Search

Many clinical trials involve partially clustered data, where some observations belong to a cluster and others can be considered independent. For example, neonatal trials may include infants from single or multiple births. Sample size and analysis methods for these trials have received limited attention. A simulation study was conducted to (1) assess whether existing power formulas based on generalized estimating equations (GEEs) provide an adequate approximation to the power achieved by mixed effects models, and (2) compare the performance of mixed models vs GEEs in estimating the effect of treatment on a continuous outcome. We considered clusters that exist prior to randomization with a maximum cluster size of 2, three methods of randomizing the clustered observations, and simulated datasets with uninformative cluster size and the sample size required to achieve 80% power according to GEE‐based formulas with an independence or exchangeable working correlation structure. The empirical power of the mixed model approach was close to the nominal level when sample size was calculated using the exchangeable GEE formula, but was often too high when the sample size was based on the independence GEE formula. The independence GEE always converged and performed well in all scenarios. Performance of the exchangeable GEE and mixed model was also acceptable under cluster randomization, though under‐coverage and inflated type I error rates could occur with other methods of randomization. Analysis of partially clustered trials using GEEs with an independence working correlation structure may be preferred to avoid the limitations of mixed models and exchangeable GEEs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Teachers can face demanding and stressful working conditions. Classroom environments in elementary schools are dynamic and challenging, which can be mentally and emotionally exhausting for teachers. This study aimed to investigate the prevalence of psychological distress and identify associated factors among elementary school teachers. METHODS: This is an analytical, observational cross‐sectional study. The participants consisted of 450 teachers selected using the cluster sampling method from elementary schools of Tabriz, Iran. Multiple regression analysis was performed to examine the associations between teachers' psychological distress and potential factors. RESULTS: The study found a significant proportion of participants (54.2%) experiencing psychological distress. Multiple regression analysis revealed age, sex, work experience, school type, family income status, teachers' efficacy, emotional labor, and presenteeism were statistically associated with teachers' psychological distress. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: To address teachers' psychological distress, schools need to adopt policies that promote teacher well‐being and mental health support. CONCLUSION: The high prevalence of psychological distress among elementary school teachers raises concerns and highlights the need for attention. Schools and administrators must provide teachers with the resources and support they need to succeed in their roles. Interventions targeting the identified associated factors must be planned to improve the mental health of elementary school teachers and enhance their overall performance. [ABSTRACT FROM AUTHOR]

Aim: To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation‐involved defects. Materials and Methods: Fifty‐seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non‐furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI‐clustering method was also applied. Results: In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p =.01) was detected in FI compared with NF; IL‐6, MMP‐3, MMP‐8, BMP‐2, SOST, EGF and TIMP‐1 levels were increased in the GCF of FI compared with NF. Conclusions: This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI‐based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic is a serious public health challenge that causes negative effects on adolescents. This study aims to investigate the mediating roles of individual, family and community resilience in the association between COVID‐19‐related stress and quality of life according to the socio‐ecological theory. The sample consists of 814 adolescents from high schools in Zhejiang province, China (mean age = 16.79 years; 51.11% girls), collected by a multi‐stage cluster random sampling. The multiple mediation model is performed by SPSS macro PROCESS. The results show that individual resilience (β = −0.017, 95% CI [−0.044, −0.003]), family resilience (β = −0.028, 95% CI [−0.058, −0.008]) and community resilience (β = −0.031, 95% CI [−0.062, −0.007]) partially mediate the relationship between COVID‐19‐related stress and life satisfaction. Moreover, individual resilience (β = −0.028, 95% CI [−0.056, −0.008]), family resilience (β = −0.017, 95% CI [−0.042, −0.002]) and community resilience (β = −0.033, 95% CI [−0.065, −0.007]) also partially mediate the relationship between COVID‐19‐related stress and subjective well‐being. This study not only elucidates the mediating roles of multidimensional resilience but also provides valuable insights into improving adolescent resilience across different systems. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the importance of maximizing program‐setting fit in scaling and spreading effective programs. However, in the context of hospital‐based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site‐initiated adaptations to STRIDE, a hospital‐based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States. Methods: STRIDE was implemented at eight hospitals in a stepped‐wedge cluster randomized trial. During the pre‐implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site‐level support calls and group‐based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications‐Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post‐implementation period. Results: A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (n = 13), patient eligibility criteria (n = 5), program enhancements (n = 3), staffing model (n = 2), and marketing and recruitment (n = 2). More than one‐half of adaptations were planned. Adaptations were common in both sustaining and non‐sustaining sites. Conclusions: Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this pragmatic stepped‐wedge cluster RCT was to determine the efficacy of a co‐designed dementia specialist training program (the PITCH program) for home care workers (HCWs) to improve their confidence and knowledge when providing care for clients living with dementia. Methods: HCWs who provided care to clients with dementia were recruited from seven home care service provider organisations in Australia between July 2019 and May 2022, and randomised into one of 18 clusters. The primary outcome was HCW's sense of self‐competence in providing care services to people living with dementia at 6 months post PITCH training measured by the Sense of Competence in Dementia Care Staff (SCIDS) Scale. Results: Two hundred and thirteen HCWS completed baseline assessment and almost half (48.4%) completed all three study assessments. HCWs in clusters that received PITCH training had significantly higher sense of competence (measured by SCIDS) than those who had not received PITCH training. Post hoc analysis revealed that face‐to‐face PITCH training consistently resulted in improvements in the HCWs sense of competence, dementia attitudes and knowledge when compared to online training and when compared to no training. PITCH training had no effect on the sense of strain HCWs felt in delivering dementia care. Conclusions: Given the majority of care for people living with dementia is provided at home by family carers supported by HCWs, it is essential that HCWs receive training that improves their skills in dementia care. This study is an important step towards better care at home for people living with dementia. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to show the association between internet addiction (IA), sleep quality, and psycho‐social problems among secondary school students Design: A cross‐sectional, descriptive, and correlational study design was used. Sample: A total of 557 students from four secondary schools in Erbil were selected using multistage cluster sampling Measurements: The questionnaires of this research contained socio‐demographic data, Internet Addiction Test (IAT), Pittsburgh Sleep Quality Index (PSQI), and Pediatric Symptom Checklist—Y (PSC‐Y) questionnaire. Results: Findings indicated that students displayed a mild IA, averaging a score of 42.9 ± 19.18. Furthermore, the average sleep quality (PSQI) score was 8.95 ± 2.75, indicating moderate sleep disturbance, and the average score for psycho‐social problems was 27.78 ± 13.29. Importantly, there was a strong and positive association between IA and psycho‐social issues, as shown by a correlation coefficient of 0.31 (p <.001). Sleep quality was correlated with IA and psychosocial issues (p <.001, correlation values:.23 and.27, respectively) Conclusions: The study highlights the urgent need for health policymakers and nursing managers in Erbil to develop targeted interventions, such as awareness campaigns and digital well‐being programs in school curricula, to mitigate the interlinked issues of IA, sleep quality, and psycho‐social problems among students. [ABSTRACT FROM AUTHOR]

Aim: Few studies have assessed the association between weight changes from childhood to adulthood and cardiometabolic factors in adulthood. The aim of this study was to explore the relationships between weight changes from childhood to adulthood and cardiometabolic factors in adulthood using national Chinese data. Methods: We included 649 participants from the China Health and Nutrition Survey from 1989 to 2009 and divided them into four groups by their body mass index from 6 to 37 years of age. They were selected using multistage random cluster sampling from 15 areas with large variations in economic and social development. Poisson regression models assessed associations between weight status changes and cardiometabolic outcomes in adulthood. Results: The risk of multiple abnormal cardiometabolic outcomes in adulthood was increased in the 126 subjects with normal weight in childhood but overweight or obesity in adulthood and the 28 with obesity at both ages, compared to the 462 with normal weight at both ages. There was insufficient evidence to demonstrate that the 33 who had weight issues as children, but not as adults, had an increased risk. Conclusion: Being overweight or obese in both childhood and adulthood or during adulthood only increased the risk of abnormal cardiometabolic outcomes in adulthood. Larger studies need to investigate whether weight problems in childhood, but not adulthood, increase the risk. [ABSTRACT FROM AUTHOR]

