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Background: Postpartum depression (PPD) is the most common complication of childbearing. Understanding potential contributors, such as cesarean deliveries, is essential to improving maternal mental health. This study investigated the relationship between unplanned versus planned cesarean birth and postpartum depressive symptoms. Methods: We employed a sequential, mixed‐methods approach wherein the Edinburgh Postnatal Depression Scale (EPDS) was first administered to participants who had experienced a cesarean birth within the previous 12 months. EPDS scores among those in the unplanned vs. planned cesarean groups were compared by means of SPSS. Twenty‐five participants with EPDS scores >8 were then interviewed to provide subjective measures of maternal well‐being. Interview data were subjected to thematic qualitative analysis using a modified grounded theory approach. Results: The average EPDS score from 120 participants with unplanned cesareans was 10.7 ± 6.4, with 68.5% scoring >8. The average EPDS score from 93 participants with planned cesarean births was 8.96 ± 5.7, with 52.7% scoring >8. The difference in mean score was statistically significant (P < 0.05). Interview findings revealed several important themes including: support, medical interaction, stress, recovery, breastfeeding, and sleep. In several cases, participants were not properly screened, or screening tool responses were ignored. Numerous participants reported medical interactions where they felt ignored by practitioners, including one interviewee who stated, "I got my tubes tied because it was so traumatizing that I never wanted to give birth again." Discussion: Findings suggest that unplanned cesareans have a higher incidence and severity of postpartum depressive symptoms. Interview analyses highlight important areas for improvement and concern about the current state of postpartum mental health care and physician‐guided supports in this US sample. [ABSTRACT FROM AUTHOR]

Background: Transforaminal epidural steroid injection (TFESI) is widely practiced for the treatment of radicular pain. As its effectiveness is still subject to debate, a better patient selection for TFESI is necessary. We aimed to evaluate the potential of bedside‐suitable qualitative sensory testing (QualST) to determine the early effectiveness of TFESI for the treatment of chronic lumbosacral radiculopathy (LSR)‐related pain. Methods: Thirty‐six patients with chronic painful unilateral LSR were evaluated in a prospective observational study using five standardized sensory tests (10 g monofilament, 200 to 400 mN brush, Lindblom rollers with controlled 25 and 40°C temperature, and 40 g neurological pin). Quality of sensory perceptions on the painful leg was compared to the non‐painful leg and rated as normal sensitivity, hyposensitivity, or hypersensitivity. Pain and related characteristics were evaluated before TFESI, 1 week after and 4 weeks after intervention. Results: Seven sensory phenotypes were distinguished according to individual sets of sensory disturbances acquired with five sensory tests. Patients were grouped into four groups of allied phenotypes (normal sensitivity, hyposensitivity to 1 to 3 modalities, hyposensitivity to 4 to 5 modalities, and hypersensitivity). The whole study group showed significant improvement in most parameters of outcome measurements. Statistical analysis revealed some significant differences between sensory groups in patient‐reported treatment effect scales after 4 weeks. We also detected significant differences between sensory groups in repeated measures after 1 and 4 weeks in some pain intensity characteristics and patient‐reported treatment effect scales. Conclusion: QualST might be clinically applicable for detecting patient subgroups that could differ in the early treatment results of radicular pain by TFESI. [ABSTRACT FROM AUTHOR]

Objective: People with severe mental illness often have difficulty sustaining employment. Work Behaviour Inventory and Work Environment Impact Scale are vocational assessments used by occupational therapists to evaluate the facilitators and barriers of work performance and work environment respectively. These factors may have an impact on job tenure and can inform occupational therapy practice. Methods: This study analysed retrospective data of 85 clients who attended a 3‐month Employment Internship Program from August 2016 to August 2017. Scores from Work Behaviour Inventory and Work Environment Impact Scale were analysed for associations with job tenure. Repeated measures were used to determine significant changes in Work Behaviour Inventory composite scores across the 3 months. Results: One‐month Work Behaviour Inventory composite scores, three Work Behaviour Inventory domains (cooperativeness, work habits, work quality), and three Work Environment Impact Scale domains (time demands, supervisor interaction, architecture) were significantly associated with job tenure. Significant differences in mean job tenure were also found between participants of different internship status. However, these factors did not predict job tenure in regression analysis. There were significant improvements in Work behaviour Inventory composite scores from the first to third month. Conclusions: Work behaviours such as cooperativeness, work habits, and work quality as well as work characteristics such as time demands, supervisor interaction, and workplace architecture may play a role in influencing job tenure. Occupational therapists may consider such factors and provide more targeted interventions to effectively sustain employment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Disasters cause significant human and monetary destruction and society as a whole is underprepared to address them. Disaster preparedness education is not covered extensively enough for health professionals or for the general public. METHODS: A disaster preparedness education intervention was performed using a non‐randomized controlled trial of a convenience sample with a pre‐ and post‐intervention survey. The adapted Emergency Preparedness Information Questionnaire (EPIQ), a validated survey tool, was utilized. Participants came from a health professions educational enrichment program for students from under‐resourced high schools in the Kansas City area. RESULTS: The experimental group shows statistically significant improvement in knowledge of disaster topics post‐intervention. Of 18 adapted EPIQ tool questions, 17 show statistically significant improvement in disaster knowledge post‐intervention for the experimental group with significance set at p <.05 (range of significant p values.000‐.017). CONCLUSIONS: The education intervention was effective and cost‐efficient. Disaster preparedness education should be included in THE secondary school curriculum. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. Methods: This study included 3896 pregnant women from the COVID‐19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic‐related preparedness stress, and pandemic‐related perinatal infection stress. Results: Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID‐19. In multivariate models, higher stress about perinatal COVID‐19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. Discussion: Women's birth preferences during the COVID‐19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in‐hospital and out‐of‐hospital birth services should be encouraged. [ABSTRACT FROM AUTHOR]

Background: Patient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes. Design: Cross‐sectional study. Setting and participants: Patients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK. Outcome measures: Patient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia. Results: 743 patients were included (eGFR: 32.3 (SD17.1) mL/min/1.73 m2, age 67.8 (SD13.9) years, 68% male). The mean PAM score was 55.1 (SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P =.004), greater number of comorbidities (P =.026) and lower haemoglobin (P =.025). Patients with low activation had a 17% greater number of CVD risk factors (P <.001). Risk factors in those with low activation were being older (P <.001) and having diabetes (P <.001). Conclusion: This study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation. Patient or Public Contribution: Patients were involved in the design of main study. [ABSTRACT FROM AUTHOR]

