patterns in their working memory capacity under silent and irrelevant speech conditions.Taking note, either in matrix form or free form, can significantly improve students' online search performance for those with high WMC ONLY in irrelevant speech or for those with low WMC in both silent and irrelevant speech conditions.Implications for practiceNote‐taking as auxiliary support may facilitate students' integration and evaluation of the online information across multiple sources during their online search.Instructions on how to self‐construct matrix note are needed to help students develop advanced note‐taking skills for their learning involving online search. [ABSTRACT FROM AUTHOR]

Background Low levels of alcohol responses (low LRs) are genetically influenced phenotypes that are identified before alcohol dependence and predict future heavy drinking and alcohol problems. A recent paper described 13 LR-related blood oxygen level-dependent ( BOLD) response contrast patterns observed during an emotional face recognition task that might reflect cognitive processes contributing to LR and that might themselves predict adverse alcohol outcomes ( Paulus et al., Biol Psychiatry 2012; 72: 848). This paper evaluates the predictive implications of those functional magnetic resonance imaging (f MRI) patterns. Methods Of 120 subjects from Paulus and colleagues (2012), 114 (57 low and high LRs; ~50% females) were interviewed 5 years later at age 25. Correlations between baseline f MRI patterns and alcohol-related outcomes were evaluated, and regression analyses were used to determine if BOLD response contrasts incremented over LR in predicting outcomes. Results Baseline f MRI patterns in 5 of 13 baseline regions of interest correlated with adverse outcomes. Such patterns in insular regions, particularly the left anterior insula, and the right frontal gyrus, added to LR in predicting alcohol problems. The relationships remained robust when exact binomial procedures were used, but, reflecting the small sample size, it was not possible to adequately consider Bonferroni corrections. Conclusions The data suggest that f MRI BOLD response contrasts predicted heavier drinking and alcohol problems 5 years later, even after considering baseline low LRs. Future work will focus on whether f MRI results can predict outcomes in larger samples and among young nondrinkers, as well as how the imaging results increase understanding of the processes through which LR operates. [ABSTRACT FROM AUTHOR]

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self‐determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother–infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self‐efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post‐partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post‐partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self‐perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post‐partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post‐partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: −2.09; 95% CI: −2.88 to −1.31; p < 0.001), 6 weeks post‐partum (MD: −4.35; 95% CI: −5.20 to −3.49; p < 0.001) and 3 months (MD: −4.89; 95% CI: −5.70 to −4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post‐partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post‐partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post‐partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post‐partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post‐partum, the intervention group's infants showed slower weight (t = −0.90, p = 0.371) and length (t = −0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post‐partum, there was a significant difference in both weight (t = −3.46, p = 0.001) and length (t = −2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self‐confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow‐up in future research. Key messages: This study validated the application of responsive breastfeeding (RBF) intervention during the exclusive breastfeeding phase of Chinese infants.The RBF intervention may help to increase mothers' level of autonomous motivation for breastfeeding, enhance breastfeeding self‐efficacy and increase exclusive breastfeedingrates. The intervention had no significant effect on the weight and length of 6 week old infants but significantly impacted 3monthold infants, with slower growth observed in the intervention group compared to the control group.Future intervention programmes shouldinclude extended follow‐up periods to investigate the long‐term effects of RBF on infant growth and development. [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]

What is already known about this subject There is an association between adiposity levels and physical activity guidelines for adolescents., Achieving physical activity recommendations helps adolescents to prevent obesity status., What this study adds This paper presents an association between physical activity levels and obesity status., This paper supports physical activity recommendations to avoid children's obesity levels., This paper emphasizes vigorous physical activity for this matter., Background There is no information about physical activity (PA) recommendations to avoid children's obesity levels and how much of vigorous PA (VPA) is included into the '60 minutes of MVPA 5 days a week' recommendation for children. Objective The aim of this study was to examine the association between PA and adiposity in children and to examine whether the current PA guidelines are associated with a low risk of having excess of body fat in children, with special focus on sex differences, and PA intensity. Methods A sample of 439 Spanish children aged 8-10 years from the European Youth Heart Study participated in the study. The variables measured were anthropometric characteristics (height, weight, body mass index [ BMI], skin-folds and waist circumference) and PA was measured during 6 consecutive days using the GT1M accelerometer. Results Receiver operating characteristic analysis showed significant cut-off points associated with non-overweight: 45 min d−1 of VPA and 67 min d−1 of moderate-to-vigorous physical activity ( MVPA) (using BMI categories); and non-fat: 41 min d−1 of VPA and 67 min d−1 of MVPA (using percentage of body fat) and 38 min d−1 of VPA and 47 min d−1 of MVPA (using waist circumference categories) for boys. For girls, the optimal cut-offs of moderate-to-vigorous activity and MVPA associated with non-overweight were 24 and 57 min d−1, respectively ( BMI). Boys who did not meet 67 min in MVPA had an increased risk of being overweight + obese and overfat + obese (odds ratio [ OR] = 2.48, 95% confidence interval [ CI] = 1.36, 4.53, and OR = 2.56, 95% CI = 1.12, 5.82). Conclusions The findings support current PA recommendations (60 min d−1 of MVPA) to avoid excess of body fat in Spanish children. However, VPA appears to be an important component for the prevention of obesity, and our findings suggest that PA recommendations should specify the dose of VPA required for optimal health. Therefore, public health PA recommendations should incorporate specifically a greater dose of VPA into the total amount of MVPA in 8- to 10-year-old boys. [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 main aim of the Swedish physical activity and fitness cohort study ( SPAF-1958) was to describe physical fitness, physical activity, health, and lifestyle across part of the lifespan, and to assess the influences on these factors from the environment, personal factors, and genetics. There is inevitable dropout from longitudinal studies, and it may be systematic. The aim of this first paper of the second follow-up of SPAF-1958 was to provide a dropout analysis to consider to what extent the participants, at 52 years of age, remain a representative sample of the original adolescent study population. Additional aims were to provide an overview of the study protocol and the ongoing study population. Ongoing study participants in SPAF born in 1958 were, at the second follow-up at the age of 52, still representative of the study cohort in terms of sex, adolescent geographical area, upper secondary school program, adolescent body composition, muscular strength, and muscular endurance. However, a higher physical activity and, among women, a higher aerobic capacity in adolescence decreased the risk for dropout. It is important when interpreting results from longitudinal studies to adjust for the systematic dropout that could bias the conclusions drawn from the results. [ABSTRACT FROM AUTHOR]

