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Limiting ultraviolet radiation exposure during early childhood can significantly reduce the risk of developing skin cancer, making early childhood a critical time for sun protection strategies. This study aimed to measure sun protection practices utilized in Australian early-childhood services over the past decade and evaluate the impact of Cancer Council Australia's SunSmart Early-Childhood Program. Results are presented from cross-sectional and repeated-measures survey data, completed by directors or other staff at randomly sampled early-childhood services in 2008, 2013 and 2018 (N  =   3243). Most sun protection practices were used by a significantly greater proportion of services in 2018 relative to earlier years, such as requiring the use of sunscreen (98.4%), and sun-protective hats (99.7%) and clothing (88.8%). However, only a small and declining proportion of services (16.3%–22.4%) required the use of specific items of sun-protective clothing. SunSmart program members reported enacting significantly more sun protection practices compared to non-members, while new members showed an increase in the use of those practices relative to services whose status did not change (d  =   0.48). The results demonstrate improvements in sun protection in Australian early-childhood settings, and highlight the benefits and limitations of the SunSmart program. [ABSTRACT FROM AUTHOR]

Background: Mixing alcohol with energy drinks (AmED use) has been purported to increase risky behavior and alcohol consumption. The current study applied a within-subject retrospective self-report design to examine the association between AmED use (versus alcohol-only) and risky behavior, alcohol consumption and motivations. Method: New Zealand alcohol consumers aged 18–35 years (n = 289; AmED users: n = 143) completed an online survey. Results: Compared to alcohol-only, AmED use was associated with significant reductions in nine of twenty-six risk taking behaviors. The average amount of alcohol consumed did not differ between sessions. Maximum alcohol intake was greater in alcohol-only sessions than in AmED sessions. Motivations for consuming AmEDs and beliefs on their effects were not related to differences in typical alcohol intake in either session. The motivation to drink AmED "for the thrill" was associated with a higher general risk-taking propensity score, but not motivations and beliefs relating to being in control and feeling less drunk. AmED users did not have a significantly higher general risk-taking propensity than non-users. Conclusions: AmED use does not appear to increase risk-taking behavior or alcohol consumption and is associated with decreased risk-taking behavior and binge drinking. [ABSTRACT FROM AUTHOR]

Background: The cause of osteochondritis dissecans (OCD) is unknown. Purpose: To determine if mechanical axis deviation correlates with OCD lesion location in the knee, if degree of mechanical axis deviation correlates with size of OCD lesion, and if the deformity was primarily in the distal femur or proximal tibia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We identified 61 knees that underwent osteochondral allograft (OCA) transplantation for femoral condyle OCD lesions and used preoperative lower extremity alignment radiographs to measure lower extremity mechanical axis, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and hip-knee-ankle angle. Lesion location and area were retrieved from operative records. Results: The location of the OCD lesion was the medial femoral condyle (MFC) for 37 knees and lateral femoral condyle (LFC) for 24 knees. Among knees with MFC lesions, alignment was varus in 25 (68%). Conversely, knees with LFC lesions had valgus alignment in 16 (67%). The mLFDA was significantly more valgus in the LFC group. mMPTA was not different between MFC and LFC groups. There was no significant correlation between degree of mechanical axis deviation and lesion size. Conclusion: In this cohort, two-thirds of patients with symptomatic OCD lesions had associated mechanical axis deviation. Lesion location correlated with mechanical axis deviation (LFC lesions were associated with a deformity in the distal femur). Degree of deformity was not correlated with lesion size. Mechanical axis deviation may play a role in OCD pathogenesis. These data do not allow analysis of the role of mechanical axis deviation in causation or prognosis of OCD lesions, but surgeons treating OCD should be aware of this common association. [ABSTRACT FROM AUTHOR]

Introduction: In November 2016, our institution switched from alfentanil to fentanyl for analgesia and sedation in adult patients receiving extracorporeal membrane oxygenation. There is no published evidence comparing the use of alfentanil with fentanyl for sedation in extracorporeal membrane oxygenation patients. We conducted a retrospective observational study to explore any significant differences in patient outcomes or in the prescribing of adjunct sedatives before and after the switch. Methods: Patients were retrospectively identified from a prospectively recorded database of all patients who received extracorporeal membrane oxygenation at our institution between January 2016 and October 2017. Patients included those sedated with alfentanil or fentanyl. The total daily doses of intravenous opioids (alfentanil or fentanyl) were calculated for each patient, and the prescribing of adjunctive sedative or analgesic agents was recorded. Patient demographics, extracorporeal membrane oxygenation modality, clinical outcomes including mortality and length of intensive care and hospital stay were recorded. Results: A total of 174 patients were identified, 69 on alfentanil and 95 on fentanyl. There was no difference found between groups for mode of extracorporeal membrane oxygenation, age, Acute Physiology and Chronic Health Evaluation 2 score (APACHE II) and Charlson score, except for body mass index (p = 0.002). No differences in patient outcomes was observed between groups, although patients in the alfentanil group received a significantly higher median total daily dose of adjuvant sedatives (quetiapine (p = 0.016) and midazolam (p = 0.009)). Conclusions: No differences in patient outcomes were found between extracorporeal membrane oxygenation patients sedated with alfentanil compared with fentanyl. There was a statistically significant reduction in some adjunctive sedatives in patients managed with a fentanyl-based regimen. Prospective studies are required to confirm these results. [ABSTRACT FROM AUTHOR]

Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions. [ABSTRACT FROM AUTHOR]

Importance: In Chinese-speaking societies, a reliable and valid measure is needed to enable early identification of young children's challenges in sensory processing. Objective: To examine the psychometric properties of the Chinese version of the Infant/Toddler Sensory Profile (ITSP--C) when used with Taiwanese children. Design: Prospective study. Setting: Multiple settings. Participants: Participants were 367 typically developing (TD) infants ages 0--6 mo (mean [M] age = 3.44 mo, standard deviation [SD] = 1.82) and 677 toddlers ages 7--36 mo (M age = 22.33 mo, SD = 8.15), along with 42 toddlers with developmental disabilities (DD; M age = 28.4 mo, SD = 6.7). Outcomes and Measures: The ITSP, a caregiver questionnaire that measures how children respond to sensory events in daily life, was translated and cross-culturally adapted into a Chinese version (ITSP--C). Results: Internal consistency was high for the 0--6 mo subscale (a = .80) and the 7--36 mo subscale (a = .82). Test--retest reliability was excellent for the 7--36 mo subscale (intraclass correlation coefficient = .94). Logistic regression analysis demonstrated that the ITSP--C discriminated between children with DD and TD children. Conclusions and Relevance: The ITSP was successfully adapted to Chinese with similar reliability and validity to the original ITSP. The 7--36 mo subscale had a higher level of reliability than the 0--6 mo subscale, and quadrant scores were more reliable than section scores. Moreover, the ITSP--C discriminated children with DD from TD children on the basis of their sensory processing patterns. What This Article Adds: The ITSP--C has sound psychometric properties and support for its use in early identification of sensory processing difficulties in young Chinese-speaking children. [ABSTRACT FROM AUTHOR]