Introduction: Handgrip strength and the 5‐time chair‐stand test are the two important muscle strength measures run through the whole sarcopenia diagnosis algorithm. There is a lack of evidence to confirm which muscle strength measures have a higher detection rate of sarcopenia among Chinese older adults, which is a challenge for community workers to choose the muscle strength measures and to identify more sarcopenia in clinical practice. Objective: We aimed to investigate the prevalence and diagnostic agreement of sarcopenia based on handgrip strength and the 5‐time chair‐stand test among Chinese community‐dwelling older adults. Methods: This cross‐sectional study sampled 1027 community‐dwelling older adults from Hunan, China. We used handgrip strength and the 5‐time chair‐stand test to assess participants' muscle strength and used gait speed and bioimpedance analysis (BIA) to assess physical performance and skeletal muscle mass, respectively. The kappa values of the agreement test were used to evaluate the agreement of handgrip strength and 5‐time chair‐stand tests in the assessment of sarcopenia. Results: A total of 1027 participants were included in this analysis including 337 males and 690 females with an average age of 70.35 ± 7.24 years. The prevalence of possible sarcopenia, confirmed sarcopenia and severe sarcopenia based on handgrip strength was 50.8%, 20.3% and 14.5% respectively, while the corresponding prevalence for using the 5‐time chair‐stand test was 27.6%, 10.8% and 10.9%. The kappa value of the consistency test between handgrip strength and 5‐time chair‐stand test in the assessment of possible sarcopenia, confirmed and severe sarcopenia was 0.26, 0.51 and 0.62, respectively (p < 0.001 for all). Conclusions: The prevalence of possible sarcopenia, confirmed sarcopenia and severe sarcopenia based on handgrip strength was significantly higher than that of the 5‐time chair‐stand test. We recommend handgrip strength as the preferred method of muscle strength measurement for Chinese community‐dwelling older adults and use 5‐time chair‐stand tests when handgrip strength is not available. Implications for Practice: The findings provide information and suggestions to healthcare providers for choosing the muscle strength measures to detect more sarcopenia in clinical practice. Compared with the 5‐time chair‐stand test, handgrip strength has a better performance to identify sarcopenia in Chinese community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Sample clustering techniques play a crucial role in the data‐driven state evaluation of electromechanical equipment, and selecting an appropriate similarity measurement method for sample sets helps improve the clustering performance. The Jaccard coefficient is a commonly employed indicator of similarity for scalar set‐type samples. In this paper, we propose an incremental clustering algorithm for matrix‐type samples by defining an improved Jaccard coefficient. First, a new binary relation is formulated to derive a relationship matrix between samples. Second, an undirected graph is given by using the relationship matrix, and an improved pruning operation is provided to simplify the graph by eliminating redundant edges. Then, a new relationship matrix is generated according to the modified graph, which enables the calculation of the improved Jaccard coefficient. By using the improved Jaccard coefficient, the improved incremental clustering algorithm updates cluster centers by selecting a particular sample to maximize the sum of similarities between the selected sample and other samples within the same cluster. Finally, the effectiveness of the proposed incremental clustering algorithm is demonstrated in fault diagnosis and remaining useful life estimation application scenarios, respectively. The experimental results indicate that the improved algorithm outperforms traditional clustering methods. [ABSTRACT FROM AUTHOR]

Young children's physical activity (PA) has been decreasing while their sports participation has been increasing. Therefore, the aim of this research was to longitudinally examine whether and, if so, how organised and non‐organised PA participation by early childhood education and care (ECEC)‐aged children (T1; 3–8 years) predicted their accelerometer‐measured PA at primary school age (T2; 7–11 years). Secondarily, changes in organised and non‐organised PA participation over time were investigated. The cluster‐randomised study participants comprised 501 Finnish children (52.3% girls: T1, Mage = 5.57 ± 1.06; T2, Mage = 8.80 ± 1.07). PA participation was queried via guardian questionnaire at T1 and T2. Organised PA participation was operationalised as non‐participation, participation in one sport or multisport (two or more) participation; non‐organised PA was operationalised as time spent outdoors on weekdays and on weekend days. PA at T2 was measured using accelerometers. The primary outcome was tested using linear regressions, while a paired sample t‐test and Mann–Whitney U test assessed differences between T1 and T2. The results showed outdoor time and organised sports participation increased from T1 to T2. Moreover, outdoor time at T1 predicted more moderate‐to‐vigorous PA (MVPA) and less sedentary time at T2, while multisport participation predicted significantly more MVPA and less sedentary time at T2. Overall, being outdoors and multisport participation at younger ages appear to have predicted Finnish children's later (MV) PA and sedentary behaviour. Highlights: Outdoor time and multisports in early childhood positively predicted subsequent physical activity (PA) in middle childhood.Spending more than 30 min a day outdoors of ECEC hours predicted higher subsequent MVPA and lower sedentary time at school age.Adults promoting outdoor activities and multisports support children to adopt a physically active lifestyle. [ABSTRACT FROM AUTHOR]

BACKGROUND: Psychosocial support provision in schools is a promising strategy for overcoming barriers to accessing mental health care. This study aimed to assess teachers' knowledge, attitudes, practices, skills, and perceived barriers in providing psychosocial support to students in Jordan. METHODS: The sample included teachers working in public schools, private schools, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools, and Zaatari camp schools, as well as non‐formal education centers. The study utilized a multi‐stage stratified cluster sampling technique to select a nationally representative sample. RESULTS: A total of 549 teachers were included, and only 25.2% have ever received mental health training. Most teachers reported a high level of good and acceptable knowledge of psychosocial support and had a positive attitude toward the provision of psychosocial support, however, about a quarter (25.5%) agreed on feeling nervous in discussing students' psychosocial problems with their parents or school administrators. The least enacted practice was the systematic engagement with parents, school administration, and other community resources in students' well‐being (sometimes, 31.6%; rarely, 20.4%). Gaps in skills were mainly in communicating with external resources and parents. The main barriers included parents' misunderstanding of teachers' role in providing psychosocial support to students (56.8%), lack of integration of psychosocial support in the curriculum (55.6%), and challenges in identifying students with psychosocial problems due to large class sizes (54.3%). CONCLUSION: The results show that gaps extend beyond the individual level of teachers to the community level. School‐based psychosocial support interventions must consider the multiple factors that influence their implementation at multiple levels, including the individual, relational, community, and societal levels. [ABSTRACT FROM AUTHOR]

Marital satisfaction is a key indicator of family members' life satisfaction and mental and physical health. Parents' marital functioning affects their children's development. Given the significant impacts of marital satisfaction on children's psychological and behavioural development, the influencing paths need to be explored. This study aims to extend prior research by examining the direct effect of marital satisfaction on children's aggression and the intermediary roles of parents' and children's psychological distress. Using multi‐stage cluster random sampling, a total of 971 children and their parents were recruited in Shaanxi Province in Mainland China. Self‐reported questionnaires regarding marital satisfaction, psychological distress and aggression were completed. Results showed no significant direct impact of marital satisfaction on children's aggression, but children's psychological distress mediated this link. Moreover, parents' and children's psychological distress served as sequential mediators in the nexus between marital satisfaction and children's aggression. It means that a chain mediating mechanism existed. A better understanding of the underlying mechanisms may offer valuable insights that would aid policymakers and clinicians in designing effective prevention and interventions targeting children's behavioural problems. [ABSTRACT FROM AUTHOR]