Aim This study aimed to demonstrate how supervisors and students use their time during the three domains of nutrition and dietetic clinical placement and to what extent patient-care and non-patient activities change during placement compared with pre- and post-placement. Methods A cohort survey design was used with students from two Queensland universities, and their supervisors in 2010. Participants recorded their time use in either a paper-based or an electronic survey. Supervisors' and students' time use was calculated as independent daily means according to time-use categories reported over the length of the placement. Mean daily number of occasions of service, length of occasions of service, project activities and other time use in minutes was reported as productivity output indicators and the data imputed. A linear mixed modelling approach was used to describe the relationship between the stage of placement and time use in minutes. Results Combined students' (n = 21) and supervisors' (n = 29) time use as occasions of service or length of occasions of service in patient-care activities were significantly different pre, during and post placement. On project-based placements in food-service management and community public health nutrition, supervisors' project activity time significantly decreased during placements with students undertaking more time in project activities. Conclusions This study showed students do not reduce occasions of service in patient care, and they enhance project activities in food service and community public health nutrition while on placement. A larger study is required to confirm these results. [ABSTRACT FROM AUTHOR]

Background/aim Engagement in desired occupations can promote health and wellbeing in older adults. Assessments of engagement often measure frequency, amount or importance of specific activities. This study aimed to develop a scale to measure older adults' evaluation of the extent to which their everyday activities are contributing to their health and wellness. Methods Eighteen items, each scored with a seven-point rating scale, were initially developed by content experts, covering perceptions of how daily activities contribute to physical and mental health, as well as satisfaction and activity participation in the last six months. Rasch analysis methods were used to refine the scale using the pencil and paper responses of 460 community-living older adults. Results Initial Rasch analysis indicated three unlabelled rating scale categories were seldom used, reducing measurement precision. Five items were conceptually different by misfit statistics and principal component analysis. Subsequently, those items were removed and the number of rating scale steps reduced to 4. The remaining 13-item, 4-step scale, termed the Activity Significance Personal Evaluation ( ASPEn), formed a unidimensional hierarchy with good fit statistics and targeting. Person separation reliability (2.7) and internal consistency (.91) indicated the tool is appropriate for individual person measurement. Relative validity indicated equivalence between Rasch measures and total raw scores. Conclusions ASPEn is a brief, easily administered assessment of older adults' perception of the contribution of everyday activities to personal health and wellness. ASPEn may facilitate occupational therapy practice by enabling clinicians to assess change in meaning of an older adult's activity over time. [ABSTRACT FROM AUTHOR]

Aim Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. Methods Data of the I- Lan Longitudinal Aging Study ( ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. Results Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m2 for men and 5.9 kg/m2 for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. Conclusions The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36-45. [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]

Purpose With its population rapidly aging, China needs prompt action to facilitate the middle-aged and senior citizens' utilization of health care. The New Rural Cooperative Medical Scheme (NCMS), a health care reform initiative started in 2003, is currently China's primary insurance program for the rural population. Methods With a 2-province pilot sample (Gansu, the poorest province, and Zhejiang, one of the richest) of people over age 45 from the China Health and Retirement Longitudinal Study (CHARLS), this paper used logistic regressions to examine the association between the coverage of New Rural Cooperative Medical Scheme and the underutilization of medical care. Findings Among those who had a need to visit a health care provider during the previous month, people covered by NCMS were more likely to underutilize outpatient care than the uninsured (Odds Ratio = 5.610, 2.035-15.466). As for those who had a need to be hospitalized in the past year, the association between NCMS coverage and the underutilization of inpatient care was not statistically significant (Odds Ratio = 1.907, 0.335-10.862). Low total household expenditure per capita, living in the inland province of Gansu, and being an urban resident were also associated with underutilizing outpatient care. Conclusion Further research is needed to understand the negative association between NCMS coverage and outpatient care utilization. [ABSTRACT FROM AUTHOR]

The objective of the paper is to explore bottom-up auditory and top-down cognitive processing abilities as part of long-term outcome assessment of preterm birth. Fifty-five adolescents (age 13-15) born with very low birth weight ( VLBW) were compared to 80 matched controls born to term, using three consonant-vowel dichotic listening ( DL) instruction conditions (non-forced, forced-right and forced-left). DL scores were correlated with cortical gray matter thickness derived from T1-weighted structural MRI volumes using FreeSurfer to examine group differences also in the neural correlates of higher cognitive processes. While showing normal bottom-up processing, VLBW adolescents displayed impaired top-down controlled conflict processing related to significant cortical thickness differences in left superior temporal gryus and anterior cingulate cortex. Preterm birth with VLBW induces fundamental changes in brain function and structure posing a risk for long-term neurocognitive impairments. Deficits emerge in situations of increasing cognitive conflict and can be related to measures of executive functions as well as morphology. [ABSTRACT FROM AUTHOR]