Because this value of 25 is impossible, as it would cause 7 successes in the second sample (which is size 6), the I P i value of the other tail is 0, and the I P i value of the two-tailed test by "Mantel's chi-squared" method will be 0.030+0 = 0.030. If "Fisher's added-tails" method is used, a I P i value of 0.031 and an exact 95%-CI of (1.07, 232.5) for the I OR i obtained by the TTST method are obtained.[14] In both cases, the CI is obtained based on the hypergeometric distribution. "Yates' chi-squared" method gives a I P i value of 0.058 and a 95%-CI for I OR i by the TOST method of (0.94, 239.1), whereas "Mantel's chi-squared" method yields a I P i value of 0.030 and a 95%-CI by the TTST method of (1.10, 180.3). In the case of Example 1, the exact values are I P i value = 0.019 and 95%-CI = (0.063, 0.729); again, the test is significant, the CI is compatible with the conclusion of the test, and it is deduced that P(A) > P(B). [Extracted from the article]

Background: Amniotomy is a commonly used, inexpensive method of labour induction; however, the optimal timing of amniotomy during labour induction is debated. Aims: To investigate whether artificial rupture of membranes <4 cm dilation is associated with caesarean, severe maternal and neonatal morbidity, and labour induction duration. Materials and Methods: Retrospective cohort study of 228 438 deliveries at 19 US hospitals. Women with a viable, singleton gestation undergoing induction ≥37 weeks with cervical dilation <4 cm were included. Women were excluded if membranes spontaneously ruptured <4 cm. Women were compared by early amniotomy (<4 cm dilation) versus not early. The primary outcome was caesarean. Secondary outcomes included severe maternal and neonatal morbidity, and labour duration. Logistic and Cox proportional hazard regression estimated the association between early amniotomy and study outcomes. Results: Of 15 525 eligible women, 10 421 (67%) had early amniotomy. Early amniotomy was associated with higher adjusted odds of caesarean and severe maternal morbidity, but not neonatal morbidity. After accounting for interaction, early amniotomy was associated with increasingly higher odds of caesarean as body mass index increased. Early amniotomy was associated with lower odds of severe maternal morbidity among multiparas with mechanical ripening. Median labour induction was 2.5 h shorter with early amniotomy, significant in hazard regression. Conclusions: Early amniotomy was associated with increased odds of caesarean among obese women. The association between early amniotomy and severe maternal morbidity varied by maternal characteristics, but early amniotomy was not associated with neonatal morbidity. Early amniotomy in labour induction may be advantageous in certain populations, particularly non‐obese women requiring mechanical ripening. [ABSTRACT FROM AUTHOR]

Aim: To identify the associations among posttraumatic stress, depressive and obsessive‐compulsive symptoms (OCS) in outpatients with psychological trauma and to examine the mediating effect of social provision. Background: Psychologically traumatized patients simultaneously experience depressive and OCS. Social provision may mediate multiple symptoms differently compared with social support. Design: Cross‐sectional and correlational study. Methods: Data were collected between August 2016–May 2017. Psychiatric outpatients (N = 151) completed a structured questionnaire consisting of the Korean versions of the Social Provision Scale, Beck Depression Inventory‐II, Maudsley Obsessional‐Compulsive Inventory and Impact of Event Scale–Revised. Structural equation modelling was used to examine the recursive association among the three symptoms and the mediation of social provision. Results: There was a recursive association between posttraumatic stress symptoms (PTSS) and depressive symptoms, which were simultaneously associated with OCS with a one‐way direction. OCS and social provision partially mediated these identified associations among three symptoms. Conclusions: Our findings provide insight into the complex associations of multiple symptoms experienced by traumatized outpatients and the partial mediation of social provision. Psychiatric and mental health professionals may enhance social functioning and interpersonal interactions based on social provision components used for helping traumatized patients with obsessive‐compulsive and depressive symptoms. Impact: There was a recursive association between PTSS and depressive symptoms that were simultaneously associated with OCS with a one‐way direction. Social provision functions as a partial mediator when working with OCS. Mental health nurses can develop social provision interventions for depressive symptoms for traumatized outpatients with OCS. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the distress thermometer for caregivers (DT‐C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. Design: A validation diagnostic accuracy study and descriptive cross‐sectional survey. Methods: DT‐C was adopted based on Harverman's distress thermometer for parents. The cut‐off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale‐21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. Results: One‐item DT of DT‐C indicated a good retest reliability (r = 0.86) and one‐item DT and the Problem List (PL) indicated good convergent validity (r = 0.67–0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70–0.90). Setting seven as the cut‐off score, the values of sensitivity (0.72–0.81), specificity (0.86–0.90), Youden's index (0.61–0.70), positive predictive value (0.67–0.74), and negative predictive value (0.84–0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88–0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut‐off. Caregivers above the cut‐off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. Conclusion: The DT‐C, with six domains containing 35 items in Problem List and with the cut‐off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. Impact: This study adapted a reliable DT‐C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether hip abductor strength–based exercise therapy could result in further function improvement and more pain relief in women with knee osteoarthritis. Design: Randomized controlled trial. Settings: Rehabilitation department of Affiliated Hospital of Southwest Medical University from years 2016 to 2018. Subjects: In total, 82 women aged 50–70 years, with knee osteoarthritis grade II–IV on the Kellgren–Lawrence scale. Intervention: The experimental group engaged in hip abductor strength–based exercises under the supervision of physical therapists (once a day for six weeks), while the control group engaged in quadriceps femoris strength–based exercises. Main measures: Osteoarthritis severity measured by the Western Ontario and McMaster Universities Osteoarthritis Index, pain on a visual analogue scale and three objective functional tests were assessed at the sixth and 12th week. Repeated measures analysis of variance and multivariable analysis were applied. Results: Finally, 72 participants completed the study: 35 in the experimental group and 37 in the control group. The self-reported functional difficulties score in the experimental group was significantly lower than that in the control group both at the sixth week and at the 12th week (P < 0.001). There were significant differences between groups in the stair ascent/descent task and Figure of 8 Walk test, but not in the Five Times Sit-to-Stand Test. The pain in the experimental group decreased compared with that in the control group at the sixth week (P < 0.05), but not at the 12th week (P > 0.05). Conclusion: Hip abductor strength–based exercises could result in better performance and higher self-reported function in women with symptomatic knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Fatigue is a prevalent symptom for adults living with HIV infection. The purpose of this randomized clinical trial was to pilot test a behavioral‐educational intervention to reduce fatigue. The intervention included education about daytime behaviors as well as nighttime sleep behaviors. Participants were HIV‐positive, between 45 and 75 years old, unemployed, and experiencing fatigue. They were randomized to intervention (n = 25) or control (n = 26) after obtaining baseline measures, administered the intervention or attention control, and followed with monthly assessments for 3 months. Primary outcome measures included the Fatigue Severity Scale (FSS) and fatigue symptom burden using the four‐dimension structure of the Memorial Symptom Assessment Scale that includes occurrence, frequency, severity, and distress of a symptom. Other measures included the International Physical Activity Questionnaire, step counts with a Fitbit Flex, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Sleep Behavior Rating Scale. Compared with attention controls, the intervention group had significantly (p <.05) lower FSS scores and fatigue symptom burden over time, particularly in the frequency dimension. Secondary outcomes for reducing daytime naps and improving sleep quality were also significant (p <.05). This intervention, focused on both daytime and nighttime behaviors, demonstrated promising effects for reducing fatigue among adults living with HIV. Results provide useful direction for larger clinical trials to reduce fatigue in adults living with other types of chronic illness. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the WhiteTeeth mobile app, a theory‐based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients. Methods: In this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check‐ups: at baseline (T0), at 6‐week follow‐up (T1) and at 12‐week follow‐up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n = 67). The control group received usual care only (n = 65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al‐Anezi and Harradine plaque index), and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behaviour and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed‐model analyses to determine the intervention effects. Results: At 6‐week follow‐up, the intervention led to a significant decrease in gingival bleeding (B = −3.74; 95% CI −6.84 to −0.65) and an increase in the use of fluoride mouth rinse (B = 1.93; 95% CI 0.36 to 3.50). At 12‐week follow‐up, dental plaque accumulation (B = −11.32; 95% CI −20.57 to −2.07) and the number of sites covered with plaque (B = −6.77; 95% CI −11.67 to −1.87) had been reduced significantly more in the intervention group than in the control group. Conclusions: The results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. Design: A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each functional independence measure item while controlling for many clinical and sociodemographic covariates. Results: After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14 of 18 functional independence measure items. Males had higher odds of reaching a supervision level on 2 of 18 functional independence measure items. Individuals who lived alone before their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all functional independence measure items. Conclusions: When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who live alone before their stroke have higher odds of discharging at a supervision level or better. [ABSTRACT FROM AUTHOR]