Background: The identification and treatment of psychiatric disorders in individuals with autism spectrum disorders (ASD) and ID presents many challenges. We describe the development of a professional network, together with a standardized protocol for clinical assessment, designed to promote clinical competence and professional development in eight clinical centers responsible for providing mental health services to autistic individuals with ID across all four health regions of Norway. Specific aims to describe: (1) patterns of psychiatric and behavior problems in patients treated by the network, (2) patterns of change over time, and (3) the relationship between psychiatric disorders and behavior problems. Method: A standardized protocol was used to assess individual progress in 132 patients (inpatients and outpatients) with autism and ID over 2 years (at referral (T1), after 1 year (T2), and after 2 years (T3)). Changes in psychiatric symptoms and behavior problems were assessed with the Psychopathology in Autism Checklist (PAC) and Aberrant Behavior Checklist (ABC). Results: Patients showed significant (p <.001) improvements from T1 to T2 on the psychosis, depression and anxiety subscales of the PAC, but no significant improvement on the obsessive compulsive disorder (OCD) subscale. Improvements were maintained from T2 to T3. Patients showed significant (p <.01) improvements on the ABC total score and on all ABC subscales except inappropriate speech from T1 to T2; these improvements were maintained from T2 to T3. Discussion The combination of a professional network and a standardized protocol for clinical assessment has promise as a strategy for improving professional competence and facilitating specialized mental health services for autistic individuals with ID and psychiatric disorders across an extensive geographical area. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a risk factor for atrial fibrillation (AF). The effect of antidiabetic medications on AF or the outcomes of catheter ablation (CA) has not been well described. We sought to determine whether metformin treatment is associated with a lower risk of atrial arrhythmias after CA in patients with DM and AF. Methods and Results: A first CA was performed in 271 consecutive patients with DM and AF (age: 65 ± 9 years, women: 34%; and paroxysmal AF: 51%). At a median of 13 months after CA (interquartile range: 6–30), 100/182 patients (55%) treated with metformin remained in sinus rhythm without antiarrhythmic drug therapy, compared with 36/89 patients (40%) not receiving metformin (p =.03). There was a significant association between metformin therapy and freedom from recurrent atrial arrhythmias after CA in multivariable Cox hazards models (hazard ratio [HR]: 0.66; ±95% confidence interval [CI]: 0.44–0.98; p =.04) that adjusted for age, sex, body mass index, AF type (paroxysmal vs. nonparoxysmal), antiarrhythmic medication, obstructive sleep apnea, chronic kidney disease, coronary artery disease, left ventricular ejection fraction, and left atrial diameter. A Cox model that also incorporated other antidiabetic agents and fasting blood glucose demonstrated a similar reduction in the risk of recurrent atrial arrhythmias with metformin treatment (HR: 0.63; ±95% CI: 0.42–0.96; p =.03). Conclusions: In patients with DM, treatment with metformin appears to be independently associated with a significant reduction in the risk of recurrent atrial arrhythmias after CA for AF. Whether this effect is due to glycemic control or pleiotropic effects on electroanatomical mechanisms of AF remains to be determined. [ABSTRACT FROM AUTHOR]

Background: An intensive care unit (ICU) delirium prediction tool, PREdiction of DELIRium in ICu patients (PRE‐DELIRIC), has been developed and calibrated in a multinational project. However, there is a lack of evidence regarding the predictive ability of the PRE‐DELIRIC among Chinese ICU patients. Aim: To evaluate the predictive validity (discrimination and calibration) of PRE‐DELIRIC. Design: This is a retrospective cohort study. Methods: A retrospective cohort study was conducted. Consecutive participants (a) admitted to the ICU for ≥24 hours, (b) aged ≥18 years, and (c) admitted to the ICU for the first time were included. Ten predictors (age, APACHE‐II, urgent and admission category, urea level, metabolic acidosis, infection, coma, sedation, and morphine use) assessed within 24 hours upon ICU admission were assessed. Delirium was assessed using the Confusion Assessment Method for ICU. Outcomes included ICU length of stay and mortality. Discrimination and calibration were determined by the areas under the receiver operating characteristic curve (AUROC), box plot, and calibration plot. Results: A total of 375 ICU patients were included, with 44.0% of patients being delirious. Delirium was significantly associated with age, PRE‐DELIRIC score, ICU length of stay, and mortality. The AUROC was 0.81 (95% confidence interval, 0.77‐0.86). The optimal cut‐off point identified by max Youden index was 49%. The calibration plot of pooled data demonstrated a calibration slope of 0.894 and an intercept of −0.178. Conclusions: The PRE‐DELIRIC has high predictive value and is suggested to be adopted in ICUs for early initiation of preventive interventions against delirium among high‐risk patients. Relevance to clinical practice: Clinicians can adopt the PRE‐DELIRIC among ICU patients to screen patients at high risk of developing delirium. Early initiative interventions could be implemented to reduce the negative impacts of ICU delirium. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. Methods: Systematic review and meta‐analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. Results: Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta‐analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare‐related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. Conclusions: This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area. [ABSTRACT FROM AUTHOR]

Anxiety and depression are common mental illnesses among nurses fighting coronavirus disease 2019 (COVID‐19). However, the precise factors that affect anxiety and depression in this population require further evaluation. This study aimed to explore factors associated with anxiety and depression among nurses fighting COVID‐19 in China. We used convenience sampling to recruit 282 nurses fighting COVID‐19 in three hospitals. Participants were questioned about demographic characteristics, daily working time, daily sleep duration, sleep quality, anxiety, depression, resilience, and coping styles. Linear regression analysis indicated that resilience (β = −0.217, P < 0.001), positive coping style (β = −0.281, P < 0.001), negative coping style (β = 0.395, P < 0.001), and sleep quality (β = 0.153, P = 0.010) were predictive factors for anxiety, and the model explained 44.20% (P < 0.001) of variability. Resilience (β = −0.239, P < 0.001), positive coping style (β = −0.222, P < 0.001), negative coping style (β = 0.152, P < 0.001), and sleep quality (β = 0.104, P = 0.003) were identified as explanatory factors for depression, and the model explained 34.50% (P < 0.001) of variability. The present study suggested that resilience, coping styles, and sleep quality could account for an individual's levels of anxiety and depression. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of an additional 2‐week health professional‐led functional exercise programme compared to usual care for patients after hip fracture during a short‐term nursing home stay directly after hospital discharge. Method: One hundred and forty participants, 65 years or older with hip fracture, admitted to a short‐term nursing home stay were randomised to an intervention group or control group. Participants in the intervention group (n = 78) received the experimental programme consisted of functional exercises, performed by health care professionals up to four times a day, 7 days a week, in addition to usual care during a 2‐week short‐term nursing home stay. Participants in the control group (n = 62) received usual care alone. Primary outcome was Short Physical Performance Battery (SPPB). Secondary outcomes were Timed Up & Go, New Mobility Score, The University of California, Los Angeles Activity Scale, Fall Efficacy Scale International, The EuroQol five dimension five‐level questionnaire, and Numeric Rating Scale for pain. Outcome measures were assessed after 2 weeks in a short‐term nursing home stay and 3 months after hip fracture surgery. The activity monitor ActivPal registered activity during the 2‐week short‐term nursing home stay. Results: No statistically significant differences between groups was found in any outcomes after 2 weeks or 3 months (p > 0.05). There were statistically significant within‐group improvements in primary outcome SPPB and in most secondary outcomes at all time points in both groups (p > 0.05). Conclusions: A 2‐week health professional‐led functional exercise programme in addition to usual care demonstrated no difference in clinical outcomes compared to usual care alone up to 3 months after hip fracture. The patients with hip fracture are fragile and vulnerable in this early phase, and usual physiotherapy may be sufficient to improve their physical function. Trial registration: ClinicalTrials.gov NCT02780076. [ABSTRACT FROM AUTHOR]