The aim of this paper was to investigate whether psychosocial functioning in adulthood (e.g., friends support, cohabitation, community connectedness and work satisfaction) could be predicted by mental health, subjective well-being, social relations and behavior problems in adolescence, and whether gender was a moderator in these associations. Data were obtained from a major population-based Norwegian study, the Nord-Trøndelag Health Study ( HUNT), in which 517 men and 819 women completed an extensive self-report questionnaires at baseline (mean age 14.4 years) and at follow-up (mean age 26.9 years). Community connectedness as well as work satisfaction were predicted by subjective well-being. Cohabitation was predicted by male gender and frequency of meeting friends in adolescence, and friends support was predicted by frequency of meeting friends. Gender had a minor effect as a moderator. Frequency of meeting friends and subjective well-being seemed to be the strongest adolescent predictors of psychosocial functioning in young adulthood. These findings may have implications both for prevention and intervention in adolescence, as well as for future research. [ABSTRACT FROM AUTHOR]

Aims This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy ( MMT) clinics in China. The intervention effects on both service providers and clients are reported. Design The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Settings Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. Participants A total of 41 providers and 179 clients were sampled from the six clinics. Measurements At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Findings Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. Conclusions The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers. [ABSTRACT FROM AUTHOR]

Background: There have been limited trend studies examining variations on the patterns of alcohol consumption among Whites, Blacks, and Hispanics in the United States. The current paper reports national trends in drinking patterns, volume of drinking (number of drinks per month), binge drinking, and drinking to intoxication among Blacks, Whites, and Hispanics over a period of 10 years and identifies sociodemographic predictors of these behaviors across the 3 ethnic groups. Methods: Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results: Trends varied across different dimensions of drinking and ethnic groups. There were no statistically significant differences in the mean number of drinks consumed per month among men and women in any of the 3 ethnic groups between 1992 and 2002, but there was a significant rise in the proportion of current drinkers in both genders and in all 3 ethnic groups. Multivariate analysis indicated that, compared to Whites in 1992, Blacks and Hispanics did not increase their volume of drinking, but Whites did. Drinking 5 or more drinks in day at all did not increase between 1992 and 2002, but drinking 5 or more drinks at least once a month was more likely for all groups in 2002 compared to Whites in 1992. Drinking to intoxication at all was more likely among Whites in 2002 than 1992, but drinking to intoxication at least once a month was more likely among Whites and Blacks in 2002 than 1992. Conclusion: The only common trend between 1992 and 2002 across both genders and 3 ethnic groups was a rise in the proportion of drinkers. There was also a rise in drinking 5 or more drinks in a day (Whites, Blacks, and Hispanics) and drinking to intoxication (Whites and Blacks), but this was limited to those reporting such drinking at least once a month. The reasons for these changes are many and may involve complex sociodemographic changes in the population. It is important for the field to closely monitor these cross-ethnic trends in alcohol consumption. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to examine the relationship between patient satisfaction and triage nursing care in order to assist nurses in defining more clearly their roles, and ultimately to improve the quality of care delivered to emergency patients. BACKGROUND: Patient satisfaction is considered an important indicator of quality care from the perspective of the consumer and has been widely studied in many settings. However, few studies have examined patient satisfaction with emergency nursing services in the particular area of triage. METHODS: A descriptive, correlational study was conducted in 2001 in one urban acute hospital in Hong Kong using Consumer Emergency Care Satisfaction Scale (CECSS), and patient and nurse demographic data were also collected. Following a power calculation, systematic sampling was carried out, and the final sample consisted of 56 urgent, semi-urgent and non-urgent patients triaged. The response rate was 61%. RESULTS: The majority of the participants were satisfied with their triage nursing care and teaching. However, difficulties were encountered during the data collection process, resulting in a relatively low response rate. Correlational analyses revealed that patient satisfaction with triage nursing care was statistically significantly correlated with age and the type of nursing intervention received. Older people were more satisfied with the teaching offered by triage nurses and patients who had received specific nursing interventions gave more positive ratings on the teaching subscale of the CECSS. There were no statistically significant relationships between patient satisfaction with triage nursing care and nurse characteristics, including gender, work experiences and educational level. CONCLUSIONS: Patients were generally satisfied with the care provided by the triage nurses. Measuring patient satisfaction with triage nursing care remains a major challenge for health care providers in emergency care settings. [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]

This study was designed to determine the effects of bladder training and Kegel exercises on urinary symptoms and the quality of life in female patients with multiple sclerosis. A pretest‐posttest quasi‐experimental study was conducted. The study was composed of 37 participants from two different hospitals in Turkey. The data collection tools included a Patient Information Form, Expanded Disability Status Scale, Multiple Sclerosis Quality of Life Scale‐54, King's Health Questionnaire, and a bladder diary. Participants were followed through phone consultation seven times during a 3 month period. The participants showed a significant improvement in both the physical and mental health of their quality of life scores compared to the baseline regarding the King's Health Questionnaire Scale, there was an increase in patients' general health perception compared to the baseline. There was reduction in the frequency, nocturia, urgency, and urinary incontinence compared to the baseline at much level of symptoms odds. In this sample, bladder training and Kegel exercises improved quality of life in female patients with MS. These techniques increased the patients'general health perception of their urinary symptoms. [ABSTRACT FROM AUTHOR]