Many studies have confirmed the positive effects of comprehensive sexuality education on the development of children's sexuality, such as the acquisition of sexual health knowledge. However, little is known about the impact of comprehensive sexuality education on children's social development, although several core aspects of the approach stress social concepts such as fairness, respect and equality. This study examined whether comprehensive sexuality education could weaken the effect of in-group bias on social decision-making towards friends and strangers. Compared to the students in a control group, who never received comprehensive sexuality education, we found that students who received six years (72 lessons) of comprehensive sexuality education had a less in-group bias towards strangers regarding trust and fairness as reflected in a trust game, an ultimatum game and a dictator game. These results suggest that comprehensive sexuality education weakened the effect of in-group bias in the experimental group and encouraged egalitarianism in the experimental group's interpersonal cooperation and social decision-making. These findings suggest that comprehensive sexuality education could positively impact children's interpersonal attitudes and contribute to their social development. [ABSTRACT FROM AUTHOR]

Osteoporosis is difficult to treat and is still incurable, and thus prevention is critically important. The aim of this study was to find out the high-risk women for osteoporosis and to correlate their bone mineral density (BMD) with their investigated risk factors. Cross-sectional design was used and it was conducted among 200 pre- and postmenopausal Saudi women. The study documented that postmenopausal females had high prevalence of osteopenia and majority of them had low serum calcium. Significant correlation was found between low BMD and family history of osteoporosis; increased BMD was seen in women, who consumed calcium-rich foods, exposure to sun light, and longer fertility period. Majority of the women 94.5% had inadequate knowledge on preventive measures of osteoporosis. The high prevalence of osteopenia in postmenopausal women indicates the ultimate importance of early intervention to prevent development of osteoporosis in later life. [ABSTRACT FROM AUTHOR]

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This in vitro study compared the performance of the XP-endo Shaper (XP; FKG, La Chaux-de-Fonds, Switzerland) in curved canals when used with a higher speed (3000 rpm) without a glide path with the manufacturer's protocol. Twenty extracted mandibular molars with separate mesial curved canals were matched to obtain 2 standardized groups (n = 20). For the XP 1000 group, a glide path up to a size 15 hand file was performed followed by rotary instrumentation with the XP shaper at 1000 rpm, following the manufacturer's recommendations. For the canals in the XP 3000 group, the file was rotated at 3000 rpm after only negotiation the canal with a size 8 hand file (patency file). The operating time and the number of strokes taken to reach the working length (WL) and fit a 30/.04 gutta-percha cone to the WL were recorded. The shaping abilities were evaluated by micro–computed tomographic imaging and file deformation by scanning electron microscopy. Data were analyzed using analysis of variance and chi-square tests at a 5% significance level. The XP 3000 group required less time and strokes to reach the WL (P <.05) and resulted in a higher percentage of adequate cone fit (P <.05). No difference was found between groups regarding the micro-CT parameters, except for the taper, which was larger in the XP 3000 group in the apical and middle thirds (P <.05). No difference was found regarding file deformation between the 2 groups. The suggested protocol for the use of the XP (3000 rpm without a glide path) appears to be more efficient than the manufacturer's recommended protocol to prepare curved canals in vitro. [ABSTRACT FROM AUTHOR]

Pregnant women need protein intake during their pregnancy, a lack of protein intake is proven to cause low birth weight (LBW). In addition, the condition of anemia during pregnancy, parity, and miscarriage history in previous pregnancy also increases LBW. This study aims to analyze the correlation between protein intake, parity, and miscarriage history anemic pregnant women in Sukoharjo Regency, Indonesia, with LBW incidence. This study used Case Control design. This research was conducted in the Sukoharjo regency from April until June 2018. The respondents were drawn from the population of anemic pregnant women who had given birth in 2016-2018 in Sukoharjo Regency, with a total of 111 respondents, of which 74 were control groups and groups case of 37 people. Data analyzed used Chi-square test with a significance value of p <0.05. Based on the Chi-square test it was found that there was a significant relationship between protein intake of pregnant women p (0,000) with an odds ratio of 0,063, parity p (0,000) with an odds ratio of 0,119, and miscarriage history in anemic pregnant women p (0,000) with odds ratios at 0,339 with LBW incidence in Sukoharjo Regency, Indonesia. [ABSTRACT FROM AUTHOR]