Background: Stressors in intensive care units (ICUs) are sometimes so severe that they result in Post‐traumatic Stress Disorder (PTSD) in ICU survivors. The memories that survivors have from the ICU may play a role in developing PTSD. Aim: This study aimed to determine the prevalence of PTSD‐related symptoms in ICU survivors in Southeast Iran and its relationship with their memories of the ICU. Methods: In this descriptive correlational study, 100 people discharged from ICUs in southeastern Iran completed the Impact of Event Scale‐Revised (IES‐R) and ICU memory tool (ICU‐MT). Results: Findings indicated that, from 100 participants who, on average, were assessed 3.19 ± 5.37 months after discharge, 13% were suffering from PTSD. The total mean IES‐R score and the scores of "Intrusion," "Avoidance," and "Hyperarousal" subscales in patients with delusional memories were higher compared with the patients who did not have such memories. In the patients who were mechanically ventilated at the time of their stay in the ICU, the total mean IES‐R score was 6.86 times higher (P =.03). Conclusion: This research provided further evidence of the relationship between delusional memories and PTSD in patients who had been discharged from the ICU. Relevance to clinical practice: In the care of patients admitted to the ICU, preventive strategies should be used to minimize delusional memories and PTSD. It is necessary to detect post‐ICU psychiatric morbidities and provide early psychological intervention in post‐discharge follow‐up programmes to improve psychological outcomes after critical illness. [ABSTRACT FROM AUTHOR]

Background: Healthcare environment can affect health. Adverse events (AEs) are common because rapid changes in the patients' status can suddenly arise, and have serious consequences, especially in intensive care. The relationship between the design of intensive care units (ICUs) and AEs has not been fully explored. Hence, an intensive care room was refurbished with cyclic lightning, sound absorbents and unique interior, and exterior design to promote health. Aims: The aim of this study was to evaluate the differences between a regular and a refurbished intensive care room in risk for AEs among critically ill patients. Design: This study retrospectively evaluated associations of AEs and compared the incidence of AEs in patients who were assigned to a multidisciplinary ICU in a refurbished two‐bed patient room with patients in the control rooms between 2011 and 2018. Methods: There were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive statistics were used to present the experienced AEs. Binary logistic regressions were conducted to estimate the relationship between the intervention/control rooms and variables concerning AEs. Statistical significance was set at P < 0.05. Results: For the frequency of AEs, there were no significant differences between the intervention room and the control rooms (10.6% vs 11%, respectively, P < 0.805). No findings indicated the intervention room (the refurbished room) had a significant influence on decreasing the number of experienced AEs in critically ill patients. Conclusions: The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previously described. However, our study did not find any decreases in the AEs due to the design of the rooms. Relevance to clinical practice: Further research is needed to determine the relationship between the physical environment and AEs in critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Portopulmonary hypertension (PoPH) is a rare condition with poorer survival compared to idiopathic/familial pulmonary arterial hypertension (IPAH/FPAH). Aims: To compare the characteristics, survival, prognostic factors and management of PoPH and IPAH/FPAH patients and to assess the impact of treatment on survival of PoPH patients. Methods: Analysis of data of prevalent and incident PoPH patients enrolled in the Spanish registry of PAH (REHAP) from January 1998 to December 2017 and comparison with IPAH/FPAH patients. Variables analysed: patient and disease (PAH and liver) characteristics, first‐line PAH‐targeted therapy, causes of death, prognostic factors and survival (according to aetiology and treatment in PoPH patients). Results: Compared to IPAH/FPAH patients (n = 678), patients with PoPH (n = 237) were predominantly men, older and had better functional class and higher prevalence of ascites. Haemodynamics were better. Biomarkers for heart failure were worse. Age‐ and sex‐adjusted 5‐year survival rate from diagnosis was 49.3% for PoPH patients and 68.7% for IPAH patients (P < 0.001). Treated PoPH had better survival than non‐treated. PAH‐ and liver‐related causes accounted for 30.2% and 24.7% of deaths in PoPH patients. PoPH patients were less likely to receive first‐line PAH‐targeted therapy and this was associated with greater mortality. Increasing age, worse exercise capacity and ascites were independent prognostic factors of poorer survival; first‐line oral monotherapy was associated with improved survival. Eight (3.4%) PoPH patients underwent liver transplantation. Conclusions: PoPH patients are undertreated and show poorer survival than IPAH/FPAH patients. First‐line treatment with PAH‐targeted therapy was associated with better survival. Presence of ascites was a predictor of mortality. [ABSTRACT FROM AUTHOR]

Objective: To investigate the factors that are associated with medical student interest in remote and very remote practice in Australia. Design: Aggregated data of an annual cross‐sectional survey from 2013 to 2017. Setting: Australia. Participants: Medical students from 17 medical schools, at the point of finishing one year of clinical training in a rural or remote location in Australia. Main outcome measures: Intention for working in a remote or very remote location as a doctor. Results: Responses were analysed from 3328 medical students. From this cohort, 37.6%, 54.0% and 7.0% of students reported future career intent in capital or major cities; regional Australia; and remote or very remote Australia respectively. Multivariable analysis indicated students interested in remote and very remote practice compared to those interested in regional practice were more likely to be from a rural background, have prior generalist intentions, felt as though their rural clinical school (RCS) experience increased interest in remote and very remote practice, and had higher rural practice self‐efficacy. Odds ratios were larger for these factors when students interested in remote or very remote practice were compared with students interested in practicing in capital or major cities. Conclusions: Rural background, prior generalist intentions, rural practice self‐efficacy and the overall influence of the RCS experience are associated with interest in remote and very remote practice. [ABSTRACT FROM AUTHOR]

People show a robust tendency to gaze at other human beings when viewing images or videos, but were also found to relatively avoid gaze at others in several real‐world situations. This discrepancy, along with theoretical considerations, spawned doubts about the appropriateness of classical laboratory‐based experimental paradigms in social attention research. Several researchers instead suggested the use of immersive virtual scenarios in eliciting and measuring naturalistic attentional patterns, but the field, struggling with methodological challenges, still needs to establish the advantages of this approach. Here, we show using eye‐tracking in a complex social scenario displayed in virtual reality that participants show enhanced attention towards the face of an avatar at near distance and demonstrate an increased reactivity towards her social gaze as compared to participants who viewed the same scene on a computer monitor. The present study suggests that reactive virtual agents observed in immersive virtual reality can elicit natural modes of information processing and can help to conduct ecologically more valid experiments while maintaining high experimental control. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated alterations in cell population data (CPD) in patients with bacteraemia confined in an Indian tertiary care hospital. Topics explored include the additional CPD parameters obtained through leucocyte differential count, the analysis of the white blood cell count, haemoglobin, and neutrophil count of both normal and bacteraemic patients, and the leucocyte parameters of patients with bacteraemia compared to healthy individuals.