Vegan dietary patterns are increasingly being adopted by endurance athletes, yet research examining the influence of this dietary pattern on exercise‐related physiology is limited. This pilot study, therefore, aimed to explore nutrient status, diet quality and cardiovascular and inflammatory responses in aerobically trained adult males following vegan and omnivorous dietary patterns during aerobic exercise. An incremental ramp running test was used to assess peak oxygen consumption (VO2peak) in males aged 18–55 years, engaging in >4 h training/week. Exercise testing was performed during walking and steady‐state running conditions (60% and 90% of VO2peak). Participants were grouped by dietary pattern type and were equivalent for age, training volume and VO2peak. When compared to the omnivorous group (n = 8, age 35.6 years, VO2peak 55.7 mL/kg/min), the vegan group (n = 12, age 33.4 years, VO2peak 56.4 m/kg/min) consumed more energy from carbohydrates (p = 0.007), and less energy from protein (p = 0.001) while exhibiting a higher overall diet quality score (p = 0.008). No differences in inflammatory biomarkers were observed before or after running. Total red blood cell count, haemoglobin and haematocrit levels were lower in the vegan dietary group. In summary, aerobically trained males, following a long‐term vegan diet, can tolerate a short bout of running broadly comparatively to their omnivore counterparts. More arduous endurance exercise conditions should be explored to further uncover potential outcomes of consuming a vegan dietary pattern and exercise‐related physiology. [ABSTRACT FROM AUTHOR]

Background: Internationally, placental growth factor (PlGF)‐based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF‐based tests in New Zealand (NZ). Aims: To investigate the predictive value of soluble fms‐like tyrosine kinase 1 (sFlt‐1)/PlGF ratio in suspected preeclampsia in a NZ population. Materials and Methods: A prospective cohort study of singleton pregnancies at 20+0–36+6 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria. Primary objective: to evaluate a sFlt‐1/PlGF ratio >38 at ≤35+0 weeks gestation to predict birth ≤14 days. Secondary objectives: to assess a sFlt‐1/PlGF ratio cut‐off of 38 at ≤37+0 weeks gestation, to rule out preeclampsia ≤1 week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt‐1/PlGF ratio results. Results: Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt‐1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6–63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4–98.1), median (interquartile range) days to birth 14 (2–27) vs 49 (33–70), P < 0.000. A sFlt‐1/PlGF cut‐off of 38 ruled out preeclampsia ≤1 week (NPV 96.2% (95% CI, 92.3–98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0–82.9)). A sFlt‐1/PlGF >38 was associated with greater perinatal morbidity. Conclusions: The predictive value of the sFlt‐1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt‐1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Upper limb activity measures for children with cerebral palsy have a number of limitations, for example, lack of validity and poor responsiveness. To overcome these limitations, we developed the Children's Arm Rehabilitation Measure (ChARM), a parent‐reported questionnaire validated for children with cerebral palsy aged 5–16 years. This paper describes both the development of the ChARM items and response categories and its psychometric testing and further refinement using the Rasch measurement model. Methods: To generate valid items for the ChARM, we collected goals of therapy specifically developed by therapists, children with cerebral palsy, and their parents for improving activity limitation of the upper limb. The activities, which were the focus of these goals, formed the basis for the items. Therapists typically break an activity into natural stages for the purpose of improving activity performance, and these natural orders of achievement formed each item's response options. Items underwent face validity testing with health care professionals, parents of children with cerebral palsy, academics, and lay persons. A Rasch analysis was performed on ChARM questionnaires completed by the parents of 170 children with cerebral palsy from 12 hospital paediatric services. The ChARM was amended, and the procedure repeated on 148 ChARMs (from children's mean age: 10 years and 1 month; range: 4 years and 8 months to 16 years and 11 months; 85 males; Manual Ability Classification System Levels I = 9, II = 26, III = 48, IV = 45, and V = 18). Results: The final 19‐item unidimensional questionnaire displayed fit to the Rasch model (chi‐square p = .18), excellent reliability (person separation index = 0.95, α = 0.95), and no floor or ceiling effects. Items showed no response bias for gender, distribution of impairment, age, or learning disability. Discussion: The ChARM is a psychometrically sound measure of upper limb activity validated for children with cerebral palsy aged 5–16 years. The ChARM is freely available for use to clinicians and nonprofit organisations. [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]

In this series we address key topics for clinicians who conduct research as part of their work in the ED. In this section we will address important statistical concepts for clinical researchers and readers of clinical research publications. We use practical clinical examples of how to describe clinical data for presentation and publication, and explain key statistical concepts and tests clinical researchers will likely use for the majority of ED datasets. [ABSTRACT FROM AUTHOR]

Aim: We compared Japan nurse practitioner‐led care and physician trainee‐led care in terms of patients' length of stay in a secondary emergency department in Japan. Methods: This was a retrospective observational study, utilizing medical records. Participants (n = 1419; mean age = 63.9 ± 23.4 years; 52.3% men) were patients transferred to the emergency department by ambulance between April 2016 and March 2018 in western Tokyo. Multiple linear regression analyses were performed, with length of stay as the dependent variable and factors related to the length of stay, including medical care leaders, as the independent variable. Results: Approximately half of the patients (n = 763; 53.8%) received Japan nurse practitioner‐led care. Patients' length of stay was significantly shorter, by 6 min, in the Japan nurse practitioner‐led care group, compared with the physician trainee‐led care group (unstandardized coefficient: −6.81; 95% confidence interval: −13.35 to −0.26; p < 0.05). Conclusion: Patients' shorter length of stay in the Japan nurse practitioner group, compared with the physician trainee group, suggests that Japan nurse practitioners are not inferior to physician trainees in terms of the time spent to manage patients. [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]

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]