BACKGROUND: The work of nurses and correctional officers alike has long been pointed at as among the most stressful in the world. OBJECTIVE: The primary aim was to evaluate the prevalence and level of occupational burnout among 214 hospital nurses and 201 correctional officers from Bulgaria. One of the focuses was to examine whether gender roles or occupational roles were more related to burnout. METHODS: The current work used a descriptive cross-sectional inter-occupational comparative survey design. The participation was voluntary, individually and anonymously without any financial compensation. The only qualification in the sample selection was that the employee had direct contact with patients and inmates respectively. A translated MBI-Bulgarian version was used to measure burnout. Data were entered into SPSS17.0 to carry out data analysis. RESULTS: The level of emotional exhaustion and personal accomplishment of nurses were significantly higher than that of correctional officers. Mean depersonalization score of correctional officers was significantly higher than that of nurses. Correctional officers demonstrated a higher prevalence of burnout syndrome compared with nurses. To examine whether gender is associated with burnout, Mann-Whitney U test was utilized to assess gender differences of correctional officers. Our results suggest that being male or female is not a critical determinant of burnout. CONCLUSION: Correctional officers were found to have a higher prevalence of burnout syndrome compared with nurses. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is a disease that needs attention, considering its prevalence is increasing and results in patient morbidity and mortality. More than 250,000 people live with disabilities caused by strokes which result in not being able to fulfill basic Activity Daily Living (ADL). This study aims to explain the depressive level with the level of dependence on basic Activity Daily Living (ADL) fulfillment in post-stroke patients after being treated at the RSUD Prof. Dr. Soekandar, Mojokerto Regency. Method: The design of this study is analytic to analyze the relationship of dependent variables with independent variables. The population in the study were all post-stroke patients who had been hospitalized at the RSUD DR Soekandar Mojosari, Mojokerto Regency, with a total sample of 25 patients. Result: The results of the Chi-Square test produce a significance value of 0.001 where the value is less than 0.05 and thus H0 is rejected so that there is a significant relationship between depression and the level of dependence on Stroke Patients after hospitalization at the RSUD Prof. Dr. Soekandar, Mojokerto Regency. Discussion: The conclusion of this study is that there is a relationship between depression and the level of dependence on stroke patients after hospitalization at the RSUD Prof. Dr. Soekandar, Mojokerto Regency. Ischemic stroke patients experience severe and prolonged depression due to a disturbance in the function of the device (parese) which affects the level of dependence of the patient in meeting basic Activity Daily (ADL) [ABSTRACT FROM AUTHOR]

Background: Transitional care (TC) has been shown to improve stroke rehabilitation in discharged stroke patients. Previous TC interventions did not report satisfactory stroke rehabilitation outcomes or risk management. Incorporating a health behavior theory in interventions can effectively improve health behaviors and metabolic indicators. Objectives: This study was a clinical controlled trial to investigate the impact of the Integrated Behavioral Model (IBM)-based 3-month TC on health behaviors, clinical outcomes, and stroke knowledge in discharged elderly stroke patients. Methods: Sixty elderly patients were recruited from two wards of a public teaching hospital in China. To prevent potential treatment contamination, patients were allocated into either a control or intervention group depending on which wards they were admitted to. The TC intervention considered all the IBM constructs to provide patients assistance in implementing health behaviors as recommended by the Chinese stroke guidelines. The TC intervention commenced one day before discharge and lasted three months after discharge. A linear mixed model was used to measure the impact of the intervention. Results: The TC intervention improved the discharged elderly stroke patients' health behaviors, activities of daily living, quality of life, and stroke knowledge. The intervention also controlled the patients' systolic blood pressure, body mass index, total cholesterol, triglycerides, and low-density lipoprotein cholesterol. Conclusions: This study provided evidence of concurrent self-reported and objective clinical indicators in discharged elderly stroke patients for the impact of the IBM-based 3-month TC intervention, which can be recommended for clinical practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to determine the rate of inadequate empirical antimicrobial treatment in older nursing home residents with bacteremic urinary tract infection and its influence on prognosis. Methods: We carried out a multicentric prospective observational study in five Spanish hospitals. Patients aged >65 years with pyelonephritis or urinary sepsis with bacteremia were included. Clinical characteristics, the percentage of inadequate empirical antibiotic treatment, length of hospital stay and mortality were evaluated. Results: A total of 181 patients, 54.7% women, were included in the study, and 35.9% of the patients came from nursing homes. These patients had higher percentages of ultimately or rapidly fatal disease (92.3% vs 53.4%; P < 0.001), were older (83.15 ± 6.97 years vs 79.34 ± 7.25 years; P = 0.001) and had higher Acute Physiology And Chronic Health Evaluation II (28.38 ± 8.57 vs 19.83 ± 5.88). The percentage of extended‐spectrum beta‐lactamases was higher in patients from nursing homes (30.6% vs 16.3%; P = 0.045), as was the percentage of inadequate empirical antibiotic treatment (40% vs 20.7%; P = 0.005). Length of hospital stay was longer (10.82 ± 3.62 days vs 9.04 ± 4.88 days; P < 0.001). However, 30‐day mortality was not related to nursing home by multivariate analysis (OR 1.905, 95% CI 0.563–6.446; P = 0.300). Conclusions: Nursing home patients with bacteremic urinary tract infections had a higher rate of extended‐spectrum beta‐lactamase‐producing enterobacteriacea and inadequate empirical antimicrobial treatment. Clinicians should consider these findings and avoid inappropriate antimicrobial agents for empirical treatment. Geriatr Gerontol Int 2019; 19: 1112–1117. [ABSTRACT FROM AUTHOR]

Background: Subgroup analyses of the Latarjet procedure have suggested that age over 40 years is a risk factor for dislocation arthropathy. Purpose: To analyze long-term results of the open Latarjet procedure for recurrent anterior shoulder dislocation in patients at least 40 years of age. Study Design: Case series; Level of evidence, 4. Methods: A total of 39 consecutive patients (40 shoulders) with a mean age of 48 years (range, 40-66 years) at surgery were evaluated at a mean follow-up of 11.0 years (range, 8-16 years). Of these, 15 patients (38%) had undergone previous soft tissue stabilization surgery. Long-term results were assessed clinically and radiographically, including computed tomography scanning at final follow-up. Results: No recurrence of dislocation was noted. Subluxation had occurred in 3 patients (8%), and apprehension persisted in 5 patients (13%). The total Walch-Duplay score averaged 89 points at the final follow-up, and the mean Subjective Shoulder Value (60%-91%) had improved significantly (P <.001). In total, 36 patients rated their result as excellent, 3 as good. Further, 6 patients (15%) underwent joint-preserving reoperation, and 1 patient (3%) had reverse total shoulder arthroplasty for severe dislocation arthropathy. Dislocation arthropathy was severe in 14 patients (37%) and had progressed by at least 2 grades in 17 patients (45%). Patients with severe dislocation arthropathy had already shown degenerative changes preoperatively as opposed to those who ultimately had no or moderate dislocation arthropathy (n = 24) (P <.001). Progression of dislocation arthropathy was associated with lateral (>1 mm) graft positioning (P <.001) and older age at surgery (r = 0.58; P <.001). Conclusion: The open Latarjet procedure for recurrent anterior shoulder instability in patients older than 40 years reliably restores stability and leads to high patient satisfaction. This procedure is, however, associated with a substantial rate of advanced but clinically mild symptomatic dislocation arthropathy, which is associated with the degree of preoperative joint degeneration, older age at surgery, and lateral graft placement. [ABSTRACT FROM AUTHOR]

Background: Intermittent fetal monitoring (IFM) is a recommended strategy for intrapartum fetal heart rate assessment in low-risk pregnancies; however, this "high touch, low tech" approach is underutilized. Objective: The aim of the study was to examine the relationships between labor and delivery nurses' intellectual capital and their perceptions of barriers to research utilization in the work setting. Methods: A cross-sectional correlational design using data derived from a larger study of labor and delivery nurses (N = 248) was used. Covell's theory of nursing intellectual capital was used as the conceptual and analytic framework to examine labor and delivery nurses' intellectual capital and their perceived barriers to research utilization. Results: Nurses who receive paid time off from their employer to attend conferences (p <.01) and nurses who do not report nurse-to-patient ratios as a problem in providing IFM (p <.01) perceive fewer barriers to research utilization. Discussion: Time, especially available time, has an effect on labor and delivery nurses' attitude toward IFM and their perceptions of barriers to research utilization. [ABSTRACT FROM AUTHOR]

