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Background: Trials demonstrated an increased risk of distal median nerve dysfunction (DMND) and carpal tunnel syndrome (CTS) associated with teriflunomide in people with multiple (pwMS). Objective: To estimate the real-world prevalence of clinical CTS and electrodiagnostic DMND in teriflunomide-treated pwMS. Methods: Cross-sectional study on selected teriflunomide (WHOATC code: L04AK02)-treated, risk factor-free pwMS at the Isfahan MS clinic in 2022. CTS was diagnosed through history and physical examination, and DMND was diagnosed by nerve conduction studies (NCS). Outcome consisted of an ordinal scale of DMND as follows: no DMND, all values within normal limits; mild, sensory conduction velocity < 40 m/s with motor onset latency < 4.5ms; moderate, motor onset latency between 4.5–6.5ms; severe, motor onset latency > 6.5ms with amplitude > 0.2mV; and very severe, motor amplitude < 0.2mV. Results: 52 participants were included (median [range] duration of teriflunomide treatment: 3 [18] years); 5.8% were diagnosed with CTS, yet, 51.9% showed at least some evidence of DMND; of the 104 hands, 25% showed mild, 11.5% moderate, 2.9% severe, and none showed very severe DMND. Right hand side (aβ [SE]: 0.67 [0.26]; p = 0.01), duration of MS (aβ [SE]: -0.14 [0.05]; p = 0.01) and age (aβ [SE]: 0.06 [0.03]; p = 0.05) were associated with a worse grade of DMND, while the association of DMND grade with sex, EDSS score, duration of teriflunomide treatment, and prior DMT, were not confirmed (all p values > 0.05). Conclusion: A considerable proportion of teriflunomide-treated pwMS had DMND in at least one hand. The etiology, along its optimal management strategy, remains to be explored. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the concavity (angle β, central and peripheral concavity) of the descending limb of the maximal expiratory flow-volume (MEFV) curves to reflect various ventilatory defects, including obstructive, restrictive, or mixed patterns. Methods: We conducted a cross-sectional study collecting spirometry data from a healthcare center and a tertiary hospital between 2017 and 2022, with additional raw flow-volume curve data from primary healthcare institutions in 2023. We analyzed differences in concavity between spirometric patterns. Receiver operating characteristic curves were used to assess the predictive power of concavity for spirometric patterns. The relationship among concavity indices was examined. Results: This study included 18,938 cases, with 22% exhibiting an obstructive pattern. The dataset comprised 14,868 cases for training, 3716 cases for validation, and 354 cases for testing. In the training set, the mean angle β were 180.3 ± 12.4 and 148.5 ± 12.7 degrees in normal and obstruction patterns. The angle β had an AUC of 0.970 (95% CI 0.966–0.973) for identifying normal and obstructive patterns, with a cut-off value of 163.0 degrees. In the validation set, out of 2311 cases with a normal forced vital capacity (FVC), 3.1% cases exhibited a Z-score of forced expiratory volume in 1 s to FVC ratio (FEV1/FVC) ≥ − 1.645 but an angle β < 163.0 degrees. In testing set, a correlation coefficient of − 0.96 and − 0.79 was found between the angle β and the central or peripheral concavity. Conclusion: The concavity of the descending limb of MEFV curves may be crucial in identifying spirometric patterns. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is a significant health issue, especially in low- and middle-income countries like India, where it ranks fourth among women. The Human papillomavirus (HPV) vaccination, a vital preventive measure, has suboptimal uptake among nursing students. We aimed to assess the level of knowledge, attitudes, willingness, and reasons for non-uptake of HPV vaccination among nursing students. Methods: A descriptive cross-sectional study was conducted from April to June 2023, using a total enumeration method. Data were collected from 313 nursing students using a validated questionnaire covering sociodemographic information, knowledge, attitudes, and reasons for non-uptake of HPV vaccination. Statistical analysis was performed using SPSS version 26.0. Descriptive statistics summarized the data, while binary and multivariable logistic regression analyses identified factors associated with knowledge, attitude, and willingness for HPV vaccination. Results: The mean age of the students was 20.98 ± 2.38 years, with the majority being females (81.2%) and unmarried (93.0%). About half of the participants demonstrated moderate knowledge (52.4%) and negative attitudes (50.1%) towards HPV vaccination, with none having received the vaccine. Female students had 4.24 times the odds of having good knowledge (AOR = 4.24, 95% CI = 1.66–10.80), while those pursuing a bachelor's degree exhibited 2.70 times the odds of good knowledge (AOR = 2.70, 95% CI = 1.40–5.21). In contrast, first-year students had 0.30 times the odds of having good knowledge (AOR = 0.30, 95% CI = 0.11–0.79) but displayed 4.69 times the odds of having a positive attitude (AOR = 4.69, 95% CI = 1.92–11.41). Additionally, Hindu students had 2.44 times the odds of being willing to receive the vaccine (AOR = 2.44, 95% CI = 1.15–5.20). Most participants expressed willingness to receive the vaccine (62.0%), citing reasons such as not being sexually active (35.8%) and needing more information (18.2%) for non-uptake of the vaccine. Conclusions: The study highlights gaps in knowledge and negative attitudes towards HPV vaccination among nursing students. Targeted educational interventions and policy initiatives are essential to improve awareness, promote positive attitudes, and increase HPV vaccination uptake among nursing students. [ABSTRACT FROM AUTHOR]

Background: Evidence shows harmful effects of e-cigarettes on health. There is limited data on the use of e-cigarettes among nursing students. This study aimed to investigate the usage, knowledge, and attitudes towards e-cigarettes among nursing students in Croatia, as well as their views on the role of nurses in counseling patients and assisting with smoking cessation. Methods: This cross-sectional study was conducted via an online questionnaire among nursing students at 10 universities in Croatia in March/April 2024. Students were asked questions about socio-demographics, knowledge and attitudes towards e-cigarettes and their views on the role of nurses in counseling patients and assisting with smoking cessation. Results: The study included 1,039 participants; 89% were women, 43% were smokers; 53% used e-cigarettes and 76% used them for recreational purposes. 21% of participants agreed that e-cigarettes are an effective method for quitting smoking. More than half indicated that e-cigarettes could encourage non-smokers to start smoking. The majority (60%) reported that they had never received education on smoking cessation at university. Furthermore, 66% stated that they did not feel confident advising smokers about e-cigarettes. The majority (70%) considered physicians to be the most knowledgeable health experts to advise and educate users of e-cigarettes. There were no significant differences in attitudes between smokers and non-smokers on the use of e-cigarettes. Participants demonstrated insufficient knowledge about e-cigarettes. Non-smokers had more positive attitudes towards the role of nurses in combating smoking compared to smokers. Participants who had received education on smoking cessation were more willing to advise smokers and had clearer views on the risks and the importance of the nurse’s role in the quitting process compared to those who had not received such education. Smoking status and age were significant predictors of counseling confidence. Conclusion: The study found a high prevalence of smoking and e-cigarette use among Croatian nursing students, along with limited knowledge and generally negative attitudes towards e-cigarettes. It highlighted gaps in education regarding the health risks of e-cigarettes and the lack of practical skills needed to help smokers quit, suggesting that nursing programs should update their curricula to better prepare students in these areas. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia, a prevalent muscle disorder in the older adults, is characterized by accelerated loss of muscle mass and function, contributing to increased risks of falls, functional decline, and mortality. The relationship between dietary oxidative balance score (DOBS) and sarcopenia, however, remains unclear. Methods: We conducted a cross-sectional analysis of the National Health and Nutritional Examination Survey (NHANES) 2011–2018 cohort, which included 8,240 participants, aged 47.2 ± 17.6 years (48.6% male, 51.4% female). The participants were selected from geographic locations across all 50 states and the District of Columbia, using a stratified, multistage probability sampling design to collect health and nutritional data