Introduction: Although circumstantial evidence suggests children with tic disorders (TD) experience challenges in handwriting which may be attributed to their tics, few studies have systematically investigated handwriting performance among children with TD. This study examined the relationship between handwriting deficits and TD using a causal comparative research design. Methods: Thirty‐four children with TD completed the Test of Handwriting Skills‐Revised (THS‐R). The overall percentile ranks of the THS‐R were analysed to determine if children with TD have lower scores compared to the test's normative values. Writing speed, letter reversals, touching letters and case errors were also evaluated. Results: Data revealed the median percentile rank of the THS‐R for the participants was significantly lower than the median percentile score of the THS‐R for the normative sample. Close to 80% (n = 27) of writing samples were scored below 50th percentile. More than one‐third (35.3%, n = 12) of the writing samples were scored greater than one standard deviation below the normative mean on the THS‐R. Of the four ancillary scores, 82.4% (n = 28) of the participants' writing samples scored below 50th percentile (in the categories of watch or test further) on case errors and 67.6% (n = 23) scored below 50th percentile on writing speed. Conclusion: Findings suggested that children with TD took longer to complete the writing task, and committed more case substitution errors than the normative sample of the THS‐R and were likely to exhibit handwriting deficits. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) causes high rates of hospital admissions. It is known that disease progression impacts the health‐related quality of life (HRQoL) of both patients and caregivers, yet to date, this finding is based on cross‐sectional studies with limited samples. Objectives: The study aim is to analyze the relationship between HF patients' use of hospital services (a proxy for disease progression) and the HRQoL of their family caregivers. Methods: This work is a multicenter nested case‐control study on a population of patients admitted to hospitals in southern Spain due to heart failure. The sample comprised 530 patient‐caregiver dyads. Hospital admission data were retrospectively collected for the 5 years prior to inclusion in the study. Bivariate analyses and multivariate logistic regression were used to determine associations between patient deterioration and caregivers' quality of life. Results: Patients' use of hospital services was associated with worsened quality of life for family caregivers, with an overall OR of 1.48 (95% CI: 1.23‐1.79). A positive correlation was found between patients' perceptions of their physical health and the perceived mental health of caregivers (r = 0.127, p = 0.004) and between the perceived mental health of both (r = 0.291; p <0.0001). Conclusions: Greater use of hospital services by patients with HF is an independent predictor of deterioration of family caregivers' HRQoL. The physical and mental components of patients' and their family caregivers' HRQoL interact and influence each other. Additional factors, such as the nature and intensity of care provided, also determine the worsening of a family caregiver's HRQoL. Clinical Relevance: These results can be used to identify family caregivers of people with heart failure at risk of suffering a deterioration in their health‐related quality of life. Increased use of hospital services is an independent predictor of the deterioration of the family caregivers' health‐related quality of life. Since clinical nurses are the main provider who gives support and education to family caregivers, they should be alert to this situation and individualize interventions to prevent this deterioration. [ABSTRACT FROM AUTHOR]

Background: The Acute Physiology and Chronic Health Evaluation (APACHE) II is still commonly used as an index of illness severity in patients admitted to intensive care unit (ICU) and has been validated for many research and clinical audit purposes. Aims and objectives: To investigate the diagnostic value of the APACHE II score for predicting mortality rate of critically ill patients. Design This was a single‐centre, retrospective study of 200 Iranian patients admitted in the medical–surgical adult ICU from June 2012 to May 2013. Methods: Demographic data, pre‐existing comorbidities and variables required for calculating the APACHE II score were recorded. Receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curves was calculated to assess the predictive value of the APACHE II score. Results: Of the 200 patients with a mean age of 55·27 ± 21·59 years enrolled in the study, 112 (54%) were admitted in the medical ICU and 88 (46%) in the surgical ICU. Finally, 116 patients (58%) died, and 84 patients (42%) survived. The overall actual and predicted ICU mortality were 58% and 25·16%, respectively. The mean APACHE II score was 16·31 in total patients, 17·78 in medical ICU and 14·45 in surgical ICU patients (P = 0·003). Overall, the APACHE II score had the highest prognostic value for predicting the mortality rate of critically ill patients with an area under the cure of 0·88, and with a cut‐off value of 15, the APACHE II score predicted mortality of patients with a sensitivity of 85·3%, a specificity of 77·4%, a positive predictive value of 83·9% and a negative predictive value of 73·9%. Conclusion: This study shows that an APACHE II score of 15 provides the best diagnostic accuracy to predict mortality of critically ill patients. Our observed mortality rate was greater than the predicted death rate, in comparison to the other prestigious centres in the world. Therefore, it appears that we must improve our intensive care to reduce mortality. Relevance to clinical practice: There is a need to create a suitable scoring system to predict the mortality rate of critically ill patients in accordance with the advanced technological equipment and experienced physicians and nurses in that ICU. [ABSTRACT FROM AUTHOR]

Background: The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants' perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. Methods: A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89‐question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7‐point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free‐text open‐response items. Results: From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6‐week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87‐3.39]), quality care (2.94 [2.28‐3.79]), and feeling actively involved in decision‐making (3.21 [2.35‐4.37]). Conclusions: Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk. [ABSTRACT FROM AUTHOR]

Objectives: To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti‐Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects. Methods: Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use). Results: Sixty‐six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1‐T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0‐T2) was −9.82 (SD = 9.27; 95% CI −5.48 to 14.16; P = 0.000), −19.31 (SD = 11.33; 95% CI −14.15 to −24.47; P = 0.000) and −21.13 (SD = 12.56; 95% CI −15.70 to −26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106). Conclusions: Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX. [ABSTRACT FROM AUTHOR]