Background: Information on the current status of oral health and related risk factors is lacking in Turkiye. This study aimed to evaluate dental caries and associated factors among the Turkish population using the findings of the third national oral health survey. Methods: This cross‐sectional epidemiological survey was carried out between March and September in 2018 including five index ages and age groups (5‐, 12‐, 15‐year‐olds, 35–44 and 65–74 age groups). A multistage cluster sampling design was used to obtain a national representative sample of these age groups. Participants were interviewed face‐to‐face using a structured questionnaire, and oral examinations were performed based on the methods and criteria suggested by the World Health Organization. The adjusted prevalence ratio for dental caries was estimated considering sociodemographic and behavioural characteristics by using log‐binomial and robust Poisson regression analysis in R and SAS software. Results: After data cleaning, a total of 11 091 participants remained. The prevalence of dental caries was 76.5% (95% confidence interval: 75.4%–77.7%) and determined to be associated with age, dental visit, and pain or discomfort history during the previous year among the Turkish population. Prevalence was also associated with the mother's education level among 5‐, 12‐ and 15‐year‐olds. For the 35–44 age group, individuals living in urban areas had lower dental caries than those living in rural areas. For 65–74 age group, none of the factors were significantly associated with dental caries. Conclusion: A high prevalence of dental caries was observed in Turkish children and adults. Therefore, it is necessary to strengthen current preventive oral health programs. Regular disease surveillance should be maintained. National oral health targets should be formulated in accordance with Turkiye's needs, resources and structure. [ABSTRACT FROM AUTHOR]

Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age‐disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0–5 months. In children aged 6–59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting. [ABSTRACT FROM AUTHOR]

Women empowerment is an underlying factor of child feeding and nutrition. However, the lack of standardized measurements has made it difficult to design interventions that embed women empowerment and measure their impacts. This study aimed to assess temporal trends in women empowerment in Ethiopia and evaluate their contribution towards improving dietary diversity in infants and young children. We used women and child data from the Ethiopian Demographic and Health Survey 2005, 2011, and 2016, yielding a total sample of 6113 mother–child pairs. The survey‐based women's empowerment index (SWPER) developed and validated for use in Africa was used to assess three dimensions of women empowerment: (i) social autonomy, (ii) decision making; and (iii) attitude to violence. We used multiple‐linear and multivariable logistic regression to assess the associations between SWPER and the number of food groups consumed/and the minimum dietary diversity (MDD). To determine drivers of changes over time, a regression decomposition analysis was run. Women empowerment indices have improved over the 2005–2016 period, but a significant proportion of women had low standardized SWPER scores for autonomy/social independence (47%) and attitude to violence (49%) domains in 2016. SWPER autonomy and SWPER decision‐making scores were strongly associated with the odds of meeting MDD. Changes in women empowerment accounted for 17% of the improvements in MDD between 2005 and 2016. SWPER was a stronger predictor of the change in MDD, than known predictors like wealth, child age, and urban residence. As a critical underlying driver of child nutrition, women empowerment should be boldly addressed and integrated in nutrition interventions. [ABSTRACT FROM AUTHOR]

Camera traps have transformed the way we monitor wildlife and are now routinely used to address questions from a wide range of ecological and conservation aspects. Sampling design optimization and a better understanding of drivers determining the precision of detection rates (i.e. the number of detections per unit of effort) are important methodological issues. Little attention has been focused on the effect of placing more than one camera on each sampling point (hereafter, clustered design), and/or rotating (i.e. redeploying) the cameras to new placements during the sampling period.We explored the differences in the precision of detection rates between clustered vs. single camera designs when cameras remained in the same location during the study. Furthermore, the effect of keeping the placement of cameras fixed or rotating them (i.e. moving them to new locations during the sampling period), when a limited number of camera devices are available, was also evaluated. We used simulations and field data to test differences in detection rate precision for the different sampling designs. We simulated three different population distributions (random, trail‐based and aggregated) and three abundance scenarios. The simulations were validated with a field experiment focused on eight species with different behavioural traits, including artiodactyls, carnivores, lagomorphs, and birds.When a fixed number of sampling points were monitored simultaneously, clustered designs generally resulted in an increase in the precision of detection rates compared to single designs. The absolute reduction in the coefficient of variation by clustered designs was on average 0.07 units (min: 0.01, max: 0.15), which represents an average relative reduction in CV of 31% (min:6%, max:44%). An improvement in precision was also observed as a higher number of sampling points was used for all population distributions and sampling designs tested. When a fixed number of cameras were available, rotating the cameras to independent locations improved precision (an absolute reduction of 0.19 CV units) when monitoring aggregated populations, but not for random and trail‐based population distributions.Synthesis and applications: Our research provides a guideline for wildlife managers and researchers to improve the precision of camera trap detection rates and optimize resource allocation. In general, the study design should accommodate the behaviour of the target species (e.g. spatial aggregation and abundance), monitoring program logistic resources (both human and economic) and study area characteristics (e.g. accessibility and vandalism). [ABSTRACT FROM AUTHOR]

Few studies have discussed ethnic disparities in school bullying victimization within developing countries. Based on an empirical survey of 1763 children in the Tibetan, Hui and Miao regions in China, this study reached two findings: First, there are significant ethnic disparities in bullying victimization within China's multiethnic regions, where a balanced representation of different cultures can contribute to reducing the risk of victimization. Second, the bullying victimization of different ethnicities is associated with microsystem factors, including the ethnic composition of a school, family dysfunction and children's aggressive behaviour, which displays more homogeneity than heterogeneity. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12‐aged children in primary schools in Hargeisa, Somaliland.A school‐based survey was conducted in Hargeisa in December 2022. Using 2‐stage cluster sampling, 405 children (12‐aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer‐administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA.The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non‐public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non‐public school (95% CI 1.16–2.12) and having many previous dental visits (95% CI 1.22–2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well‐educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning.Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one‐third most affected are a cause for concern. Children enrolled in non‐public schools formed the high‐risk group. Preventive oral public health programs targeting Somali school children are recommended. [ABSTRACT FROM AUTHOR]

Background: Students with intellectual and developmental disabilities (IDD) were disproportionately impacted by the COVID‐19 pandemic. This study's goal was to assess the effectiveness of 2 messaging strategies on participation in SARS‐CoV‐2 weekly testing. Methods: Cluster randomized trials were conducted at 2 school systems, the special school district (SSD) and Kennedy Krieger Institute (Kennedy) to assess messaging strategies, general versus enhanced, to increase weekly screening for SARS‐CoV‐2. Testing was offered to staff and students from November 23, 2020 to May 26, 2022. The primary outcomes were percentage of students and staff consented weekly and percentage of study participants who had a test performed weekly. Generalized estimating equation models were utilized to evaluate the primary outcomes. Results: Increases in enrollment and testing occurred during study start up, the beginning of school years, and following surges in both systems. No statistical difference was observed in the primary outcomes between schools receiving standard versus enhanced messaging. Implications for School Health Policy, Practice, and Equity: Frequent and consistent communication is vital for families and staff. Weekly screening testing within schools is possible and highlighted the importance of utilizing equitable protocols to provide important testing to students with IDD. Conclusion: Enhanced messaging strategies did not increase the number of participants enrolled or the percentage of enrolled participants being tested on a weekly basis. [ABSTRACT FROM AUTHOR]

Background: Based on previous evidence person‐centred care (PCC) as a quality indicator is important in long‐term care (LTC) settings for older people. Effective ways to increase nurses' person‐centred care competence are missing. Aim: To evaluate the effectiveness of a continuing education (CE) intervention named 'Person First—Please' (PFP) for improving nurses' PPC competence and its connection to PPC climate. Methods: Quasi‐experimental cluster design with intervention and control groups was carried out in LTC settings for older people. The intervention group (n = 77) received a 10‐week CE intervention, with control group (n = 123) working as usual. The primary outcome was professional nurses' PCC competence. Secondary outcome was the PCC climate as perceived by nurses and, residents with their next of kin. Measurements were conducted pre−/post‐intervention and after 6 weeks using the validated, Person‐centred Care Competence scale and the Person‐centred Care Climate questionnaire, staff and patient versions. Data was analysed with descriptive and inferential statistics. Results: PCC competence was significantly increased in the intervention group and remained after 6 weeks of follow‐up. PCC climate increased in the intervention group in total score and also in all sub‐scales, across residents with their next of kin. The control group did not show any significant change. Comparisons of PCC competence and PCC climate in time between intervention and control groups confirmed that changes seen between groups were statistically significant in intervention group. Limitations: Measurements were self‐assessments, which may have been affected by bias, especially in context of competence assessment. Conclusion: The intervention was effective in increasing professional nurses' PCC competence and on person‐centred care climate in long‐term care settings for older people. [ABSTRACT FROM AUTHOR]