Aim: This study aims to evaluate the effects of daily life activities simulation on the attitudes of first‐year nursing students toward older adults within the scope of geriatric nursing. Methods: The study was carried out using a pretest‐posttest, quasi‐experimental design. First‐year undergraduate students (N = 119) of a nursing faculty constituted the study sample. The students were divided into two groups as intervention and control groups. The intervention group performed the daily life activities simulation. Data were collected by using Kogan's Attitudes Towards old People Scale (KAOP) and Positive and Negative Ageism Scale (PNAS). SPSS Ver. 22.00 software was used for statistical analysis. Chi‐square test, and t test were used for comparative statistics. Results: Most of the participants were female, and mean age was 20.96 ± 3.24. Intergroup comparison of the KAOP and PNAS scores reveals a statistically significant difference between the pretest and posttest scores for the simulation group (p ˂.05). The posttest KOAP and PNAS scores of the simulation and control groups were statistically significantly different (p ˂.05). Conclusion: Daily life activities simulation is an effective method to improve nursing students' positive attitudes toward older adults. Participant feedback from our study shows that the simulation increased empathy and awareness of geriatric nursing. [ABSTRACT FROM AUTHOR]

PURPOSE: To verify the relevance of the clinical indicators, the clarity and precision of the conceptual, and operational definitions for Ineffective breathing pattern (IBP). METHODS: A content analysis by 39 judges. FINDINGS: The results showed 28 clinical indicators for IBP. However, only seven were not considered relevant for the diagnosis. These are not listed in NANDA International taxonomy. All conceptual and operational definitions were adequate, according to the analysis of the judges. CONCLUSION: The list of 28 clinical indicators of IBP was submitted for analysis by judges, which then resulted in the validation of 21 of these elements. IMPLICATIONS FOR NURSING PRACTICE: This study clarifies that gaps in the structure of diagnoses, helping nurses' diagnostic reasoning process in clinical practice. [ABSTRACT FROM AUTHOR]

In Bangladesh, two food composition tables (FCTs) were published over two consecutive years, in 2012 and in 2013. When different databases are used to calculate nutrient intakes, assessment of divergence and agreements is required. This study aimed to compare the differences in nutrient intakes, to assess the similarities in nutrient intakes between the two FCTs, and to explore the factors that cause the difference in nutrient intakes, if any. A total sample of 40 households was taken from the Household Income Expenditure Survey of 2010. Adult male equivalent (AME) units were used to estimate weighted average intake. Weighted k statistics were used to assess agreements between the two FCTs. Although median intake of energy and energy‐yielding nutrients (protein, fats, and carbohydrates) were found statistically significant between the two databases, the differences were not large enough to have practical significance. Excellent agreements were found in energy and carbohydrates with good for fats and fair for protein. However, statistically significant median percent differences were seen in beta carotene (441%), vitamin B6 (153%), and folate (129%), vitamin C (106%), zinc (101%), and iron (41%) intakes. For thiamin, iron, calcium, and phosphorous, more than 50% of the subjects were found in the same quintile, whereas nine out of 15 vitamins and minerals were misclassified into the opposite quintiles (≥10%). Fair agreements were found for most of the micronutrients. Variations in analytical methods and sources of nutrient information were the main contributing factors for actual differences. FCT data should be interpreted with caution, especially for micronutrients. [ABSTRACT FROM AUTHOR]

Background: Colposcopy has been recommended for all women with recurrent post‐coital bleeding (PCB) even if their cervical cytology or co‐test (involving oncogenic human papillomavirus (HPV) DNA testing and cytology) are negative. Aims: To determine the risk of cervical cancer and its precursors among women with recurrent PCB with negative cytology or co‐test. Materials and Methods: A retrospective analysis of two cohorts of women with PCB referred to a tertiary colposcopy clinic. Cohort (1) (n = 1846) between 1 January 2000 and 31 December 2016 (cytology‐based screening) and Cohort (2) (n = 215) from 1 January 2018 to 31 December 2019 after introduction of primary HPV screening. Results: In 1217 (65.9%) women in Cohort (1) referred with negative cytology, there was one cancer (0.08%) and 22 high‐grade squamous intraepithelial lesions (HSIL (cervical intraepithelial neoplasia 2/3)) on histopathology. In Cohort (2), there was no cancer or HSIL in 83 women with negative co‐tests (negative for oncogenic HPV and cytology). False‐negative cytology after a negative referral cytology or co‐test was low with 2% of repeat cytology at initial colposcopy showing possible HSIL or worse. Conclusions: Women presenting with PCB and negative cytology alone have a low risk of cancer and could have HPV testing before being triaged to colposcopy. We showed that with the assurance of a negative co‐test and the low likelihood of false‐negative cytology, these women could avoid colposcopy unless cervical cancer is clinically suspected. There is a need for a larger cohort study to substantiate our findings with more precision. [ABSTRACT FROM AUTHOR]

Aim: Skeletal muscle loss is often observed in advanced cancer patients. This study investigates whether skeletal muscle loss is associated with survival outcomes of advanced epithelial ovarian cancer (EOC) patients after induction chemotherapy (IC) in a Japanese cohort. Whether serum inflammatory markers are associated with skeletal muscle changes is also addressed. Methods: We retrospectively reviewed 60 patients with stage III/IV EOC who underwent IC between 2010 and 2017. Skeletal muscle area (SMA) was measured at the third lumbar vertebrae level on a single axial computed tomography‐scan image. Receiver operating curve analysis was used to determine cut‐off values of pre‐ and post‐IC SMA and SMA ratio (SMAR). Univariate and multivariate analyses of overall survival (OS) were conducted using the log–rank test and Cox proportional hazards regression model, respectively. Results: The SMA decreased significantly after IC (P = 0.019). The cut‐off value between low and high SMAR was 0.96. High or low SMAR was observed in 34 (57%) and 26 (43%) patients, respectively. Univariate analysis revealed that low SMAR was associated with poor OS (P = 0.025). Multivariate analysis showed that incomplete resection during interval debulking surgery (hazard ratio, 0.30; 95% CI, 0.11–0.80; P = 0.016) and a low SMAR (hazard ratio, 3.17; 95% CI, 1.18–9.06; P = 0.022) were independent predictors of poor OS. Of the serum inflammatory markers investigated, only post‐IC absolute neutrophil count correlated significantly with SMAR (P = 0.012). Conclusion: Low SMAR can be used to predict poor prognosis in advanced EOC patients who have undergone IC. [ABSTRACT FROM AUTHOR]

This is a cross‐sectional study conducted with 537 family caregivers of people with mental disorders. The objective was to quantify the degree of burden experienced by men and women, and identify the most affected dimensions of their lives and the factors associated with burden manifestation by gender. The Zarit Burden Interview (ZBI) scale was used to assess burden. Mean burden was 22.8 points (SD = 6.3) for men and 27.8 points (SD = 17.8) for women. The most affected dimensions among the two groups were the same; however, among the 22 items on the scale, 11 presented significantly higher means among women. The factors associated with the manifestation of burden in both groups were as follows: low income; use of psychotropic drugs; greater degree of dependence of the service user; not receiving family support; and dissatisfaction with family relationships. For men, manifestation of burden was also associated with age. For women, there were further associations of the outcome with the presence of health problems, not having someone to share care with, and caring for the assisted person for >10 years. Our findings suggest that the degree of burden of family members caring for those with mental disorders is associated with gender, and this should be considered by services responsible for planning care shared by professionals and relatives. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE Statement) were adhered to in this study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Boys use cannabis at a younger age and more frequently than girls. It has been suggested these sex differences might vary according to students' relationship to school. We explored whether the association between sex and adolescents' cannabis use varies among schools and according to students' school connectedness. METHODS: The study population consisted of all students from 11 secondary schools in the greater Québec City area. The sample included 6185 respondents in years 1 to 5 at the secondary level (equivalent to grades 7‐11). Study outcomes were monthly cannabis use and early cannabis use. RESULTS: The association between sex and monthly cannabis use varied significantly among schools after controlling for students' main characteristics and school socioeconomic environment. We found a statistically significant modifying effect of school connectedness on the association between sex and monthly cannabis use. For early cannabis use, we found no modifying effect of school connectedness nor any association with sex. CONCLUSIONS: Measures to reduce adolescents' cannabis use could be better adapted to local context and more tailored to specific higher‐risk groups. School connectedness is a protective factor for cannabis use, although this effect appears stronger for girls than boys. [ABSTRACT FROM AUTHOR]