Background: The prevalence of adults with Type 1 diabetes (T1D) is increasing, and their risk of cardiovascular disease is high. Comorbid diabetes distress and depressive symptoms may affect their cardiovascular health. Objectives: The purpose of this study was to describe the relationship between diabetes distress and depressive symptoms with cardiovascular health factors. Methods: This was a cross-sectional survey of a sample of adults with T1D. Valid and reliable instruments were used to collect the data on sociodemographics, diabetes-related complications, psychological factors, and cardiovascular health factors. Independent-sample t tests, analysis of variance, chi-square analyses, and linear regression were used to compare the cardiovascular health factors among the three levels of diabetes distress scores and the two levels of depressive symptom scores. Results: Our sample included 83 adults with a mean age of 45.2 years and a mean duration of T1D of 20 years. The majority scored low in the Diabetes Distress Scale, whereas 18% scored moderate and 18% scored high. Twenty-two percent had increased levels of depressive symptoms. There were significant correlations between diabetes distress and fear of hypoglycemia, depressive symptom scores, hemoglobin A1c, and total cholesterol. Depressive symptom scores were significantly correlated with hemoglobin A1c. Hemoglobin A1c and total cholesterol were significantly higher in those with higher levels of diabetes distress. There were no significant differences in cardiovascular health between those who scored below or above the cut point for depressive symptoms, but there was a finding toward higher mean body mass index, hemoglobin A1c, and a lower weekly step count in those who had elevated depressive symptoms. In the linear regression, only diabetes distress was significantly associated with hemoglobin A1c. Discussion: This is a sample with elevated diabetes distress and depressive symptoms, both of which may affect their risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Prior research has found that pimps use both non-coercive and coercive management styles across and within market segments of the illicit sex trade. The current study is the first to examine the socialization processes underlying variation in the self-reported coerciveness of pimps. This study begins to fill a void in the almost non-existent research on pimps who are actively managing Internet-solicited sex workers, and adds to the sparse research on pimps' coerciveness. We extend Anderson's concepts of "street code" families, where respect is acquired through displaying physical violence and toughness, and "decent" families, where middle class values of avoiding unnecessary aggression and complying with the law prevail, to understand variation in the degree of coerciveness that pimps utilize toward sex workers. A purposive sample of 44 active pimps was obtained through referrals from selected pimps and through placing advertisements on Backpage, a website utilized by the illicit prostitution trade. Qualitative coding revealed a wide range of coercive control tactics such as supplying drugs, surveillance, and physical violence. Pimps who served as sex workers and those raised by parents who supported "the code of the street" reported use of a greater number of more severe coercive tactics. College-educated pimps, pimps operating business that charged fees of at least US$300, and those from "decent" families were more likely to use non-coercive management. These findings suggest that early prevention programs might address the "street code" mentality that contributes to coerciveness, and that "End Demand" policies need to recognize that many male pimps also have served as sex workers. [ABSTRACT FROM AUTHOR]

Backgroud: Oral Health is a fundamental human right. It is an integral portion reflecting the status of overall general health. Poor oral health is commonly associated with many systemic diseases. Oral diseases qualify as a major public health problem at global level owing to its high prevalence. India is no exception and due to its large population size, the absolute burden of oral diseases is immense. Oral health is not usually considered as a matter of concern and given priority in most of the developing countries. Aim: To assess the status of oral health of residents in Chennai for formulating a draft oral health policy. Materials and Method: A cross-sectional survey was carried out using convenient sampling methodology. Data were collected according to the World Health Organization oral health assessment criteria 2013. The data tested for significance using statistical software packages, SPSS Software version 17.0. Frequency tables were computed. Chi square test was done to test whether the difference in the various parameters is statistically significant. Results: Out of 318 males, 117 (36.79%) require scaling and 250 (78.61%) of them need restorative treatments. Extraction is indicated for 27 (8.49%). Prosthetic treatment is recommended for nearly 50 (15.72%) of them. It also shows that out of 282 females, around 178 members comprising of 63.12% require scaling, 220 (63.12%) need restorative treatments while extraction is indicated for 78(27.65%) of them and 50(15.72) women were recommended prosthetic treatments. Conclusion: The study population was characterized by high prevalence of dental caries. [ABSTRACT FROM AUTHOR]

Purpose: This research project aims to evaluate the effectiveness of a physical activity (PA) intervention model for people with severe mental illness in a Chinese society. Methods: A quasi-experimental design was adopted in this study. In addition to treatment-as-usual (TAU), the treatment group (n = 52) participated in a supervised jogging activity twice a week for a total of eight sessions, followed by four sessions of psychoeducation on nutrition and personal appearance. The control group (n = 42) received TAU. Standardized assessment tools were used for the outcomes assessment at pre- and posttreatment. Results: 2 × 2 repeated measures analysis of covariance demonstrated that the treatment group was significantly more effective than the control group in reducing depressive symptoms and increasing self-esteem and social support. Conclusions: This study supports the effectiveness of a PA intervention model in a Chinese society, suggesting the importance of incorporating regular physical exercises into community-based mental health services. [ABSTRACT FROM AUTHOR]

Despite their widespread use, typical visual observation practices are not evidence‐based and adverse events – such as self‐harm and absconding – still occur even under the most intense forms of observation. This study aimed to (i) develop and implement an engagement‐focused systematized model of clinical risk management in an adult acute psychiatric inpatient unit; and (ii) prospectively evaluate its effect on rates of violence, self‐harm, absconding, sexually inappropriate behaviour, and seclusion. A new model of engagement‐focused clinical risk management was developed using a participatory action research framework and implemented in an adult acute psychiatric inpatient unit. Using a mirror‐image design, rates of violence/aggression, self‐harm, absconding, sexually inappropriate behaviour, and seclusion were compared before and after implementation, and staff satisfaction levels were measured. The clinical engagement‐based model was introduced, and 1087 admissions before implementation (24 months) were compared with 965 admissions post‐implementation (18 months). The new model was associated with significantly reduced rates of absconding (pre: 10.5/1000 occupied bed days, 95% CI [9.0, 12.1] compared with post: 6.5/1000 occupied bed days [5.2, 8.1], P < 0.001) and seclusion (pre: 43.7/1000 occupied bed days, 95% CI [40.6, 46.9] compared with post: 30.9/1000 occupied bed days [27.9, 34.1], P < 0.0001). Rates of aggression, deliberate self‐harm, and sexually inappropriate behaviour were non‐significantly decreased. Findings suggest that this engagement‐focused model of clinical risk management in an adult psychiatric inpatient unit significantly reduced adverse patient events and was preferred by staff over current practice. Other psychiatric inpatient facilities may see a reduction in adverse events following the introduction of this well‐tolerated risk management model. [ABSTRACT FROM AUTHOR]