Objective: This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. Design: Community‐based cross‐sectional study. Setting: Tigray region of Northern Ethiopia, between November 2020 and May 2022. Population: This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. Methods: The study was conducted in two phases. In the first phase, reproductive‐age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. Main Outcome Measures: Maternal mortality ratio level and cause‐specific mortality. Results: The results of the study showed that the maternal mortality ratio was 840 (95% CI 739–914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy‐induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. Conclusions: This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre‐war level of 186/100 000. Furthermore, potentially many of the pregnancy‐related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence. [ABSTRACT FROM AUTHOR]

Background: Positive development plays an important role in youth when dealing with stressful circumstances. According to the resource dilution theory, adolescents with or without siblings may receive different levels of emotional and material resources from their parents. The purpose of this study is to examine the association between the positive development of adolescents in China today with their family characteristics such as the number of siblings. Methods: A total of 2072 junior high and senior high school students (13 to 18 years old) in Chengdu, Sichuan, China, were investigated by cluster sampling. The Chinese Positive Youth Development scales (CPYDs) were used to measure positive youth development. The generalized linear model was used to explore the relationships among the number of siblings, parent–child relationships and positive youth development. Results: Adolescents from only‐child families had better performance on positive development (H = 21.87, P < 0.001) and better relationships with parents (H = 15.1, P < 0.05). The positive development of male and female adolescents does not significantly differ in families with different numbers of siblings. The generalized linear model showed that a positive parent–child relationship is positively correlated with adolescent positive development (P < 0.05). Conclusion: Positive youth development is not only associated with the number of siblings but also other modifiable familial factors. The positive relationship between parents and adolescents is of great practical value in daily life to improve youth development, and this might be the real lesson the resource dilution theory tells. [ABSTRACT FROM AUTHOR]

General population studies find that rates of child maltreatment are higher than those identified in the child welfare system. Some modes of administration may result in higher disclosure rates of child maltreatment by respondents. This study assesses differences in characteristics of parents who are recruited using telephone sampling techniques or via the internet and whether the survey was administered by telephone or the web. We have 1599 parent respondents recruited from listed samples and Craigslist advertisements. Surveys were administered via the telephone or online. Survey included measures of parenting behaviours, psychosocial characteristics and demographics for the parent, child and family. Data were analysed using logit multilevel models. We found no differences between mode of administration and our child maltreatment and parenting measures, including physical abuse, corporal punishment and supervisory neglect. Recruitment strategy was not related to leaving a child home alone and corporal punishment. However, we did find that parents recruited by Craigslist use physical abuse more frequently. That we found no difference in use of punitive and neglectful parenting practices by survey mode of administration and recruitment method provides some degree of confidence that survey methods other than random‐digit‐dialling telephone surveys may result in generalizable samples in this age of declining landline use. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this study was to assess the effects of the Bienestar/NEEMA Coordinated School Health Program (BN CSHP) on cardiorespiratory fitness (CRF) of preschool children. METHODS: A cluster randomized trial was conducted of preschools in South Texas. Of 48 eligible schools, 28 were randomly assigned (14 intervention, 14 control). Family demographics and household health characteristics were collected from parents and CRF from children. Generalized linear mixed model (GLMM) was used to analyze the data. RESULTS: Family demographics, household health characteristics, and children's weight, obesity prevalence, and sedentary activity of the control group were similar to the intervention group at baseline. After adjusting for covariates, the number of laps ran by children in the control group increased by 23% (CI: −5% to 60%) per each data collection period compared with 53% (CI: 7% to 119%) in the intervention group. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: State mandates, parent engagement, and funding are key for designing effective health and Physical Education (PE) programs. CONCLUSION: Children in the BN CSHP, compared to those in the control group, had a significantly higher increase in their CRF. This finding is important because of the health benefits of CRF in children. ClinicalTrials.gov Identifier: NCT05501392. [ABSTRACT FROM AUTHOR]

The circular economy (CE) field has moved from purely conceptual research into empirical studies. However, the literature does not provide generalized conclusions regarding the overall state of CE transition in manufacturing companies. Existing studies lack a perspective in explaining differences among companies planning or already transitioning to the CE because most empirical research so far is based on single or few case studies, generally assuming that the transition to CE, once undertaken as a purpose, moves along a continuum from a linear model to a circular one. This paper identifies differences among manufacturing companies planning and transitioning to CE and conceptualizes readiness profiles along eight dimensions of change identified in the literature as essential to CE implementation in organizations. A cluster analysis of a sample of manufacturing companies from different sectors, sizes, and locations identified five readiness profiles: the laggards, the explorers, the frontrunners, the strategizers, and the information oriented. The results show that companies may follow different approaches when exploring the potential of CE in their businesses. While some companies decide to explore and experiment across all dimensions of change, others follow a more strategic or operational approach, suggesting different states in which companies find themselves. The findings offer evidence of the change happening across the manufacturing industry and how CE transition unfolds in practice, extending existing literature by providing more overall conclusions on how the transition might unfold in manufacturing companies and different states that companies might be regarding the multiple dimensions of change that should be considered. [ABSTRACT FROM AUTHOR]

Background and rationale: Cerebral venous thrombosis (CVT) is a rare cerebrovascular disorder that mainly affects young and middle‐aged adults. Epidemiological data on the incidence, risk factors, diagnosis, treatment, and prognosis of CVT are lacking in China. In addition, there is a lack of evidence from large, multicenter, real‐world studies on the efficacy and safety of endovascular. Aim: To understand the incidence, diagnosis and treatment status of CVT in China and to estimate the effectiveness and safety of endovascular treatment in the real‐world. Methods: A multicenter, retrospective observational cohort study will be conducted on CVT patient records from 104 hospitals, between January 1, 2018 and June 30, 2022, identified using a 2‐stage cluster sampling design based on per capita gross domestic product. Each enrolled participant is required to complete a further follow‐up, which includes the current situation and the assessment at 3 and 12 months after discharge. Study outcomes: The outcomes of this study will include the current status of the incidence, pathogenesis, etiology, clinical symptoms, diagnosis, and treatment of CVT in China, as well as the effectiveness and safety of endovascular treatment in the real‐world. Discussion: Results from this study will provide evidence on the incidence, specific risk factors, symptomatic and imaging features, and clinical outcomes of CVT in China as well as indicate whether endovascular treatment is superior to medical management alone for patients with acute CVT in the real‐world. Trial registration: http://www.clinicaltrials.gov. Identifier: NCT05448248 This is a protocal about our study. This protocal introduces the design, method and content of our research. [ABSTRACT FROM AUTHOR]

Improving the management of principals has been proven to be an effective strategy to reduce preschool teachers' turnover. However, relevant empirical evidence for preschool teachers is still insufficient. A total of 3623 preschool teachers from the Chinese mainland participated in the current study through random cluster sampling and were administered self‐report questionnaires to measure their principal's restrictive behavior, work–family conflict, effort–reward imbalance (ERI), and turnover intention. This study used serial mediation models to examine the direct relationship between the principal's restrictive behavior and preschool teachers' turnover intention, as well as the indirect relationship between the two variables through the independent and serial mediating roles of ERI and work–family conflict (including work‐to‐family conflict [WFC] and family‐to‐work conflict [FWC]). Results showed that among Chinese preschool teachers, (1) the direct relationship between the principal's restrictive behavior and turnover intention was significant; (2) ERI mediated the relationship between the principal's restrictive behavior and turnover intention; (3) WFC and FWC both mediated the relationship between the principal's restrictive behavior and turnover intention; and (4) a serial mediating effect of ERI and WFC/FWC was observed. The findings have theoretical and practical significance for interventions to reduce preschool teachers' turnover. Practitioner points: Principal's restrictive behavior is significantly positively correlated with preschool teachers' turnover intention.Effort–reward imbalance and work–family conflict play a serial mediation role in the relationship between the principal's restrictive behavior and preschool teachers' turnover intention.Both aspects of work–family conflict, namely work‐to‐family conflict (WFC) and family‐to‐work conflict (FWC), served as mediators in the serial mediation model mentioned above, but the mediation effect of FWC was greater. [ABSTRACT FROM AUTHOR]