Objective: To evaluate potential prognostic factors of self‐reported lumbopelvic pain 6 months postpartum for pregnant women with and without lumbopelvic pain. Methods: Questionnaires were answered at gestational weeks 34–37 and again at 6 months postpartum. Psychosocial determinants and lumbopelvic pain symptoms were investigated using a visual analogue scale to assess pain intensity, and further using the Disability Rating Index, the Nottingham Health Profile, the Pain Catastrophizing Scale and the Fear‐Avoidance Beliefs Questionnaire. Logistic regression analysis was used to analyse the data. Results: Of the 260 women who answered the questionnaires on both occasions, 186 did not suffer from lumbopelvic pain 6 months after pregnancy. The remaining 74 did. The results of the logistic regression analysis showed that fear‐avoidance beliefs was a significant predictor of lumbopelvic pain 6 months postpartum, with an odds ratio of 1.060 (p ≤.05). Conclusion: Women with high fear‐avoidance beliefs at 34–37 weeks of gestation had a higher risk of having lumbopelvic pain at 6 months postpartum. We theorize that early lumbopelvic pain intervention postpartum may be important in avoiding chronicity. Women at risk can be identified through clinically relevant questions which may help the clinician to choose appropriate rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Aim: Rapid eye movement sleep behaviour disorder (RBD) is characterized by abnormal behaviours accordant with nightmares during rapid eye movement sleep and is considered a prodromal marker of dementia with Lewy body. Most common in the elderly population, RBD is generally treated with clonazepam (CZP), a long‐term acting benzodiazepine antiepileptic. As such, alternative drugs for RBD are urgently needed to minimize the adverse effects peculiar to benzodiazepines. The efficacy of yokukansan (YKS), a traditional Japanese herbal medicine, on RBD was initially reported by Shinno et al. in 2008. However, no study has compared YKS with CZP. Therefore, this study aimed to clarify the possibility of using YKS as an alternative to CZP. Methods: This was a retrospective cohort study conducted at Jikei University Affiliated Hospital. The subjects were selected from 36 outpatients who had been diagnosed with RBD based on the International Classification of Sleep Disorders, third edition. Of the 23 who met the inclusion criteria but not the exclusion criteria, 11 were treated with YKS monotherapy, and 12 were treated with CZP monotherapy. The primary outcome was the total score on the Japanese version of the Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ‐JP), and the secondary outcomes were the scores from the eight‐item Short‐Form Health Survey and factors 1 and 2 of the RBDQ‐JP. Results: The mean total RBDQ‐JP score significantly improved from 52.5 to 21.7 (P = 0.002) after treatment with YKS (mean dosage: 3.0 g/day), which was similar to the change after CZP treatment (from 43.8 to 21.3). On RBDQ‐JP factor 1 (dream content), the mean score on five of six items significantly improved after treatment with YKS. There was no significant change in Short‐Form Health Survey scores after treatment with either drug. Potassium concentrations were within the normal range in patients treated with YKS. Conclusions: The present results suggest that a small amount of YKS may be an alternative to CZP for RBD, without remarkable adverse events. Further study is needed to prospectively clarify the efficacy and safety of YKS in more detail. [ABSTRACT FROM AUTHOR]

Objective: To objectively determine the prevalence of overweight and obesity in elementary school children in two rural counties in Vermont prior to implementing a community‐based intervention. Methods: School‐based objective measures of body mass index (BMI) were obtained from 1,688 public school children in first, third, and fifth grades in two Northern Vermont counties in the Fall of 2017. Results: Forty‐one percentage of elementary school children were either overweight or obese, nearly double the estimated Vermont prevalence rate of 22.2%. Schools located in more rural areas showed higher levels of overweight and obesity in children than schools in less rural areas in these northern counties (p <.005). Conclusions: Indirect and self‐reported measures of BMI may be underestimating the true prevalence of overweight and obesity particularly in more rural communities. Policy implications: Data presented here in which children were measured directly by trained study staff demonstrate that the prevalence of obesity among children in elementary school is alarmingly high. Accurate, ongoing BMI measurement surveillance is one tool to better understand both the current trends in childhood overweight and obesity and the effect of community and state interventions. [ABSTRACT FROM AUTHOR]

Background: Eclampsia is a serious consequence of pre‐eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia. Aim: To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ. Materials and Methods: A two‐year population‐based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010–2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre‐eclampsia. Results: Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9–2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over‐represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty‐three (47.4%) women had pre‐eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post‐seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. Conclusions: Eclampsia is an uncommon consequence of pre‐eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low‐dose aspirin and magnesium sulphate in women at higher risk. [ABSTRACT FROM AUTHOR]

Problem: Staff member injuries are a pervasive and long‐standing problem for psychiatric inpatient units. Method: The current study analyzed the prevalence of staff member injury and characteristics of patients that injured staff on a specialized psychiatric unit for children with intellectual or developmental disabilities. We evaluated staffing patterns as well as characteristics of patients (e.g., diagnoses, body mass index) between 2016 and 2018. This time period was selected because it represented an approximately equal period before and after the introduction of a new clinical model that incorporated applied behavior analysis (ABA) and other safety‐related practices (e.g., personal protective equipment). Findings: During this study period, there were 110 cases of staff injuries caused by 42 patients. Injuries were most likely to occur during physical management of a patient engaging in aggressive behavior, but less so when strategies requiring less physical contact were implemented. The frequency of staff injury was also significantly related to patients' diagnoses, particularly those exhibiting aggressive behavior and diagnosed with moderate‐to‐severe intellectual disability and/or autism spectrum disorder. Conclusions: Robust staff training incorporating the principles of ABA and the provision of other safety‐related resources can be integrated to clinical guidelines to promote the safety of staff practicing in psychiatric inpatient units. [ABSTRACT FROM AUTHOR]

Depression is commonly seen in the course of schizophrenia and can occur during any of the phases of the psychotic illness. The present study examines the incidence of depression at baseline and de novo depression in first episode of nonaffective psychoses and the course of depression in the 12 months following first‐episode psychosis, any predictive significance of baseline depression with recurrence of depression in the subsequent phases of the psychotic illness. The study was conducted with a clinical sample of 460 patients under the care of a first‐episode psychosis programme, and data relating to duration of untreated psychosis, sociodemographic data, Positive and Negative Symptom Scale (PANSS), Global Assessment of Functioning (GAF), and Clinical Global Impression (CGI) were collected. Diagnosis was made by at least two psychiatrists using SCID‐1, and depression was measured by Patient Health Questionnaire (PHQ‐9). Statistical analysis was performed using SAS version 9. We performed multiple logistic regression analyses to identify the sociodemographic and clinical factors that were associated with depression. Statistical significance was set at p value less than 0.05. We found that baseline depression was present in 34.42% patients with a preponderance of females (p = 0.047) and in those with secondary education. A suicide attempt is a strong predictor for depression at baseline. There was lower incidence of depression in those diagnosed with brief psychotic disorder (p = 0.015) and those with lower PANSS positive scores (p = 0.017). De novo depression over 12 months was 9.44%. Depression at 1‐year follow‐up was significantly predicted by depression at baseline. [ABSTRACT FROM AUTHOR]