Purpose: Research is integral to dental hygiene practice, graduate education, and the advancement of the dental hygiene profession. The purpose of this study was to identify the motivations and challenges toward participation in research activities as perceived by undergraduate dental hygiene students. Methods: A nonprobability sample of undergraduate dental hygiene students from across the United States was used for this cross-sectional, electronic survey. Inclusion criteria were students entering their final year of their dental hygiene education program. Descriptive and inferential statistics were used to analyze the data. Results: A total of 333 respondents met the inclusion criteria (n=313). The most frequently cited motivations for participation in research were a good method to contribute to patient care, to improve understanding of medical/academic terms, an interest in developing transferable skills, and a necessary competency a future clinical career. The most frequently cited barriers were lack of time, lack of funds to conduct research projects, lack of formal research courses in curriculum and a lack of interest in research. Significant relationships were found between participation in research activities and education in research (p<.001) and the type of dental hygiene degree program and participation in research activities (p<.01). Students with previous research experience were significantly more likely to be encouraged by previous participation in research experiences than students without previous research experience (p<.01). Conclusion: Understanding the perceived motivations and challenges for research among undergraduate dental hygiene students, can help direct efforts to foster interest and overcome barriers to pursuing future research activities. [ABSTRACT FROM AUTHOR]

Background Transdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit. Methods A single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone. Results The primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47). Conclusions Adjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and poststernotomy patients in the cardiothoracic intensive care unit. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the effect of electronic and paper-based standardized nursing care plans (SNCPs) use on quality of nurses’ documentation. METHODS: Using quasi-experimental design, two wards were grouped into electronic and paper-based wards. Nurses were trained to use electronic- and paperbased SNCPs for care-planning and documentation. Data was collected before, 3, and 6 months postintervention and analyzed with SPSS version 20. FINDINGS: There was improvement in documentation quality in the two wards after introducing SNCPs with higher quality scores in the electronic ward postintervention. CONCLUSION: Providing SNCPs in electronic and paper formats is critical to improving nursing documentation. IMPLICATION FOR NURSING PRACTICE: Adequate training and support for nurses are needed for successful implementation of SNCPs in electronic health records (EHRs) in developing nations. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effect of a 12-week chair yoga program on functional fi tness and well-being in community-dwelling older women with low physical activities. Methods: A total of 31 community-dwelling older women with low physical activity participated in this quasi-experimental study. Two communities of the elderly were allocated to 2 groups through lot drawing. Subjects were randomly assigned to control or intervention groups by community to avoid contamination--the experimental group of 16 people and the control group of 15 people. The participants in the experimental group trained chair yoga exercise for 12 weeks with 2 sessions per week, 110 minutes per session, whereas the control group maintained its regular daily activities. Data collection from multiple variables was conducted using questionnaire (well-being ) and examination on functional fi tness (handgrip strength, lower limb muscle strength, upper limb muscle strength, static balance, agility and dynamic balance, lower limb fl exibility, upper limb fl exibility). Results: The results showed a signifi cant improvement for the experimental group in the handgrip strength ( P = .001), upper limb muscle strength ( P = .047), lower limb muscle strength ( P = .007), static balance ( P = .016), agility and dynamic balance ( P = .009), and in the well-being ( P = .003) after the intervention. The control group reveals deteriorated result in upper limb muscle strength ( P = .016). Among other functional fi tness and well-being variables, there is no signifi cant difference. Conclusion: The chair yoga training provides a simple and inexpensive exercise program that improves the functional fi tness and well-being effectively. [ABSTRACT FROM AUTHOR]

This study aims to analyze the level of household food security and food insecurity in Donggala Regency. Type of research was quantitative with a cross sectional approach carried out in Donggala Regency. Two districts that were selected to represent the situation of food security based on the consideration of the results of the FIA (Food Insecurity Atlas), namely Tanantovea (food insecure areas), and Balaesang (foodresistant areas). The household sample of 100 households was selected purposively. Research variables are the characteristics of respondents (age, sex, education, occupation), income and expenditure of food, food security indicators, food security programs and poverty alleviation, food insecurity status at the household and regional level. Data analysis was descriptive and chi-square test with a significance level of p < 0.05. The results of the study are the age characteristics of respondents, namely age 35-44 years at 29.0% and = 55 years at 25.0% and the main occupation was as a farmer / breeder at 57.0%. The average per capita income of respondents was Rp 818,000 in the food insecurity group and Rp 2,227,000 in the food security group. Food expenditure was higher in the food insecurity group, which was an average of Rp. 374,660 compared to non-food family expenses, which was an average of Rp. 172,426. Most of the food insecure families are in areas that are classified as food insecurity, which was 72.0%, while households that are considered food resistant are generally in food security areas, which was 90.0%. The conclusion is that household food insecurity was significantly related to the area's food security status. For regions with food insecurity status, households generally experience food insecurity. [ABSTRACT FROM AUTHOR]

To determine the test-retest reliability and criterion validity of self-reported function in mobility and instrumental activities of daily living (IADL) in older adults, a convenience sample of 70 subjects (72.9 ± 6.6 yr, 34 male) was split into able and disabled groups based on baseline assessment and into consistently able, consistently disabled, and inconsistent based on repeat assessments over 2 weeks. The criterion validities of the self-reported measures of mobility domain and IADL-physical subdomain were assessed with concurrent baseline measures of 4 mobility performances, and that of the self-reported measure of IADL-cognitive subdomain, with the Mini-Mental State Examination. Test-retest reliability was moderate for the mobility, IADL-physical, and IADL-cognitive subdomains (κ = .51-.66). Those who reported being able at baseline also performed better on physical- and cognitive-performance tests. Those with variable performance between test occasions tended to report inconsistently on repeat measures in mobility and IADL-cognitive, suggesting fluctuations in physical and cognitive performance. [ABSTRACT FROM AUTHOR]