Background: Falls are the leading cause of injury, disability, premature institutionalization, and injury‐related mortality among older adults. Home hazard removal can effectively reduce falls in this population but is not implemented as standard practice. This study translated an evidence‐based home hazard removal program (HARP) for delivery in low‐income senior apartments to test whether the intervention would work in the "real world." Methods: From May 1, 2019 to December 31, 2020, a stepped‐wedge cluster‐randomized trial was used to implement the evidence‐based HARP among residents with high fall risk in 11 low‐income senior apartment buildings. Five clusters of buildings were randomly assigned an intervention allocation sequence. Three‐level negative‐binomial models (repeated measures nested within individuals, individuals nested within buildings) were used to compare fall rates between treatment and control conditions (excluding a crossover period), controlling for demographic characteristics, fall risk, and time period. Results: Among 656 residents, 548 agreed to screening, 435 were eligible (high fall risk), and 291 agreed to participate and received HARP. Participants were, on average, 72 years, 67% female, and 76% Black. Approximately 95.4% of fall prevention strategies and modifications implemented were still used 3 months later. The fall rate (per 1000 participant‐days) was 4.87 during the control period and 4.31 during the posttreatment period. After adjusting for covariates and secular trend, there was no significant difference in fall rate (incidence rate ratio [IRR] 0.97, 95% CI 0.66–1.42). After excluding data collected during a hiatus in the intervention due to COVID‐19, the reduction in fall rate was not significant (IRR 0.93, 95% CI 0.62–1.40). Conclusions: Although HARP did not significantly reduce the rate of falls, this pragmatic study showed that the program was feasible to deliver in low‐income senior housing and was acceptable among residents. There was effective collaboration between researchers and community agency staff. [ABSTRACT FROM AUTHOR]

Undernutrition in childhood is a crucial public health issue in Ethiopia. Yet, more than an assessment of undernutrition using conventional index is needed to conclude the overall prevalence of undernutrition among children aged 6–23 months. Therefore, this study aimed to assess the prevalence of undernutrition using composite index of anthropometric failure and its associated factors among children aged 6–23 months in Southwest Ethiopia. A community‐based cross‐sectional study was employed among 440 mother–child pairs selected using a two‐stage cluster sampling method in the rural Kersa district, Jimma Zone, Southwest Ethiopia. A pretested structured questionnaire was used to collect data. Multivariable logistic regression analysis was employed to identify factors associated with undernutrition. Variables with a p‐value of <.05 were considered statistically significant. The proportion of undernutrition using composite indexes of anthropometric failure was 57.3% among children aged 6–23 months. Children being male [AOR = 1.55; 95% CI (1.013, 2.373)], not met minimum acceptable diet (MAD) [AOR = 2.104; 95% CI (1.05, 4.214)], larger family size [AOR = 1.699; 95% CI (1.0791, 2.675)], having comorbidity [AOR = 3.31; 95% CI (2.068, 5.327)], and being in food insecurity household [AOR = 3.12; 95% CI (2.0, 4.868)] were more likely to be in anthropometric failure, whereas children from the mother who attended higher and above schooling [AOR = 0.244; 95% CI (0.093, 0.641)] were less likely to be in anthropometric failure. More than half of children aged 6–23 months were experienced anthropometric failure. Male children, those who have not received the MAD, come from larger families, have comorbidities, live in food‐insecure households, and have mothers with higher education levels were found to be at higher risk of anthropometric failure. [ABSTRACT FROM AUTHOR]

Background: Several studies have explored the association between temperature and cognitive function. However, few studies have examined the effect of extreme temperature on cognitive function. In this study, we aimed to quantify the long‐term effect of extreme temperature (e.g., heat waves, cold spells, and hot night excess (HNE)) on cognitive performance in middle‐aged and older people in China. Method: We investigated 7915 aged >45 years people from the China Health and Retirement Longitudinal Study (CHARLS), surveyed in 2011 and 2015. A structured questionnaire was utilized to assess cognitive function, including four dimensions: episodic memory, attention, orientation, and visuo‐construction. Hourly ambient temperature from the ERA5‐Land datasets were used to calculate variables indicating extreme temperature. We performed difference‐in‐difference (DID) models to assess the potential causal relationship between extreme temperature and cognitive function. Results: Non‐linear analyses suggested that both sustained increases in temperature and excessive variability in temperature increased the risk of cognitive decline. Meanwhile, we observed the extra risk of global cognitive function decline was 2.3% (95% Confidence interval (95% CI): 0.2%, 4.4%) for heat waves (one unit increase) and 5.9% (95% CI: 0.6%, 11.6%) for HNE (one unit increase), while the association for cold spells was insignificant. Two cognitive dimensions, episodic memory and visuo‐construction, were sensitive to these two heat‐related factors. Conclusion: Extreme temperature was inversely related to cognitive performance in middle‐aged and older adults, which was substantial for heat waves and HNE particularly. The effect size varied by cognitive dimensions. Key points: Heat waves and hot night excess were related to cognitive function decline.Episodic memory and visuo‐construction were the two cognitive dimensions sensitive to extreme temperature.The long‐term effect size of extreme temperature varied by individual characteristics.A quasi‐experimental design was utilized to explore potential causal relationships. [ABSTRACT FROM AUTHOR]

In this study, the effects of gelatin concentrations (GC) (5.0–10.0 g/100 g), mixing rate (MR) (100–1100 rpm), and gelatin addition temperature (GAT) (55, 60, and 65°C) were investigated on the main textural and various physicochemical properties of model gels (n = 72) prepared using sucrose and glucose syrup (40–42 DE). Considering the p‐value of the F‐statistic calculated by analysis of variance and the 5% significance level, the production parameters and their interactions had a significant effect on the quality parameters. The influence of the production parameters GC, MR, and GAT, and the interaction of these parameters, GC * MR, GC * GAT, MR * GAT, and GC * MR * GAT of the model gels on the quality characteristic were expressed by converting the Type III SS values into percent values. When all quality characteristics were considered together, MR was the most influential with a score of 58%. PCAmix, a combination of factorial analysis with PCA, was used to visualize the correlations between the production parameters and the quality characteristics of the modeled gels. A great influence was observed between MR and moisture content, color properties, and texture parameters, except springiness. A moderate effect of GC and a minor effect of GAT could be characterized. With the 2D‐map of observations, the model gels could be clearly divided into two groups according to the MRs. In accordance with the observations diagram of PCAmix, the similarity dendrogram of AHC also formed two clusters, one cluster for the samples with MR 100 and 200 rpm and one cluster for the samples with MR 500 and 1100 rpm. [ABSTRACT FROM AUTHOR]