Objective: The use of e‐cigarettes is rapidly increasing in adolescents. Health care providers pay attention to e‐cigarette users because of the risk of developing addiction and problematic behavior. Based on ecological perspective, this study investigated factors influencing continued e‐cigarette use. Methods: We classified 1556 current e‐cigarette users into experimental and continued users using the Korean national representative data. Data were analyzed using the chi‐square test and logistic regression based on a complex sample analysis. Results: Among current e‐cigarette users, 55.1% were continued users. Adolescents who use e‐cigarettes because of the belief that they are less harmful than cigarettes, concealment, easy purchase, and adding various flavors had a high risk of continued use. Continued users were more likely to have a higher weekly allowance, lower rate of living with family, and higher chance of smoking parents and exposure to passive smoking at home. Conclusions: Continued e‐cigarette use was influenced by interpersonal and environmental factors, such as ease of purchase and addition of flavoring substances. Improving the environment of adolescents can prevent continued use of e‐cigarettes. [ABSTRACT FROM AUTHOR]

Objective: A collaborative research team of community/public health nursing faculty and public health nurses surveyed public health nurses to explore knowledge, skills, attitudes, and application of the Quad Council Competencies for Public Health Nurses (QCC‐PHN). Methods: Evaluate the knowledge, skills, attitudes, and application of the 2011 QCC‐PHN by public health nurses. Design: A descriptive, cross‐sectional design was used to answer the hypothesis related to the study objective. A convenience sample of 308 public health nurses completed an online survey. Measurements: ANOVA was used to determine the difference between the knowledge, skills, attitudes, and application of community/public health nurses (C/PHNs) regarding the QCC‐PHN based on nursing specialty preparation, years of nursing experience, and years of C/PHN experience. Results: C/PHNs are described and differences in knowledge, skills, attitudes, and application are delineated. A statistically significant difference was found in knowledge and attitude based upon years of C/PHN experience. Conclusions: Recommendations are proposed for increasing the QCC‐PHN awareness, implementation, and evaluation to effectively enhance the practice of nursing C/PHN. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal symptoms occur with deeply infiltrating endometriosis (DIE) of the rectum. Aims: To explore the medium‐term gastrointestinal functional outcomes after rectal disc resection for endometriosis. Methods: All women undergoing laparoscopy for stage IV endometriosis at a tertiary referral hospital between November 2016 and January 2018 and had evidence of DIE of the rectum were included. Low anterior resection syndrome (LARS) score was measured using a validated questionnaire. Results: Thirty‐six women formed the cohort of the study. The mean age was 37 years (range 20–72 years). All women underwent a laparoscopic anterior rectal disc resection for DIE. The response rate was 100%. There was an increase in the percentage of patients having no LARS postoperatively compared to preoperatively (an increase of 78–83%). There was a reduction in LARS scores postoperatively observed in 18 patients (50%) and the prevalence of major LARS decreased postoperatively from 10% to 1%. Comparison of individual symptoms revealed a significant improvement in postoperative stool frequency scores (P = 0.02). Multivariate analysis using logistic regression analysis demonstrated that reduction in postoperative stool frequency scores remained an independent factor (P = 0.008). Conclusion: Rectal disc resection is feasible and safe, achieving observable improvements in stool frequency in patients with rectal DIE. [ABSTRACT FROM AUTHOR]

Although confessions related to abusive head trauma (AHT) are reported, no detailed analysis exists. Therefore, we systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics. Employing 36 search terms across three search engines, we searched Medline and CINAHL from 1963 to 2018. All relevant studies underwent two independent reviews and data extraction. Descriptive statistics were used to characterise the sample; chi square and Fisher's exact tests were used to assess differences in demographic and clinical characteristics. Of 6759 identified studies, 157 full texts were reviewed and 55 articles from 15 countries spanning four continents were included. Included articles contained 434 confessions. The mechanisms of abuse included shaking alone (64.1%), impact alone (17.1%), shaking plus impact (18.0%) and other (0.9%). There was no statistically significant difference in the percentage of confessions reporting shaking alone when comparing continents: North America (64.0%), Europe (64.2%) and Oceania (60.0%; p = 0.92), or when comparing circumstances in which the confession was obtained: medical evaluation (74.6%) vs police or judicial investigations (63.4%; p = 0.11). Of 119 cases with identified perpetrators, 67.2 per cent were cases with males alone. Confessions reveal striking similarities in the mechanism of AHT (predominantly shaking) that occur across the globe. Key Practitioner Messages: Confessions can provide important information about AHT and have been reported in medical literature for over 40 years.The quality of evidence for the association of shaking with AHT has been questioned, but no systematic review of confessions of AHT has been performed previously.This systematic review of confessions of AHT reveals that shaking is the most common mechanism reported and that shaking and AHT occur together across the world. 'We systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics' [ABSTRACT FROM AUTHOR]

Aim: Plant‐based diets are recommended in the context of environmental sustainability and health. Since not all plant foods can be considered beneficial, a distinction needs to be made between healthful and unhealthful plant foods. The aim of this study was to investigate longitudinal associations between changes in an overall plant‐based diet index, a healthful plant‐based diet index and an unhealthful plant‐based diet index, with changes in anthropometrics and blood lipids as indicators of morphological and metabolic fitness, respectively. Methods: A 3‐day dietary record was completed by 650 Flemish adults (420 men, 230 women) in 2002‐2004 and 2012‐2014. Three plant‐based diet indices were calculated based on quintile scores regarding the intake of animal‐ or plant‐based food items. Associations between 10‐year changes in diet indices and changes in anthropometrics and blood lipids were tested using multivariate linear regression. Results: Plant‐based diet indices did not differ over time. Using the unadjusted model, few significant associations were found between changes in diet indices and changes in anthropometrics and blood lipids. However, these relationships disappeared after adjusting for confounding. In women, a positive association was found between changes in overall plant‐based diet index and changes in body mass index in the adjusted model. Conclusions: Index values did not differ over time and few longitudinal associations were found. [ABSTRACT FROM AUTHOR]

Objectives: Access to clean water is a global concern. For women living in developing countries, the lack of clean water increases their risk of bacterial infections, such as a urinary tract infection (UTI). The purpose of this study was to examine if the location of water source has a relationship with the rate of UTIs in women who lived in the Léogâne area of Haiti. Design: Descriptive, correlational, retrospective chart review used de‐identified data from medical intake flow sheets. Sample: A total of 311 medical intake flowsheets with 32.4% of the sample were treated for a UTI. The majority of women were between the ages of 20 and 44 years. Results: The youngest group, ages 10–14 years, were more likely (83.3%) to be diagnosed with a UTI (X2 = 7.956, df = 3, p < .05) when compared to the other age groups. The location of water source also had a relationship with UTI, with women who reported using pump water more likely to be treated for a UTI than those who reported using short‐well water (X2 = 4.318, df = 1, p < .05). Conclusions: Although the study only involved Haitian women, the concepts of access to clean water, reducing bacterial infections such as a UTI, and health promotion are useful for any provider practicing in or going to a developing country. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess Jordanian neonatal nurses' knowledge and beliefs toward the application of kangaroo mother care in the neonatal intensive care unit. A cross‐sectional, descriptive survey was performed using a convenience sample of 229 nurses. The findings revealed that the majority of the nurses agreed that kangaroo mother care was beneficial to both mothers and infants; however, 47.2% believed that it was not feasible for all preterm infants. The majority of nurses believed that kangaroo mother care should be restricted to infants on intravenous treatment, intubated, or with an umbilical catheter. The majority of the nurses correctly answered questions regarding kangaroo mother care. A significant relationship was found between the nurses' knowledge and their beliefs toward kangaroo mother care. The findings of this study provide insights into Jordanian nurses' knowledge and beliefs toward the kangaroo mother care approach. If addressed, these findings will help improve the practice and nursing care for preterm infants. [ABSTRACT FROM AUTHOR]