Purpose: To assess and compare the periodontal health status among permanent residents of low, optimum and high fluoride areas in Kolar District, India. Materials and Methods: A house-to-house survey was conducted in a population consisting of 925 permanent residents aged 35 to 44 years in three villages having different levels of fluoride concentrations in the drinking water. The fluoride concentrations in selected villages were 0.48 ppm (low), 1.03 ppm (optimum) and 3.21 ppm (high). The ion selective electrode method was used to estimate the fluoride concentration in the drinking water. Periodontal status was assessed using the Community Periodontal Index (CPI) and loss of attachment (LOA). Results were analysed using the chi-square test and logistic regression. The chi-square test was used to find the group differences and logistic regression to find association between the variables. Results: The overall prevalence of periodontitis was 72.9%; specifically, prevalences were 95.4%, 76.3% and 45.7% in low, optimum and high fluoride areas, respectively. The number of sextants with shallow or deep pockets decreased (shallow pockets: 525, 438, 217; deep pockets: 183, 81, 34) from low to high fluoride areas (odds ratio: 71.3). The low fluoride area had a 7.9-fold higher risk of periodontitis than the optimum fluoride area and a 30-fold higher risk than the high fluoride area, which was highly significant (χ² = 53.5, P < 0.0001 and 2 = 192.8, P < 0.001, respectively). Conclusions: The severity of periodontal disease is inversely associated with the fluoride concentrations in drinking water. This relation can provide an approach to fluoride treatments to reduce the prevalence or incidence of this disease. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect and safety of pre-emptive oral nonsteroidal anti-inflammatory drugs (NSAIDs) for the success of inferior alveolar nerve block (IANB) in irrevesible pulpitis treatment. Method and Materials: Medline (via OVID, 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2011) EMBASE (via OVID, 1984 to July 2011), Chinese BioMedical Literature Database (1978 to July 2011), China National Knowledge Infrastructure (1994 to July 2011), and WHO International Clinical Trials Registry Platform were searched electronically. In addition, relevant journals as well as reference lists of included studies were hand searched for randomized clinical trials comparing the effect or safety of NSAIDs in irreversible pulpitis treatment. Risk of bias assessment with the Cochrane collaboration tool and data extraction were independently performed by two reviewers. Meta-analysis was delivered with RevMan 5.1. Results: Seven studies were included. Six of them had low risk of bias, and one had an unclear risk of bias. A dosage of 600 to 800 mg of ibuprofen showed a significant effect in increasing the success rate of IANB (relative risk [RR], 1.52; 95% confidence interval [CI], 1.17 to 1.98; P = .002), and the results were moderately reliable. A dosage of 75 mg of indomethacin had a significant effect compared to a placebo (RR, 1.94; 95% CI, 1.22 to 3.06; P = .005), as did 8 mg of lornoxican (RR, 2.80; 95% CI, 1.59 to 4.93; P = .0004) and 50 mg of diclofenac potassium (RR, 2.40; 95% CI, 1.34 to 4.31; P = .003). Other NSAIDs such as ketorolac, ibuprofen and acetaminophen together, and acetaminophen alone showed no statistical significance compared to the placebo. No serious adverse events were reported. Conclusion: The clinical evidence suggests that pre-emptive oral NSAIDs might have a good effect and are safe in increasing the success rate of IANB, but more studies are necessary to confirm such outcomes. (Quintessence Int 2012;43:209-219)

Little is known about the effect of reduced vision on physical activity in older adults. This study evaluates the association of visual acuity level, self-reported vision, and ocular disease conditions with leisure-time physical activity and calculated caloric expenditure. A cross-sectional study of 911 subjects 65 yr and older from the University of Alabama at Birmingham Study of Aging (SOA) cohort was conducted evaluating the association of vision-related variables to weekly kilocalorie expenditure calculated from the 17-item Leisure Time Physical Activity Questionnaire. Ordinal logistic regression was used to evaluate possible associations while controlling for potential confounders. In multivariate analyses, each lower step in visual acuity below 20/50 was significantly associated with reduced odds of having a higher level of physical activity, OR 0.81, 95% CI 0.67, 0.97. Reduced visual acuity appears to be independently associated with lower levels of physical activity among community-dwelling adults. [ABSTRACT FROM AUTHOR]

Aims: To field-test carefully designed criteria for pain following trigeminal nerve trauma. Methods: In order to characterize the clinical phenotype, posttraumatic pain patients were studied and compared with classical trigeminal neuralgia patients (CTN, defined according to the International Headache Society's criteria). Based on etiology and features, trigeminal pain following trauma was defined as "peripheral painful traumatic trigeminal neuropathy" (PPTTN). Data were analyzed with t tests, ANOVA, chi-square, and regression analyses. Results: A total of 145 patients were included: 91 with PPTTN and 54 with CTN. Findings indicated that PPTTN criteria are clinically applicable in the detection and characterization of relevant cases. In contrast to accepted characteristics for PPTTN, the observed profile included both continuous and paroxysmal pain that was stabbing and/or burning. The quality, duration, and intensity were significantly different from the CTN patients (P < .05). PPTTN was consistently accompanied by trigeminal sensory abnormalities (96%) that were mostly allodynia, hyperor hypoalgesia, and only 1% of the PPTTN cases had anesthesia. Conclusion: Overall, the proposed PPTTN criteria have proven to be clinically useful. In view of these results, modified PPTTN diagnostic criteria are proposed for use in future research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effects of a 6-wk intervention that used guided relaxation and exercise imagery (GREI) to increase self-reported leisure-time exercise behavior among older adults. A total of 93 community- dwelling healthy older adults (age 70.38 ± 8.15 yr, 66 female) were randomly placed in either a placebo control group or an intervention group. The intervention group received instructions to listen to an audio compact disk (CD) containing a GREI program, and the placebo control group received an audio CD that contained 2 relaxation tracks and instructions to listen to music of their choice for 6 wk. Results revealed that listening to a GREI CD for 6 wk significantly increased self- reported leisure-time exercise behaviors (p = .03). Further exploration of GREI and its effects on other psychological variables related to perceived exercise behaviors may substantiate its effectiveness. [ABSTRACT FROM AUTHOR]

This study descriptively measured the universal accessibility of "accessible" fitness and recreational facilities for Ontarians living with mobility disabilities. The physical and social environments of 44 fitness and recreational facilities that identified as "accessible" were assessed using a modified version of the AIMFREE. None of the 44 facilities were completely accessible. Mean accessibility ratings ranged between 31 and 63 out of a possible 100. Overall, recreational facilities had higher accessibility scores than fitness centers, with significant differences found on professional support and training, entrance areas, and parking lot. A modest correlation was found between the availability of fitness programming and the overall accessibility of fitness-center specific facility areas. Overall, the physical and social environments of the 44 fitness and recreational facilities assessed were limited in their accessibility for persons with mobility disabilities. Future efforts should be directed at establishing and meeting universal accessibility guidelines for Canadian physical activity facilities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess fitness and gross motor performance of children with ADHD, including users and nonusers of methylphenidate medication. Seventy boys took part in the study. Fitness level of children with ADHD using medication or not, including body composition, flexibility, and muscular endurance, was similar to that of a control group. The only difference was observed for body mass index, which was lower in children with ADHD using medication. Aerobic capacity was also similar when measured by a treadmill test. A lower performance was observed when aerobic capacity was estimated using a field shuttle test, however, suggesting that the methodology used is important. Finally, both groups of children with ADHD presented significantly lower scores for locomotion skills. [ABSTRACT FROM AUTHOR]

In the current study NCAA Division I student-athletes (n = 2,440) completed a Web-based survey assessing their willingness to seek mental skills training, perceptions of the potential benefits of mental training for their team, and support of possible roles for a sport psychology consultant at their institution. Multiple chi-square tests revealed significant (p < .001) dependence of respondents' ratings on gender, sport type (individual vs. team), prior experience with a sport psychology consultant, and perceived effectiveness of prior experience (low, moderate, high). Generally, females were more receptive than males, individual and team sport athletes were interested in different types of mental skills, athletes with prior consulting experience were more open than those with none, and athletes with highly effective prior experience were more receptive than those with less effective experience. These findings extend previous research examining collegiate student-athletes' attitudes toward sport psychology consulting and provide several important insights for consultants conducting mental skills training for NCAA Division I level athletes. [ABSTRACT FROM AUTHOR]