Objective: This study explored the relationship between unhealthy weight control behaviors (UWCBs) and their associated economic costs among adolescents using the 2014–2018 Longitudinal Study of Australian Children (LSAC). Methods: LSAC data in Wave 6 (n = 3538 adolescents aged 14–15 years), Wave 7 n = 3089 adolescents aged 16–17 years), and Wave 8 (n = 3037 adolescents aged 18–19 years) were derived from a representative sample of Australian adolescents. UWCBs were measured using the self‐reported Branched Eating Disorder Test questionnaire. UWCBs were sub‐classified into having fasting behaviors, using weight loss supplements or purging behaviors. Economic costs include healthcare and productivity costs to caregivers. Healthcare costs were measured using data from the Medicare and Pharmaceutical Benefits, which includes both medical and pharmaceutical costs. Productivity losses were measured using caregivers' lost leisure time due to UWCBs among adolescents. Results: The mixed effect model identified statistically significant higher economic costs (mean difference = $453, 95% CIs $154, $752), higher health care costs (mean difference = $399, 95% CIs $102, $695), and higher productivity costs (mean difference = $59, 95% CIs $29, $90) for adolescents with UWCBs compared to their peers with no UWCBs. Subgroup analysis revealed that higher costs were associated with fasting and purging behaviors. Discussion: UWCBs were associated with increased economic costs during adolescence. Our finding suggests there should be a policy focus on tackling UWCBs to reduce the economic burden on the healthcare system and society. Public Significance: The study contributes to existing knowledge by investigating the direct healthcare costs and productivity losses associated with unhealthy weight control behaviors in Australian adolescents (14–18 years old) using a dataset that follows Australian adolescents over time. We found that engaging in unhealthy weight control behaviors such as fasting, using weight loss supplements, and purging was linked to higher costs among adolescents, suggesting policies should focus on addressing these behaviors. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to investigate the association between violent sexual victimization and muscle‐building exercise among adolescents. METHODS: Cross‐sectional data from the 2019 National Youth Risk Behavior Survey (N = 8408) were analyzed. Two indicators of non‐dating‐related sexual violence (lifetime, past 12 months), along with one indicator of adolescent sexual violence (past 12 months), were assessed. Days of muscle‐building in the past week were reported. Multinomial logistic regression analyses were conducted to determine the associations between the three violent sexual victimization variables and muscle‐building exercise. RESULTS: Among the sample (50.3% girls), lifetime violent sexual victimization (relative risk ratio [RRR] 1.87, 95% confidence interval [CI] 1.29 to 2.72), past 12‐month violent sexual victimization (RRR 1.60, 95% CI 1.15 to 2.22), and past 12‐month sexual dating violence (RRR 1.60, 95% CI 1.03 to 2.51) were associated greater relative risk of high engagement (ie, 6 to 7 days) in muscle‐building exercise relative to no engagement. CONCLUSIONS: A history of violent sexual victimization is associated with greater involvement in muscle‐building exercise, particularly among adolescent girls. Engagement in muscle‐building exercise in relation to violent sexual victimization may be a means of emotion regulation and occur due to body dissatisfaction resulting from experiencing violence. [ABSTRACT FROM AUTHOR]

Introduction: Uganda was using a threshold of 1000 copies/mL to determine viral non‐suppression for antiretroviral therapy monitoring among people living with HIV, prior to this study. It was not clear whether people living with HIV with low‐level viraemia (LLV, ≥50 to <1000 copies/mL) would benefit from intensive adherence counselling (IAC). The purpose of this study was to determine the effectiveness of IAC among people living with HIV, receiving antiretroviral therapy, and with LLV in Uganda, to guide key policy decisions in HIV care, including the review of the viral load (VL) testing algorithm. Methods: This cluster‐randomized clinical trial comprised adults from eight HIV clinics who were living with HIV, receiving ART, and had recent VL results indicating LLV (tested from July 2022 to October 2022). Participants in the intervention arm clinics received three once‐monthly sessions of IAC, and those in the comparison non‐intervention arm clinics received the standard of care. At the end of the study, all participants were re‐tested for VL to determine the proportions of those who then had an undetectable VL (<50 copies/mL). We assessed the statistical association between cross‐tabulated variables using Fisher's exact test and then modified Poisson regression. Results: A total of 136 participants were enrolled into the study at eight HIV clinics. All 68 participants in the intervention arm completed all IAC sessions. Only one participant in the non‐intervention arm was lost to follow‐up. The average follow‐up time was 3.7 months (standard deviation [SD] 0.2) and 3.5 months (SD 0.1) in the intervention and non‐intervention arms, respectively. In total, 59 (43.7%) of 135 people living with HIV achieved an undetectable VL during the study follow‐up period. The effect of IAC on attaining an undetectable VL among people with LLV was nearly twice as high in the intervention arm (57.4%) than in the non‐intervention arm (29.9%): adjusted risk ratio 1.9 (95% confidence interval 1.0–3.5), p = 0.037. Conclusion: IAC doubled the likelihood of an undetectable VL among people living with HIV with LLV. Therefore, IAC has been instituted as an intervention to manage people living with HIV with LLV in Uganda, and this should also be adopted in other Sub‐Saharan African countries with similar settings. ClinicalTrials.Gov Identifier: NCT05514418. [ABSTRACT FROM AUTHOR]

Background: Anxiety is a prevalent mental disorder among the elderly, leading to discomfort, disability, increased expenses, reduced quality of life, and dysfunction. Consequently, this study was conducted to determine the prevalence of COVID‐19 anxiety and geriatric anxiety, along with the factors influencing anxiety, in the elderly population served by urban healthcare centres in Quchan. Methods: This cross‐sectional study involved 650 elderly individuals aged 60–95 years. The participants were selected using a two‐stage cluster sampling method. Data were collected through three questionnaires: the Geriatric Anxiety Inventory (GAI), the Corona Disease Anxiety Scale (CDAS), and a questionnaire on factors contributing to anxiety. Data analysis was performed using simple and multiple regression with IBM SPSS 24. Results: The prevalence of geriatric anxiety among the elderly was 40.3%, while the prevalence of COVID‐19 anxiety (moderate and severe) was 22.8%. Significant relationships were observed between geriatric anxiety and substance abuse, stressful life events, comorbidities, COVID‐19 anxiety, financial support, loneliness, walking habits, and sleep patterns (P < 0.05). Conclusion: COVID‐19 anxiety and geriatric anxiety are prevalent concerns among the elderly. Factors like substance abuse, stressful life events, COVID‐19‐related anxiety, comorbidity, living alone, lack of financial support, and poor walking and sleeping habits, which affect anxiety in the elderly, it is essential to address these factors in life planning and provide services through relevant organisations, healthcare teams, and initiatives by the elderly themselves. [ABSTRACT FROM AUTHOR]