Aim: This study explores Australian clinical nurses' and midwives' familiarity with a new code of conduct and understanding in what ways the code is important for nurses as they carry out clinical practice. Background: Codes specify the expectations of nurses' responsibilities, legal requirements, behaviour and conduct. Being familiar with the code is central to being a professional nurse or midwife. As nursing continues to advance, updating the code is crucial to maintain professional and safe practice. Design: This project utilized a cross‐sectional descriptive design. Methods: A survey was developed incorporating Likert‐type scale assessments of the 7 value statements from the 2018 Australian Nurses' Code of Conduct for familiarity and importance. The survey included open‐ended questions to elicit clinical nurses' experiences of conduct breaches, opinions regarding usefulness and relevance of the code for current practice. Data were collected at an acute care hospital in Sydney during January 2018. Results: Significant differences relating to cultural and patient‐centred approaches were revealed in the study. The new value involving the role of research was least understood and ranked least important by nurses and midwives. Professional 'integrity' resonated with participants when considering the behaviour of nurses, and short, unambiguous values were the most popular. Additionally, a substantial number of participants had no knowledge of the code or were not aware of the recently revised version. Conclusion and implications for nursing: A code of conduct provides structure and guidance for workplace values and principles. A respected code is important to the nursing profession to help prevent inappropriate and incompetent behaviour and as a guide for nursing performance. Nurses in this study claimed the code was highly relevant to their work as a nurse and was incorporated into their daily practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to examine prevalence and correlates of skipping breakfast in a representative sample of children and adolescents. Methods: Cross‐sectional, observational study. Population data derived from a school‐based health survey carried out in 2015 on 177 091 Greek children aged 8–17 years. Trained investigators performed all anthropometric evaluations. Breakfast skipping and adherence to the Mediterranean diet (MD) was assessed through the Mediterranean Diet Quality Index for children and adolescents. Physical activity status, sedentary activities and sleeping hours were assessed through self‐completed questionnaires. Results: Almost one in four (22.4% of boys, 23.1% of girls) schoolchildren skipped breakfast. Participants' characteristics associated with skipping breakfast were being female, being older, being overweight/obese, poorer diet, inadequate physical activity levels, insufficient sleep and increased screen time. Regression models adjusted for several potential confounders demonstrated that poor dietary habits, insufficient sleeping status (<8–9 hours per day), and increased screen time (>2 hours per day), increased the odds for skipping breakfast by almost 80% (95% CI: 1.78–1.82), 23% (95% CI: 1.20–1.26) and 22.5% (95% CI: 1.19–1.26), respectively. Conclusions: Skipping breakfast was common among schoolchildren. Participants who skipped breakfast tended to have an unhealthy lifestyle profile. Policies designed to increase breakfast consumption should target schoolchildren with unhealthy lifestyle profiles. [ABSTRACT FROM AUTHOR]

Aim: To identify the association between sexual behavior and suicidal ideation among South Korean middle school students. Methods: This study used raw data from the 2013 Korean Youth Risk Behavior Web‐Based Survey. Among the data from 72,435 students, the data from 36,530 individuals in middle school were analyzed. The prevalence of sexual behavior and suicidal ideation, according to the participants' general characteristics, and suicidal ideation, according to sexual behaviors, were assessed by using a complex sample Chi‐squared test. A complex sample logistic regression was used to examine the association between sexual behavior and suicidal ideation. Results: Overall, 3.8% of the students reported having had sexual intercourse and 17.6% of the students reported suicidal ideation during the past 12 months. Having had sexual intercourse was statistically significantly associated with suicidal ideation. The students who had had sexual intercourse usually used contraception and those who had contracted sexually transmitted diseases were more likely to report suicidal ideation in both the unadjusted and adjusted models. Conclusion: This study illustrates the need to develop a prevention program that addresses the common factors between sexual behavior and suicidal ideation in order to effectively reduce both sexual behavior and suicidal ideation in middle school students. [ABSTRACT FROM AUTHOR]

Background: Understanding how nursing students in European countries perceive their future professional role is an important step in creating awareness of the diversity and similarities between countries. Investigating nursing students' perceptions of their future profession could help in the design of education and the retention of nurses. Aim: To compare nursing students' perceptions of the professional nurse's role between Belarus, Lithuania, Poland and Sweden. Method: A cross‐sectional design was implemented. The study used two scales of the Professional Nursing Image Survey, which has questions about 10 skills and abilities and 14 functions and duties of a nurse. Results: A total of 392 final‐year nursing students in four countries participated in the study. Statistically significant differences were found between countries in terms of all 10 skills and abilities and in the distribution of responses concerning functions and duties of a nurse. Conclusions: Nursing students in Belarus, Lithuania, Poland and Sweden perceive differently the role of a nurse in terms of some functions and responsibilities. This may influence the adaptation of nurses who enjoy freedom of movement among the countries. Implications for nursing policy: The knowledge gained in this study could be beneficial in improving nursing education, as it could illuminate the discrepancy between educational goals and students' perceptions of their future professional role. [ABSTRACT FROM AUTHOR]

The Leiden Rankings can be used for grouping research universities by considering universities which are not statistically significantly different as homogeneous sets. The groups and intergroup relations can be analyzed and visualized using tools from network analysis. Using the so‐called "excellence indicator" PPtop‐10%—the proportion of the top‐10% most‐highly‐cited papers assigned to a university—we pursue a classification using (a) overlapping stability intervals, (b) statistical‐significance tests, and (c) effect sizes of differences among 902 universities in 54 countries; we focus on the UK, Germany, Brazil, and the USA as national examples. Although the groupings remain largely the same using different statistical significance levels or overlapping stability intervals, these classifications are uncorrelated with those based on effect sizes. Effect sizes for the differences between universities are small (w <.2). The more detailed analysis of universities at the country level suggests that distinctions beyond three or perhaps four groups of universities (high, middle, low) may not be meaningful. Given similar institutional incentives, isomorphism within each eco‐system of universities should not be underestimated. Our results suggest that networks based on overlapping stability intervals can provide a first impression of the relevant groupings among universities. However, the clusters are not well‐defined divisions between groups of universities. [ABSTRACT FROM AUTHOR]