Background: Communication impairments are common and pervasive for people a long time following acquired brain injury (ABI). These impairments have a significant impact on a person's quality of life (QOL) post‐injury. Project‐based treatment is a treatment approach that could have an impact on communication skills and QOL for people with ABI a long‐term post‐injury. This treatment is embedded in a context of meaningful activities chosen by people with ABI, whereby, as a group, they work collaboratively to achieve a tangible end product. Aims: To evaluate the feasibility and initial efficacy of project‐based treatment on improving the communication skills and QOL for people with ABI. Methods & Procedures: An exploratory controlled trial with alternate allocation of groups, and follow‐up at 6–8 weeks, was completed. Twenty‐one people with chronic ABI were recruited in groups of two to three from community settings, allocated to either a TREATMENT (n = 11) or WAITLIST group (n = 10). Participants attended a 20‐h group‐based treatment over 6 weeks where they worked towards achieving a project that helped others. To determine feasibility, four criteria were used: demand, implementation, practicality and acceptability. A range of communication and QOL outcomes was used to determine a fifth feasibility criterion, initial efficacy. Some of these criteria were additionally used to evaluate the feasibility of the outcomes. Outcomes & Results: All participants received the treatment as allocated with high attendance and no dropouts. The treatment was feasible to deliver as intended and was highly acceptable to participants. Medium and large effect sizes were found from pre‐ to post‐treatment, and from pre‐treatment to follow‐up for measures of conversation, perceived communicative ability and QOL. Conclusions & Implications: Project‐based treatment is feasible with indications of initial efficacy for both communication skills and QOL. The treatment provides a promising new approach for improving communication skills and QOL in people with chronic acquired brain injuries in the community setting. [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]

Aim: The psychological construct of ‘therapeutic alliance’ can be used to better understand the effectiveness of consultations, particularly goal setting for weight management. We analysed audio‐recorded health coaching sessions during a weight loss trial to explore relationships between therapeutic alliance and various contextual factors. Methods: Audio recordings of 50 health coaching sessions were analysed. After assessing fidelity to the protocol, therapeutic alliance was measured using an adapted Working Alliance Inventory Observer‐rated Short Version (WAI‐O‐S), and examined by (i) identifying relationships between contextual factors and WAI‐O‐S scores (Spearman's coefficients); (ii) testing the impact of preparatory exercises and body mass index on WAI‐O‐S scores (one‐way analysis of variance and least‐squared differences tests) and (iii) comparing differences in WAI‐O‐S scores based on relationship status, gender and follow‐up session completion (independent samples t‐tests). Results: Fidelity was high (mean 88%). WAI‐O‐S total scores ranged from 55 to 70 (out of 84). Session duration was significantly correlated with WAI‐O‐S component of ‘Bond’ (r = 0.42, P = 0.002). Those who completed preparatory exercises had significantly higher total WAI‐O‐S scores, ‘Goal’ and ‘Task’ scores. Participants who completed the follow‐up session scored significantly higher for ‘Goal’ compared to no follow‐up. Conclusions: Spending more time in a session appears related to increased bonding, a key component of therapeutic alliance. Preparatory work may help build therapeutic alliance and agreement on goals appears to influence follow‐up completion. These exploratory findings provide directions for research addressing the professional relationship in dietetic consultations for weight loss. [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]

Abstract: Background: As allied health professions change over time to keep up with and reflect a rapidly changing society, it is quite possible that the people attracted to the profession may also change. If this is the case, then knowing this could be critical for future workforce marketing, training and planning. Aims: The aim was to investigate whether the personality of students entering a speech‐language pathology (SLP) program had changed over time and whether there were generational differences in personality. Methods & Procedures: The study used the Big Five personality inventory to consider whether there were differences in the personality in speech–language pathology (SLP) students enrolled in the same regional university in Australia in 2005 and 2016. Outcomes & Results: The results showed there were significant differences between the two groups on the Agreeableness and Extroversion scales. The students who were more Conscientious were also more Confident in their ability to perform as an SLP. Generational differences across the two cohorts were also considered. Conclusions & Implications: SLP is a dynamic profession that is reflected through an evolving scope of practice, increasing utilization of technology and specialization. As careers evolve it is logical that the people attracted to those careers may also shift; as demonstrated here via changes in the personality of SLP students. Understanding the personality of current SLP students and future Generation Z students may assist universities to identify specific skills and experiences students need to be successful in the workforce. [ABSTRACT FROM AUTHOR]

Abstract: Physical health problems and unhealthy lifestyle behaviours are common in people with severe mental illness (SMI), leading to high levels of mortality.There is some evidence that nurse‐led interventions involving comprehensive health checks may be effective in improving physical health in people with SMI. This quasi‐experimental before‐and‐after study investigated the impacts of the Thai Health Improvement Profile (HIP‐T) on the physical health and health behaviours of people with schizophrenia over 1‐year. All 105 service‐users who volunteered to participate completed the study. There were significant reductions in mean BMI (−0.78 kg/m2, P < .001) and bodyweight (−1.13 kg, P < .001) at post‐test. There was also a significant decrease in the total number of “red‐flagged” HIP‐T items, suggesting lowered potential health risks (P < .001). Overall, 23 patients (22%) were found to have moved to a healthier BMI classification after 1‐year. The findings suggest that the HIP‐T intervention has potential for improving the physical health of people with SMI when integrated into routine community mental health care. [ABSTRACT FROM AUTHOR]