representative of the civilian, non-institutionalized U.S. population. We employed the generalized additive model to identify potential non-linear relationships and utilized the two-piecewise linear regression model to investigate the association between DOBS and sarcopenia in American adults. Results: Participants were categorized into quartiles based on their DOBS, and sarcopenia was diagnosed in 702 individuals (8.5%). In the unadjusted model, DOBS exhibited a significant negative correlation with sarcopenia (β = 0.97, 95% Confidence Interval (CI): 0.96 to 0.99, P < 0.001). This association remained consistent in the model with minimal adjustment for age and gender (β = 0.97, 95% CI: 0.96 to 0.98, P < 0.001) and in the fully adjusted model including additional covariates (β = 0.97, 95% CI: 0.96 to 0.99, P < 0.001). After adjusting for potential confounders, we identified a non-linear association DOBS and sarcopenia, with an inflection point at 23. The effect sizes and CIs to the left and right of the inflection point were 1.62 (95% CI: 1.09 to 2.41, P = 0.016) and 0.97 (95% CI: 0.95 to 0.98, P < 0.001), respectively. Subgroup analyses confirmed the stability of this relationship across various demographic and health-related variables. Conclusions: This research provides new insights into the association between diet quality, as assessed by DOBS, and sarcopenia, reinforcing the critical role of a balanced, antioxidant-rich diet in adult muscle. [ABSTRACT FROM AUTHOR]

Background Observational studies suggest sodium-glucose co-transporter 2 (SGLT2) inhibitor kidney outcome trials are not representative of the broader population of people with chronic kidney disease (CKD). However, there are limited data on the generalizability to those without co-existing type 2 diabetes (T2D), and the representativeness of the Study of Heart and Kidney Protection with Empagliflozin (EMPA-KIDNEY) trial has not been adequately explored. We hypothesized that SGLT2 inhibitor kidney outcome trials are more representative of people with co-existing T2D than those without, and that EMPA-KIDNEY is more representative than previous trials. Methods A cross-sectional analysis of adults with CKD in English primary care was conducted using the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub. The proportions that met the eligibility criteria of SGLT2 inhibitor kidney outcome trials were determined, and their characteristics described. Logistic regression analyses were performed to identify factors associated with trial eligibility. Results Of 6 670 829 adults, 516 491 (7.7%) with CKD were identified. In the real-world CKD population, 0.9%, 2.2% and 8.0% met the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), Dapagliflozin and Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) and EMPA-KIDNEY eligibility criteria, respectively. All trials were more representative of people with co-existing T2D than those without T2D. Trial participants were 9–14 years younger than the real-world CKD population, and had more advanced CKD, including higher levels of albuminuria. A higher proportion of the CREDENCE (100%), DAPA-CKD (67.6%) and EMPA-KIDNEY (44.5%) trial participants had T2D compared with the real-world CKD population (32.8%). Renin–angiotensin system inhibitors were prescribed in almost all trial participants, compared with less than half of the real-world CKD population. Females were under-represented and less likely to be eligible for the trials. Conclusion SGLT2 inhibitor kidney outcome trials represent a subgroup of people with CKD at high risk of adverse kidney events. Our study highlights the importance of complementing trials with real-world studies, exploring the effectiveness of SGLT2 inhibitors in the broader population of people with CKD. [ABSTRACT FROM AUTHOR]

Introduction The Illicit Tobacco Trade (ITT) subverts tobacco control efforts. Cigarette packs sold without legal health warnings undermine efforts to warn the public about the dangers of tobacco. Furthermore, cigarettes sold below minimum retail prices are indicative of tax evasion leading to revenue loss and budgetary deficits in high tobacco-burden economies. The extent of the ITT in rural areas of such countries might differ from urban. We estimated the extent of illicit cigarette sales in selected rural areas of Pakistan. Aims and Methods We analyzed cigarette packs collected from 85 villages in Pakistan as part of a cross-sectional consumer survey of 2550 rural households. We