Patients with squamous cell carcinoma of head and neck (HNSCC) often receive post-operative radiotherapy (PORT) following surgical cancer removal. It has been shown that a total package time between surgery and completion of PORT of 100 days or less is correlated with lower rates of local and distant recurrence, and longer survival. However, limiting the package time to 100 days can be challenging, as adjuvant RT typically takes 6-7 weeks, leaving 8 weeks or less between surgery and the start of radiation. In this study, we investigate the impact of outside facility referral and dental extractions, both hypothesized to prolong the total treatment package time, with secondary detriment to relapse free survival (RFS) and overall survival (OS). We conducted a retrospective chart review on patients with HNSCC treated at our facility. Inclusion criteria were: HNSCC treated with surgery and PORT within the last five years, age 18 or older upon receiving surgery, and completion of radiation. Patients were excluded from analysis if they had distant metastatic disease at the time of presentation, had received prior radiation to the cancer site, or died during treatment. We then calculated average values for package time and time to recurrence and performed Kaplan-Meier analysis for survival. We performed statistical hypothesis testing via t-test for comparing package time as a continuous variable and via chi-square test for categorical variables. Of 148 patients with HNSCC treated at our facility, 94 met eligibility criteria. 35% of patients experienced local or distant recurrence and 21% of patients died. The median package time was 89.5 days, with 76% of patients achieving a package time of 100 days or less. 44% of patients received PORT at our facility (in-house), and these patients had a shorter package time (85 days vs 101 days, p = 0.0004) and higher likelihood of completion within 100 days (88% vs 66%, p = 0.01). 33% of patients received dental extractions, and this did not affect package time (97 days vs 93 days, p = 0.57) or likelihood of completion within 100 days (74% vs 76%, p = 0.83). A package time of 100 days or less was not associated with significantly lower rates of recurrence (31% vs 48%, p = 0.14) or death (23% vs 17%, p = 0.6), although recurrence was numerically higher with prolonged package times. A Kaplan-Meier analysis was performed to study patient survival over time, and a package time under 100 days was not associated with a change in RFS (p = 0.4) or OS (p = 0.7). In this study, we identified that outside facility referrals for PORT, but not dental extractions, prolong treatment package times. We also saw no effect of package time on RFS or OS, although there was limited variation of package time in this analysis, so our findings do not necessarily contradict previous studies. These results suggest that patients requesting outside facility referrals for PORT may benefit from a streamlined program that expedites the referral process. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the clinical parameters associated with long-term success and failure of single-tooth titanium plasma-sprayed (TPS) cylindric implants. Materials and Methods: Thirty-nine implants in 39 subjects were followed for 5 years. The following data were collected: subject age and gender, implant length, implant location, bone density, and implant position in relation to crestal bone. Assessments made at recall intervals included: Gingival Index (GI), probing depth, relative attachment level, and standardized radiographs. Failure was defined as a mean annual attachment loss rate (ALR) of ⩾ 0.25 mm after the first year of implant function. Between-group differences were assessed non parametrically using the Mann-Whitney and chi-square tests. Results: Nineteen implants were considered successes and 20 were considered failures with respective mean ALRs of 0.12 ± 0.07 mm and 0.42 ± 0.19 mm. The following factors were associated with success: longer implants (P < .001), lower GI (P < .001), higher bone density (P < .0001), and implant position at the crest or supracrestally (P < .0001). Age, gender, probing depth, and implant location were not related to outcome. Conclusions: A model using attachment loss as a parameter for success and failure has not been previously utilized. Longer implants, lower GI, higher bone density, and implant position at the crest or supracrestally were clinical factors associated with long-term success of single-tooth TPS cylindric implants in this patient population. [ABSTRACT FROM AUTHOR]

Behavioral researchers use analysis of variance (ANOVA) tests of differences between treatment means or chi-square tests of differences between proportions to provide support for empirical hypotheses about consumer behavior. These tests are typically conducted on data from "between-subjects" experiments in which participants were randomly assigned to conditions. We show that, despite using internally valid experimental designs such as this, aggregation biases can arise in which the theoretically critical pattern holds in the aggregate even though it holds for no (or few) individuals. First, we show that crossover interactions-often taken as strong evidence of moderating variables-can arise from the aggregation of two or more segments that do not exhibit such interactions when considered separately. Second, we show that certain context effects that have been reported for choice problems can result from the aggregation of two (or more) segments that do not exhibit these effects when considered separately. Given these threats to the conclusions drawn from experimental results, we describe the conditions under which unobserved heterogeneity can be ruled out as an alternative explanation based on one or more of the following: a priori considerations, derived properties, diagnostic statistics, and the results of latent class modeling. When these tests cannot rule out explanations based on unobserved heterogeneity, this is a serious problem for theorists who assume implicitly that the same theoretical principle works equally for everyone, but for random error. The empirical data patterns revealed by our diagnostics can expose the weakness in the theory but not fix it. It remains for the researcher to do further work to understand the underlying constructs that drive heterogeneity effects and to revise theory accordingly. [ABSTRACT FROM AUTHOR]

Two-tailed significance testing for 2 × 2 contingency tables has remained controversial. Within the medical literature, different tests are used in different papers and that choice may decide whether findings are adjudged to be significant or nonsignificant; a state of affairs that is clearly undesirable. In this paper, it is argued that a part of the controversy is due to a failure to recognise that there are two possible alternative hypotheses to the Null. It is further argued that, while one alternative hypothesis can lead to tests with greater power, the other choice is more applicable in medical research. That leads to the recommendation that, within medical research, 2 × 2 tables should be tested using double the one-tailed exact probability from Fisher's exact test or, as an approximation, the chi-squared test with Yates' correction for continuity. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to map end-of-life care in acute hospital settings against Elements 1–5 of the Australian Commission on Safety and Quality in Health Care's (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods: A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC's Elements 1–5 were used to evaluate end-of-life care. Results: Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P < 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P < 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P < 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P < 0.0001). Conclusion: There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1–5 of the ACSQHC's Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic?: Acute care settings provide the majority of end-of-life care. Despite the ACSQHC's Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add?: There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural diversity. What are the implications for practitioners?: The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care. [ABSTRACT FROM AUTHOR]

Objective. To know the characteristics of medical education and identify its strengths and weaknesses. Materials and methods. A transversal and quantitative study of the characteristics of medical education in 29 medical schools in Mexico was carried out, between April and September 2017. Questionnaire with Likert scale was applied to explore context, regulation, structure, process, results and impact of medical education. Bivariate analysis was performed with a Chi square test and the significance level was equal to or less than 0.05. Results. The political context obtained 64%, economical context 10% and mechanisms of regulation 31%. The educational structure was 61% and the social impact was 93%. Conclusions. Public policies, regulatory mechanisms and public investment must be strengthened to improve the quality of medical education. [ABSTRACT FROM AUTHOR]