Objectives Lung ultrasound detection of B-lines has become a simple, semiquantitative, noninvasive tool for evaluating pulmonary congestion in heart failure (HF) patients. This study compared the correlation of B-lines with E/eʹ, NT-proBNP, and ejection fraction (EF) in acute decompensated heart failure (ADHF). Methods Eighty-two consecutive patients who were diagnosed with acute decompensated HF were divided into two groups: preserved ejection fraction heart failure (HFpEF, EF≥50%, n=32) and reduced ejection fraction heart failure (HFrEF, EF<50%, n=50). Spearman's correlation was used to evaluate associations of B-lines with E/eʹ, NT-proBNP, and EF in the two groups. Receiver operating characteristic (ROC) analysis was performed to compare B-lines with the E/eʹ ratio. Results Results revealed no significant differences were observed in the B-lines between the HFpEF and HFrEF groups. However, compared with the control group, B-lines were significantly increased in the HFpEF and HFrEF groups ( P<.05). The B-lines were positively correlated with E/eʹ (r=0.742, r=0.52) and NT-proBNP (r=0.678, r=0.417) but were negatively correlated with EF (r=−0.365, r=−0.337), and the correlation coefficients were higher in the HFpEF group than in the HFrEF group. In ROC analyses, considering E/eʹ ≥14 as a reference, B-lines yielded a C-statistic value of 0.94 (sensitivity 92%, specificity 83%) in the HFpEF group and 0.84 (sensitivity 86%, specificity 78%) in the HFrEF group. Conclusions B-lines were significantly correlated with the more established parameters of ADHF. The correlation between B-lines and E/eʹ was better, especially in the HFpEF group. [ABSTRACT FROM AUTHOR]

Aim The present study developed and evaluated a patient-centred, patient-directed, group-based education program for the management of type 2 diabetes mellitus. Methods Two frameworks, the Medical Research Council (MRC) framework for developing and evaluating complex interventions and the RE-AIM framework were followed. Data to develop the intervention were sourced from scoping of the literature and formative evaluation. Program evaluation comprised analysis of primary recruitment of participants through general practitioners, baseline and end-point measures of anthropometry, four validated questionnaires, contemporaneous facilitator notes and telephone interviews with participants. Results A total of 16 participants enrolled in the intervention. Post-intervention results were obtained from 13 participants, with an estimated mean change from baseline in weight of −0.72 kg (95% CI −1.44 to −0.01), body mass index of −0.25 kg/m2 (95% CI −0.49 to −0.01) and waist circumference of −1.04 cm (95% CI −4.52 to 2.44). The group education program was acceptable to participants. The results suggest that recruitment through general practitioners is ineffective, and alternative recruitment strategies are required. Conclusions This patient-centred, patient-directed, group-based intervention for the management of type 2 diabetes mellitus was both feasible and acceptable to patients. Health professionals should consider the combined use of the MRC and RE-AIM frameworks in the development of interventions to ensure a rigorous design process and to enable the evaluation of all phases of the intervention, which will facilitate translation to other settings. Further research with a larger sample trialling additional recruitment strategies, evaluating further measures of effectiveness and utilising lengthier follow-up periods is required. [ABSTRACT FROM AUTHOR]

Aim To test whether an incentive-based intervention that increased adherence to naltrexone also increased opiate abstinence. Design Post-hoc combined analysis of three earlier randomized controlled trials that showed individually that incentives for adherence to oral and to extended-release injection naltrexone dosing schedules increased naltrexone adherence, but not opiate abstinence. Setting Out-patient therapeutic work-place in Baltimore, MD, USA. Participants One hundred and forty unemployed heroin-dependent adults participating from 2006 to 2010. Interventions Participants were hired in a model work-place for 26 weeks and randomized to a contingency ( n = 72) or prescription ( n = 68) group. Both groups were offered naltrexone. Contingency participants were required to take scheduled doses of naltrexone in order to work and earn wages. Prescription participants could earn wages independent of naltrexone adherence. Measures Thrice-weekly and monthly urine samples tested for opiates and cocaine and measures of naltrexone adherence (percentage of monthly urine samples positive for naltrexone or percentage of scheduled injections received). All analyses included pre-randomization attendance, opiate use and cocaine use as covariates. Additional analyses controlled for cocaine use and naltrexone adherence during the intervention. Findings Contingency participants had more opiate abstinence than prescription participants (68.1 versus 52.9% opiate-negative thrice-weekly urine samples, respectively; and 71.9 versus 61.7% opiate-negative monthly urine samples, respectively) based on initial analyses [thrice-weekly samples, odds ratio (OR) = 3.3, 95% confidence interval (CI) = 1.7-6.5, P < 0.01; monthly samples, OR = 2.6, 95% CI = 1.0-7.1, P = 0.06] and on analyses that controlled for cocaine use (thrice-weekly samples, OR = 3.9, 95% CI = 3.3-4.5, P < 0.01; monthly samples, OR = 3.4, 95% CI = 1.1-11.1, P = 0.04), which was high and associated with opiate use. The difference in opiate abstinence rates between contingency and prescription participants was reduced when controlling for naltrexone adherence (monthly samples, OR = 1.1, 95% CI = 0.7-1.7, P = 0.84). Conclusions Incentives for naltrexone adherence increase opiate abstinence in heroin-dependent adults, an effect that appears to be due to increased naltrexone adherence produced by the incentives. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To study the association between body composition measures and menstrual status in a large sample of adult patients with a history of anorexia nervosa and to calculate the predicted probability of resumption of menstrual function. Furthermore, to establish whether fat percentage is superior to body mass index in predicting the resumption of menses. Method One hundred and thirteen adult women with a history of anorexia nervosa underwent a dual energy X-ray absorptiometry (DXA) scan and completed questionnaires regarding medication prescription and menstrual function. Results Fifty percent of patients were expected to resume their menstrual function at a body mass index of 19 kg m−2 or a fat percentage of 23%. Twenty-five percent of patients were expected to resume their menstrual function at body mass index 14 kg m−2 or fat percentage 11%. Fat percentage and body mass index were equally capable of predicting the resumption of menses. Discussion Fat percentage and body mass index were positive predictors of the resumption of menses, however, body composition measured by dual energy X-ray absorptiometry was not superior to body mass index in predicting menstrual recovery, which is of great clinical relevance as body mass index is easier and cheaper to obtain. Body composition measures only account for one of numerous factors involved in the resumption of menses. Regression models based on our data had a R2 value of 0.14, indicating that only 14% of the variation in menstrual recovery could be explained by the variables included. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:370-377) [ABSTRACT FROM AUTHOR]