Background: The early development of left‐behind children requires great concern and improvement. Yet, current interventions for left‐behind children are mainly focussed on children older than 3. This study aims to assess the effectiveness of a home visiting programme on family responsive care and early development of rural left‐behind children and examine whether family responsive care mediates the effects of intervention on child development. Methods: A quasi‐experimental study design was utilized in this study. A stratified clustered sampling was employed to choose villages in programme towns into intervention group. A control village was matched with every intervention village. All of the left‐behind children and their caregivers meeting the inclusion criteria in the chosen villages were enrolled in the survey. The outcomes included child development, caregiver's early stimulation, parent–child communication, and learning materials. Baseline assessments were conducted in 2018, and endline assessments were conducted in 2020. Results: In the endline survey, we enrolled 608 children with 258 in the intervention group and 350 in the control group. Left‐behind children in the intervention group were less likely to have development delay compared with the control group (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.36, 0.96). Migrant parents of children in the intervention group showed higher proportion of expressing emotional support to their children when communicating (OR = 1.69, 95% CI: 1.05, 2.72). Children who received home visits more than once per 2 months had lower level of suspected development delay than children in the control group (OR = 0.34, 95% CI: 0.18, 0.68). Caregiver's early stimulation and migrant parents' emotional support to left‐behind children mediated the intervention dose and left‐behind children's development. Conclusion: Caregiver's early stimulation mediates the intervention and child's development. The findings suggest a promising future for scaling similar early childhood development interventions for left‐behind children in rural settings. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the early development and nurturing care environment of children aged 0–6 years in rural China and to evaluate the sex‐ and age‐specific associations of nurturing care environment with child developmental outcomes. Methods: A cross‐sectional survey involving 2078 children aged 0–6 years was conducted using a stratified cluster sampling strategy. We used face‐to‐face interviews to collect information on child, family and nurturing care. The Ages & Stages Questionnaires‐Chinese version and ASQ: Social‐Emotional were applied to assess children's neuro‐ and social–emotional development, respectively. Lower neurodevelopmental scores indicate an increased risk for neurodevelopmental delay, and higher social–emotional scores are indicative to a risk of social–emotional problems. The multiple linear regression model examined the associations of nurturing care environments with childhood development. Results: Among the investigated children, the average age was (42.9 ± 19.8) months and 55.8% were boys; 67.9% of the children had absent fathers because of labour migration and 54.0% had limited access to books and toys. Overall, boys had a lower total neurodevelopmental score than girls; similar gender patterns were also found in the domains of communication, fine motor, problem‐solving and person‐social. Concurrent absent fathers and limited access to books and toys were significantly associated with reduced neurodevelopmental scores [β − 11.44, 95% CI (−18.20, −4.68)] and increased social–emotional developmental scores [β 5.88, 95%CI (1.35, 10.41)] after controlling for confounding factors. Sex‐specific analysis only echoed the results in boys. Additionally, having an absent father and limited access to books and toys was associated with lower neurodevelopmental scores [β − 14.58, 95%CI (−25.41, −3.75)] in children under 3 years of age and higher social–emotional developmental scores among children aged 3–6 years [β 10.66, 95%CI (5.09, 16.24)]. Conclusions: Children, especially boys, with absent fathers due to labour migration have poorer neuro‐ and social–emotional development. Limited access to books and toys and father absence are linked to the children's developmental delay, especially for those under 3 years of age. Our findings suggest that intervention programs in resource‐constrained rural areas are desirable; more importantly, such programs should begin before 3 years of age to achieve a benefit–cost outcome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Since 2002, the Chinese Ministry of Education has conducted reform in the physical education (PE) curriculums of schools in China, with a focus on shifting from sports skills to regular participation in physical activity (PA) and promoting health. The aim of the study, therefore, is to examine the effects of school PE on the exercise habits of children and adolescents in China over time. METHODS: Data based on 5941 observations of 3708 individuals aged 6 to 17 were collected from the China Health and Nutrition Survey (CHNS) for the period 2004 to 2015. The data were analyzed using the fixed‐effect Logit model and the random‐effect Tobit model. RESULTS: The likelihood of exercising outside of school is 20.2% higher for students who have school PE than those who do not. Our study found that increasing the duration of PE at school by 100%, increases the duration of out‐of‐school PA by 22.3%. The variety of the types of sports schools offer encourages students to participate in out‐of‐school physical activity. The likelihood of students exercising outside of school increases by 5.6% when 1 more exercise type is provided in school PE. In addition, soccer, basketball, badminton, and volleyball education increases students' participation in after‐school exercises. Soccer and basketball education, in particular, improves the duration of after‐school PA. CONCLUSIONS: To form exercise habits in children and adolescents, we encourage the promotion of a variety of physical activities in schools, especially team sports such as soccer and basketball. [ABSTRACT FROM AUTHOR]

In this work, we study how to improve well-known techniques for detecting progenitors/descendants of galaxies, such as the NDpredict program, when applied to galaxies in clusters. The improvement of this particular method is based on the use of the red sequence of galaxies in those environments. Objects close to the red sequence in the color and magnitude diagram are more likely to belong to the cluster. This defines a probability scale which is then combined with the one generated by NDpredict. This procedure is optimized for the study of galaxies in clusters over different epochs. Our main result is that, for a sample composed of 120 clusters, withmasses greater than 1013.25M?, selected from the IllustrisTNG simulations (namely, the TNG100 runs). In 99% of the cases (i.e., 119 systems), we obtain better performance with the red sequence method in comparison to the original NDpredict, and the average gain obtained is 28% in the identification of descendants for this sample of cluster galaxies. [ABSTRACT FROM AUTHOR]

Purpose: Our study explored the mediating effect of sleep‐related variables on older adolescents' mental health in the context of a school‐based physical activity intervention. Methods: We evaluated the Burn 2 Learn (B2L) intervention using a cluster randomized controlled trial, which included two cohorts. Participants for this sub‐study were from the second cohort, which included 292 older adolescents (16.0 ± 0.5 years) from 10 secondary schools in New South Wales, Australia. Teachers at intervention schools delivered two high‐intensity activity breaks (approximately 10 mins) per week to students during academic lessons. Participants completed measures of mental health (i.e., perceived stress and internalizing problems) and hypothesized mediators (i.e., sleep duration, sleep latency, awakenings, and daytime sleepiness) at baseline (February–April 2019) and post‐intervention (August–September 2019). Single mediation analyses were conducted to explore the potential mediating effects of sleep variables on mental health outcomes using a product‐of‐coefficient test. Results: We observed a small statistically significant effect for perceived stress (β = −0.11, SE = 0.034, p = 0.002), but not for internalizing problems (β = 0.02, SE = 0.051, p = 0.760). There were no significant intervention effects for sleep‐related variables. Several sleep‐related variables were associated with mental health outcomes but no mediated effects were found. Conclusion: The B2L intervention had a small beneficial effect on perceived stress, however our mediation analyses suggest this was not explained by changes in sleep‐related variables. Markers of sleep were associated with mental health constructs, highlighting the importance of sleep for good psychological health. However, in the context of a physical activity intervention, effects on mental health may be driven by other behavioral, neurobiological, or psychosocial mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: The public health system faces major challenges due to the double burden of diabetes mellitus (DM) and tuberculosis (TB) in China. We aimed to investigate the prevalence and impact of diabetes on patients with TB. Methods: Stratified cluster sampling was used to select 13 counties as study sites in the Zhejiang province. Patients who visited designated TB hospitals in these areas participated in this study between 1 January 2017 and 28 February 2019. Multiple logistic regression models were performed to investigate the association between DM and bacteriological and imaging results. A decision tree was used to predict the bacteriology and imaging results under the influence of DM. Results: Of 5920 patients with newly diagnosed pulmonary tuberculosis, 643 (12.16%) had DM. Patients with pulmonary TB and DM were more likely to have pulmonary cavities (adjusted odds ratio [aOR], 2.81; 95% confidence intervals [95% CI]: 2.35–3.37) and higher rates of positive bacteriological tests (aOR, 2.32; 95% CI:1.87–2.87). Decision‐tree analysis showed similar results. Conclusions: Concurrence of DM and pulmonary TB makes patients more likely to have positive bacteriological results and pulmonary cavities. Therefore, appropriate measures are necessary to promptly identify and manage patients with TB and DM. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between insulin resistance markers and periodontitis in adolescents, analyzing confounder variables and the adiposity as a mediator. Methods: This is population‐based study is representative of adolescents aged 17–18 years from public schools in São Luís, Brazil (n = 405). Insulin resistance was assessed using the Model of Assessment of the Homeostasis of the Insulin Resistance Index (HOMA‐IR) and its percussor triglycerides/HDL‐cholesterol ratio (TG/HDL‐c). The outcome was Initial Periodontitis, a latent variable estimated by the common variance shared among bleeding on probing, probing depth ≥ 4 mm, and clinical attachment loss ≥ 4 mm. The association between insulin resistance and Initial Periodontitis was modeled via pathways triggered by socioeconomic status, smoking, alcohol, and Adiposity, using structural equation modeling. Results: Higher TG/HDL‐c was directly associated with higher Initial Periodontitis (standardized coefficient [SC] = 0.130, p < 0.001). HOMA‐IR was not associated with periodontal outcome (SC = 0.023, p = 0.075), but it was with Adiposity (SC = 0.495, p < 0.001). Higher TG/HDL‐c was associated with Adiposity (SC = 0.202, p < 0.001). Conclusion: The insulin resistance markers were associated with early signs of periodontal breakdown among adolescents, suggesting a possible relationship between diabetes and periodontitis commences early in life. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study examines the influence of 2 noncognitive skills, self‐esteem and teamwork, on social disaster response awareness among Korean adolescents. Although self‐esteem is a well‐established predictor of health‐related knowledge, the inclusion of teamwork in this study is motivated by its collective nature and its relevance to social norms. METHODS: This study used data from the Korean Children and Youth Panel Survey 2018 (KCYPS 2018). Sibling fixed effects models, which account for the common unobserved characteristics shared by siblings within the same family, were estimated. RESULTS: Conventional ordinary least square models showed that both self‐esteem and teamwork are significant predictors of social disaster response awareness (bs =.011 and.014, respectively). However, our preferred sibling fixed effects estimates revealed that the controlling for unobserved family‐level confounders attenuates the association for self‐esteem, rendering it statistically insignificant (b =.003, p =.33). Despite some attenuation, the association between teamwork and social disaster response awareness was robust to controlling for sibling fixed effects (b =.010, p <.001). CONCLUSIONS: The study's finding emphasizes the role of students' interpersonal noncognitive abilities in their social disaster response awareness. An intervention aimed at enhancing adolescents' teamwork may be effective to improve their awareness about how to respond to social disasters. Policymakers and practitioners may consider developing social disaster preparedness curricula that highlight the importance of social disaster response measures as community rules or social norms, in addition to safeguarding personal safety. [ABSTRACT FROM AUTHOR]