BACKGROUND We examined prevalence, incidence, and trajectory of obesity from kindergarten through grade 8 in one of the first states to implement annual surveillance. METHODS: Participants included 16,414 children enrolled in kindergarten in Arkansas in 2004 with complete body mass index (BMI) measurements in kindergarten and eighth grade. Repeated measures of weight status were entered in multiple linear and logistic regression models with demographics and family poverty status. RESULTS: The prevalence of obesity (BMI ≥ 95th percentile) was lowest in kindergarten (14.9%), with subsequent incidence rates consistent at 4%. Prevalence and incidence peaked in eighth grade (24.5% and 4.9%, respectively), with 33.8% of children measuring obese at least once by eighth grade. Kindergarten obesity was a significant predictor of eighth grade obesity (odds ratio, 17.5; 95% confidence interval, 15.8‐19.3). We found statistically significant 3‐way interactions for sex, race, and time, suggesting unique patterns for Hispanic boys and black girls. CONCLUSIONS: Our study documents unique longitudinal patterns of obesity from kindergarten through eighth grade that expand our understanding of risk. It demonstrates the value of public school health systems that collect routine administrative data about student BMI that is integrated with education records to foster program and policy discussions. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effect of progressive muscle relaxation on the caregiver burden and level of depression among the caregivers of older patients with a stroke. Methods: This randomized, controlled experimental study was conducted between December, 2015 and July, 2017 with the caregivers of older patients with a stroke who had been admitted to the home care unit of a state hospital. The caregivers were randomly assigned to intervention (n = 23) and control (n = 21) groups, based on the study's inclusion criteria. The caregivers in the intervention group practiced progressive muscle relaxation exercises at home 3 days per week for 8 weeks. The control group had no intervention. Results: The mean age of the older patients with a stroke was 80.15 ± 9.86 years and the mean duration of the disease was 39.07 ± 44.69 months. The mean age of the caregivers was 50.29 ± 12.62 years, 84.1% of whom were female, 38.6% were elementary school graduates, and 86.4% were married. It was found that there was a statistically significant decrease in the mean Zarit Caregiver Burden Scale and Beck Depression Scale scores of the caregivers in the intervention group after practicing progressive muscle relaxation, but this decrease was not statistically significant when the intervention and control groups were compared. Conclusion: This study showed that there was a statistically significant decrease in the caregiver burden and level of depression among the caregivers in the intervention group after progressive muscle relaxation exercises, but that there was no statistically significant difference when the intervention and control groups were compared. [ABSTRACT FROM AUTHOR]

Objective: To quantify screening rate for gestational diabetes mellitus and completion of oral glucose tolerance test in rural and remote Western Australia. Design and participants: Retrospective audit of 551 antenatal records from women of 16 years and older without pre‐existing diabetes and with singleton pregnancies delivered in 2013. Main outcome measures: Number of women recorded screened for gestational diabetes mellitus in second or third trimester using oral glucose tolerance test or other tests; gestational diabetes mellitus rate. Results: Only 278 (50.5%) women were screened with oral glucose tolerance test; 113 (20.5%) had no record of any screening related to gestational diabetes mellitus. In a nested mixed‐effects logistic regression model, women with a previous gestational diabetes mellitus diagnosis, two or more risk factors (excluding ethnicity) or high‐risk gestational diabetes mellitus ethnicity other than Australian Aboriginal were more likely to be screened, while Australian Aboriginal women were less likely to be screened with oral glucose tolerance test. Clinicians reported patient and clinician factors and logistical difficulties as reasons for the oral glucose tolerance test not being completed at their site. Of those screened with oral glucose tolerance test, a high rate of gestational diabetes mellitus was diagnosed (14.7% versus Western Australia state‐wide average of 7.4%). Conclusion: Adherence to oral glucose tolerance test screening in rural Western Australia is inadequate for effective screening for gestational diabetes mellitus. Screening was not acceptable or available for a significant proportion of women at risk. Efforts to improve oral glucose tolerance test adherence and exploration of alternative gestational diabetes mellitus screening strategies are required. [ABSTRACT FROM AUTHOR]

Background: Severe fetal growth restriction (FGR) is a leading cause of adverse perinatal morbidity and mortality; however, in Victoria, 35% of severely growth‐restricted infants are undelivered by 40 weeks gestation. Aims: We aimed to identify factors associated with failure to deliver severely growth‐restricted fetuses by 40 weeks gestation. Methods: We conducted a retrospective case‐control study of term singletons born <3rd centile for gestation at a single tertiary centre (2010–2017). Infants with a planned delivery for FGR between 37.0–39.6 weeks gestation ('planned birth' group; n = 187) were compared with those undelivered by 40.0 weeks ('undelivered' group; n = 233). Variables assessed included the presence of risk factors for FGR, model of care, symphyseal‐fundal height measurements and third trimester ultrasounds. Results: An equivalent proportion of women were 'high‐risk' for FGR on history (31.3% vs 38.0%, P = 0.187) in the planned and undelivered groups. Women booked under low‐risk models (shared care and midwifery‐led care) were significantly more likely to be in the undelivered group compared to those booked under traditional collaborative models (79.8% vs 37.4%, P < 0.001). Women in the undelivered group were less likely to have received a third trimester ultrasound (93.0% vs 40.3%, P < 0.001); however, they were more likely to have had a reassuring ultrasound with an estimation of fetal weight or abdominal circumference >10th centile (78.7% vs 16.1%, P < 0.001). Conclusions: Failure to deliver the severely growth‐restricted fetus before 40.0 weeks is more likely to occur in the following situations: (i) failure to receive an indicated third trimester ultrasound; (ii) the presence of falsely reassuring third trimester ultrasound scan; and (iii) booking under a low‐risk rather than traditional collaborative models of care. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the effectiveness of a peer coaching smoking cessation program in a high‐risk Medicaid population. Design and Sample: In this manuscript, we present an evaluation of a pilot program. Participants (N = 138) were recruited out of a larger smoking cessation program administered statewide and funded by the Center for Medicare and Medicaid Services. The participant sample was diverse, with 52% self‐identifying as White, 39% as Black, and 56% Latino ethnicity (any race). Methods: Motivational interviewing techniques were utilized by peer coaches in clinical and community settings to achieve smoking cessation using face‐to‐face, telephone, and text/email encounters over a period of 6 months. Results: There was a statistically significant increase in the number of participants who had quit smoking from program enrollment to discharge (5.1%–18.5%, p = 0.02). Number of peer coaching encounters predicted quitting in program participants. Conclusions: This study adds to the literature that community‐based smoking cessation services led by peer coaches can be effective in a diverse, high‐risk population. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between ADL and oral health status in older adults. Design and Sample: Quantitative, analytical, cross‐sectional research with 280 people aged ≥60 in public primary health care centers in the city of Fortaleza, Northeastern Brazil. Measures: Collection of sociodemographic data, oral discomfort data, and general health data and application of the Community Oral Health Indicator—COHI and the activities of daily living scale. Results: Significant differences in functional dependence were found between age groups (p < .001), incomes (p = .034), and levels of education (p = .003). Tooth loss (OR = 2.13; p = 0.025), having no teeth (OR = 2.97), difficulties in chewing and swallowing food (OR = 2.56; p = 0.003), problems with taste of food (OR = 2.06; p = .044), poor self‐rated general health (OR = 3.7; p = .001), hearing problems (OR = 2.23; p = .009) and speech problems (OR = 3.15; p = .002) increased chances for functional dependence. Dependent individuals were less likely to use toothpaste, thereby increasing the potential for caries (p = .013). Age 80 or older (p < .001), ages 70–79 (p < .001), three or more visible dental cavities (p = .030) and difficulty chewing and swallowing food (p = .027) remained associated with dependence in ADL in the logistic regression model. Conclusion: Functional dependence in activities of daily living has implications for the oral health status of older people. [ABSTRACT FROM AUTHOR]