classified cigarette packs as noncompliant if these were missing: A text health warning, pictorial health warning (PHW), underage sale prohibition warning, retail price, or manufacturer details. To measure the extent of tax evasion, we estimated the proportion of packs purchased below the legal minimum retail price. Results Only 35% (429/1228) of rural smokers were able to show their cigarette packs. Out of these, 89% (382/429) of packs were noncompliant with the cigarette packaging and labeling laws. In rural areas, 83% (357/429) of packs did not have PHW and 33.8% (145/429) did not have printed retail prices. Among all packs, 41% (177/429) were purchased below the minimum retail price of 63 Pakistani Rupees and hence highly likely to have evaded taxes. Conclusions We found a very high previously unreported proportion of noncompliant cigarette packs in selected rural areas of Pakistan indicating weaker implementation of tobacco control laws in rural areas. Implications This paper presents previously unreported estimates of the share of illicit cigarette sales in rural areas of Pakistan. Most packs (89%) in our sample were noncompliant with the packaging and labeling regulations and a significant proportion (41%) were purchased below the minimum price. The extent of illicit tobacco was found to be far greater in rural than in urban areas of Pakistan. Taking advantage of poor law enforcement, the tobacco industry may be complicit in flooding the rural markets with illegal and cheap cigarettes. Given this disparity, law enforcement authorities must focus on rural areas. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pulmonary resections are critical interventions for treating various lung pathologies, both benign and malignant. Understanding the impact of these surgeries on patients' Quality of Life (QoL) is essential for optimizing care. This study aims to compare the Health-Related Quality of Life (HRQoL) and psychological well-being in patients who underwent pulmonary resections for benign versus malignant etiologies. Methods: A cross-sectional study was conducted involving 117 patients who underwent pulmonary resection between January 2022 and June 2023. Participants were divided into two groups: 51 patients with benign lung conditions and 66 with malignant lung tumors. HRQoL was assessed using the SF-36 and WHOQOL-BREF questionnaires. Anxiety and depression levels were evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10). Patients were assessed pre- and post-intervention. Results: Patients with malignant etiologies were older (58.7 vs. 54.2 years) and had lower FEV1% predicted (79.1% vs. 82.5%) compared to the benign group. Malignant patients reported significantly lower scores in physical functioning (68.1 vs. 75.4), role-physical (65.0 vs. 72.3), and general health domains of the SF-36 (62.4 vs. 70.2). WHOQOL-BREF scores indicated a lower overall QoL in the malignant group, particularly in the physical health (65.3 vs. 72.1) and psychological domains (68.0 vs. 74.5). HADS scores revealed higher anxiety (9.1 vs. 7.2) and depression levels (8.5 vs. 6.8) among malignant patients. Correlation analyses showed strong associations between lower QoL scores and higher anxiety and depression levels. Conclusions: Pulmonary resections for malignant conditions are associated with a significant decline in HRQoL compared to benign conditions. Patients with malignant etiologies experience higher levels of anxiety and depression, emphasizing that clinicians should integrate specialized mental health services and tailored physical rehabilitation programs for patients undergoing pulmonary resections for malignant lung conditions to address their significantly reduced quality of life and increased psychological distress. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary Resuscitation (CPR) is considered as the most important skill for physicians. The practice of effective CPR depends on the quality of the CPR training, team work skills and hospital management. Because of complexity and several variables involved, the outcome of CPR may vary in the different times of day and different days of the week. Methods: This study is a cross sectional and the data were provided from the medical records. All the patients who underwent CPR from July 2021 to Feb 2022 in the Children's Medical Center Hospital were included. The ward, disease, gender and age, the time of the day and the day of the week in which CPR event happened and