Switzerland is a direct democracy, so its citizens are very often called to vote on various issues. Gaining voter status is, however, a very difficult process for many Swiss citizens with intellectual disability. This research describes the voting status of people with intellectual disability in four French–speaking cantons of Switzerland. It tries to understand systemic or structural factors, such as the guardianship legislation and the legal frameworks, that might have an impact on the voting status of these people. Three hundred individuals with intellectual disability (18–72 years) took part in the study. They were recruited in 11 facilities through a full selection or a letter‐cluster sampling procedure depending on the age group. A questionnaire for each participant was anonymously completed by a support person in the facilities. The questionnaire was constructed with the assistance of self–advocates with intellectual disability, as well as that of people with various roles in decisions regarding voting rights, or providing support to people with intellectual disability, in the participating cantons. Descriptive analyses have been used. The results show that on average slightly more than one person with intellectual disability out of two received voting material, and about one out of two used it. Non‐receipt of voting material is significantly linked to general curatorship, higher financial allowance, living in less independent conditions and/or working in the most protective sectors. People who use their rights more are those who live in more protective environments. Having an intellectual disability implies a higher risk of being deprived of one's political rights, even when the law does not systematically prescribe such a restriction. Even a tailor‐made gradual guardianship system can result in rigid applications of the law, characterized by illegitimate deprivation of rights, such as the right to vote. [ABSTRACT FROM AUTHOR]

Background: We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP). Methods: The Nepal Perinatal Quality Improvement Package was a stepped‐wedge cluster‐randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before–after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group. Results: There were 25 977 deliveries in the three hospitals during the study period: 10 207 (39%) in the control and 15 770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12–1.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96–2.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25–1.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55–2.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98–3.50). The cesarean birth rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64–3.68). Conclusions: The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low‐resource settings. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify a new barrier to the use of the Mini‐Nutrition Assessment Short‐Form (MNA‐SF), which is a malnutrition assessment tool for the risk assessment of sarcopenia in a nourished population. Methods: The MNA‐SF was completed, and individuals with a score of > 11 were considered nourished in this cross‐sectional feasibility study of a registry. Sarcopenia was assessed in 766 healthy, nourished adults (33.4% men, 64.9 ± 7.1 years) based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Results: The MNA‐SF scores for non‐sarcopenia, pre‐, confirmed, and severe sarcopenia were 13.59 ± 0.69, 13.73 ± 0.60, 12.64 ± 0.74, and 12.5 ± 0.71, respectively. The higher MNA‐SF score association with pre‐sarcopenia [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.06–1.86, P = 0.02], confirmed sarcopenia (OR = 0.25, 95% CI: 0.13–0.49, P < 0.001), and severe sarcopenia (OR = 0.20, 95% CI: 0.09–0.46, P < 0.001) was as significant as in the MNA‐SF categories. Individuals with a score = 13 (compared with 14), had a higher risk of confirmed sarcopenia (OR = 10.07, 95% CI: 1.92–52.71, P = 006) and severe sarcopenia (OR = 12.09, 95% CI: 1.24–117.50, P = 0.032). Individuals with a score of 12 had a higher risk of confirmed sarcopenia (OR = 30.94, 95% CI: 4.25–103.02, P < 0.001) and severe sarcopenia (OR = 35.90, 95% CI: 4.25–303.07, P = 0.001) compared with subjects with a score of 14. The models also showed that MNA‐SF < 13 could predict sarcopenia. Conclusion: There was a significant association between MNA‐SF and confirmed and severe sarcopenia in nourished people. Sarcopenia assessment in people with MNA‐SF < 13 can be beneficial. Developing a tool to identify the risk of malnutrition and sarcopenia at the same time based on MNA‐SF can be considered. [ABSTRACT FROM AUTHOR]

This cross‐sectional study explored the relationship between violent video game exposure (VVGE) and aggression in left‐behind adolescents (LBAs) in China, taking into account the effects of moral sensitivity and father presence. A cluster sampling design was applied in this study; we recruited 615 adolescents (45.85% male, age range 12–18 years, Mage = 14.70 years, SD = 1.66) from China. The results by using SPSS 25.0 and the PROCESS macro showed that VVGE was positively associated with LBAs' trait aggression and its items, and moral sensitivity played a partial mediating role in these relationships. Moreover, father presence moderated VVGE and LBAs' trait aggression, verbal aggression and hostility. Specifically, at a high level of father presence, the direct effect of VVGE on trait aggression was significantly moderated by increasing the level of father presence, whereas this moderating effect was not significant at a low level of father presence. The results were similar for verbal aggression and hostility. Thus, moral sensitivity and father presence should be considered in prevention and intervention strategies aimed at reducing LBAs' aggression. [ABSTRACT FROM AUTHOR]

Aims: To investigate the association between professionalism and social media competence among Chinese mainland nursing undergraduates. Design: This study employed a cross‐sectional descriptive correlation design. Participants: From June to July 2021, 797 nursing students from four nursing colleges in Jiangsu Province, China, were chosen using stratified cluster sampling. Methods: The questionnaire included the Chinese version of the Nursing Professionalism Scale and the Social Media Competency Scale. The association between professionalism and social media competency was examined using Pearson's correlation analysis. Results: The professionalism of nursing undergraduates (average scores:70.44 ± 8.82) was at a medium level. Social media self‐efficacy, performance expectancy, facilitating conditions and social influence (3.76 ± 0.75, 3.87 ± 0.60, 3.53 ± 0.69, 3.41 ± 0.76) were at a medium–high level, while social media experience and effort expectancy (3.03 ± 0.72, 2.60 ± 0.59) were at medium and low levels. Among nursing undergraduates, professionalism was related to social media competence, among which, professionalism was positively correlated with social media self‐efficacy (r = 0.40, p < 0.01), social media experience (r = 0.50, p < 0.01), performance expectancy (r = 0.34, p < 0.01), facilitating conditions (r = 0.41, p < 0.01), but negatively correlated with effort expectancy (r = −0.10, p < 0.01). Conclusion: The professionalism of nursing undergraduates is related to social media. The scores of social media self‐efficacy, social media experience, performance expectancy and facilitating conditions of nursing students with high professionalism were higher than those of nursing students with low professionalism. Impact: This study suggests that developing a course on health communication on social media can help nursing students improve their professionalism. Patient or Public Contribution: Participants completed a survey via the online survey platform Wenjuangxing. [ABSTRACT FROM AUTHOR]

Nutrition‐sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed‐methods design to describe the links between household dynamics—specifically intrahousehold power inequalities and intrahousehold cooperation—and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster‐randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross‐sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision‐making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family‐centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate. Key messages: Household cooperation and intrahousehold power inequalities may influence children's and mothers' dietary diversity in rural OdishaThese factors partly determine the effects of nutrition‐sensitive agriculture (NSA) interventions tested in Upscaling Participatory Action and Videos for Agriculture and Nutrition, indicating that NSA interventions may be more effective if they include multiple family members.There is wide heterogeneity in household dynamics and the constraints that families face. Further research is needed to identify how interventions can respond to this heterogeneity so that NSA interventions are effective in an inclusive and empowering way. [ABSTRACT FROM AUTHOR]