Objectives To evaluate the expression of p-AKT, p-JNK, FoxO3a, and Ki-67 in samples of oral squamous cell carcinoma (OSCC) and oral epithelial dysplasias (OEDs) to understand their possible involvement in the malignant transformation process of oral lesions. Materials and Methods Tissue samples of 20 cases of OSCCs, 20 OEDs, and normal oral mucosa were subjected to immunohistochemistry reactions for anti-p-AKT, anti-p-JNK, anti-FoxO3a, and anti-Ki-67 antibodies. It was analyzed using quantitative (number of immunostained cells) and qualitative (immunostaining intensity) parameters in different cell immunostaining sublocations. Results Nuclear p-AKT was observed significantly greater immunostaining in OSCC (21.2 ± 19.0) than in dysplasias (7.9 ± 8.1) and controls (1.8 ± 4.7) ( P = 0.002). Immunostaining of strong nuclear p-JNK was greater in controls (48.3 ± 13.7) than in OEDs (11.0 ± 10.3) and OSCCs (1.1 ± 1.3) ( P < 0.001). Strong nuclear immunostaining of FoxO3a proved to be absent in OSCCs (0.0 ± 0.1) with little staining on dysplasias (3.2 ± 5.4) and increased expression in controls (13.5 ± 4.8) ( P < 0.001). Immunostaining of strong nuclear Ki-67 was grater in OSCCs (48.1 ± 49.6) than in OED (11.8 ± 10.6) and controls (1.9 ± 2.0) ( P < 0.001). Conclusions Malignant process of OEDs in this research may involve the same mechanisms of established malignant lesions. [ABSTRACT FROM AUTHOR]

Prenatal methyl donor deficiency leads to homocysteine accumulation in the brain and impaired neurodevelopment in rats. We investigated the effect of moderately elevated preconception fasting total plasma homocysteine (tHcy) on child neurodevelopment in a prospective study of 67 and 76 mother-child pairs at 4 months and 6 years of age, respectively. Fasting blood samples at 2-10 weeks preconception, from the cord (nonfasting) and the mother and child 6 years after birth, were collected. Psychomotor and mental development were assessed at 4 months using the Bayley Scale of Infant Development (BSID) and cognitive development at 6 years using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Highest tertile preconception tHcy (≥9.04 µmol/L) was categorized as moderately elevated and low-mid tertile tHcy as normal. Children, born to mothers with moderately elevated compared to normal preconception tHcy, scored lower [mean (95% CI)] in the BSID psychomotor [115 (105, 124) vs. 126 (121, 130), p = 0.03] and mental [101 (93, 109) vs. 113 (107, 119), p = 0.03] development tests. Multiple logistic regression analysis showed that moderately elevated compared to normal preconception tHcy was associated with greater probability, OR (95%CI), of scoring in the lowest tertile for BSID psychomotor development (≤120): 4.0 (1.1, 14.3) and lowest tertiles for WPPSI full (≤111), verbal (≤104) and performance (≤111), intellectual quotient: 6.0 (1.5, 23.7), 3.5 (1.1, 11.2) and 4.1 (1.1, 15.7), respectively. We conclude that moderately elevated preconception tHcy is inversely associated with psychomotor and cognitive development scores in infants and children. [ABSTRACT FROM AUTHOR]

Aims Selection of patients who are viable candidates for cardiac resynchronization therapy (CRT), prediction of the response to CRT as well as an optimal definition of a favorable response, all require further exploration. The purpose of this study was to evaluate the interplay between the prediction of the response to CRT and the definition of a favorable outcome. Methods Seventy patients who received CRT were included. All patients met current guideline criteria for CRT. Forty-three echocardiographic parameters were evaluated before CRT and at 1, 3, 6, and 12 months. M-mode, 2D echocardiography, and Doppler imaging were used to quantify left ventricular (LV) systolic and diastolic function, mitral regurgitation, right ventricular systolic function, pulmonary artery pressure, and myocardial mechanical dyssynchrony. The following definitions of a favorable CRT response were used: left ventricular ejection fraction (LVEF) improvement more >5% acutely following CRT, LVEF improvement >20% at 12-month follow-up, and a LV end-systolic volume (LVESV) decrease >15% at 12-month follow-up. Results For the LVEF improvement >5%, the best predictor was isovolumetric relaxation time (IVRT; P=.035). For improvement of LVEF >20%, the best predictors were left ventricular stroke index (LVSI; P=.044) and left ventricular fractional shortening (LVFS; P=.031). For the drop in left ventricular systolic volume (LVESV >15%), the best predictor was septal-to-lateral wall delay (Δ T) ( P=.043, RR=1.023, 95% CI for RR=1.001-1.045). Conclusion The definition of a favorable CRT response influenced the optimal predictor variable(s). Standardization of defining a favorable response to CRT is needed to guide clinical decision making processes. [ABSTRACT FROM AUTHOR]