the Survival to Discharge from Hospital (SDH), had been registered. We compared The SDH rate of CPRs between different days of the week (working days and weekends) and also different working shifts (morning, afternoon and night) were compared. Results: The rate of SDH of the patients who underwent CPR was to 21.2%. There wasn't a significant difference between SDH during working days and weekends and during the morning, afternoon and night shifts. Conclusion: The SDH rate was lower in the night shifts and during the weekends but the difference wasn't significant. It is recommended to improve the medical team CPR skills in all shifts specially in the evening and night shifts. Also, an appropriate dissemination of health care staff in working shifts should be done to increase the success rate of CPR procedure. [ABSTRACT FROM AUTHOR]

Background: Long-term use of antipsychotics confers increased risk of cardiometabolic disease. Ongoing need should be reviewed regularly by psychiatrists. Aim: To explore trends in antipsychotic management in general practice, and the proportions of patients prescribed antipsychotics receiving psychiatrist review. Design and setting: Serial cross-sectional study using linked general practice and hospital data in Wales (2011–2020). Method: Participants were adults (aged ≥18 years) registered with general practices in Wales. Outcome measures were prevalence of patients receiving ≥6 antipsychotic prescriptions annually, the proportion of patients prescribed antipsychotics receiving annual psychiatrist review, and the proportion of patients prescribed antipsychotics who were registered on the UK serious mental illness, depression, and/or dementia registers, or not on any of these registers. Results: Prevalence of adults prescribed long-term antipsychotics increased from 1.055% (95% confidence interval [CI] = 1.041 to 1.069) in 2011 to 1.448% (95% CI = 1.432 to 1.464) in 2020. The proportion receiving annual psychiatrist review decreased from 59.6% (95% CI = 58.9 to 60.4) in 2011 to 52.0% (95% CI = 51.4 to 52.7) in 2020. The proportion of overall antipsychotic use prescribed to patients on the serious mental illness register decreased from 50.0% (95% CI = 49.4 to 50.7) in 2011 to 43.6% (95% CI = 43.0 to 44.1) by 2020. Conclusion: Prevalence of long-term antipsychotic use is increasing. More patients are managed by GPs without psychiatrist review and are not on monitored disease registers; they thus may be less likely to undergo cardiometabolic monitoring and miss opportunities to optimise or deprescribe antipsychotics. These trends pose risks for patients and need to be addressed urgently. [ABSTRACT FROM AUTHOR]

Introduction: Emerging and re-emerging infectious diseases continue to pose a severe threat to public health in Sub-Saharan Africa (SSA) and globally. Community-related interventions, such as community e-Health literacy, can contribute to the preparedness to respond effectively to emerging and re-emerging infectious diseases. This study investigated the relationship between e-Health literacy and SSA countries' perceptions of the importance of readiness for potential pandemics. Method: This cross-sectional study was conducted in sub-Saharan African countries (Nigeria, Rwanda, Burundi, and South Africa) among adults aged 18 years and above between July 2020 and August 2021, respondents were recruited through a non-probability sampling technique. Participants were asked to self-report the perceived importance of 13 items on future pandemic preparedness scored on a 5 Likert-point scale. The four key dimensions of pandemic preparedness were online medical consultation, online courses, messaging for healthcare, and shopping. E-Health literacy was the key exposure. The questionnaire was adapted from a previously validated e-Health literacy scale. Data was collected through a self-administered questionnaire online. Data analysis was done using Stata and descriptive statistics including frequency, proportions, means, and standard deviation were used to summarize variables. Inferential statistics including chi-square and logistic regressions were used to test the significance of association between e-health literacy and pandemic preparedness setting the level of significance at 5%. Results: A total of 1295 people participated in this study. Roughly half of all participants, 685 (52.90%), were aged between 18 and 29 and 685 (52.90%) were females. The standardised average (SE) e-Health literacy score was 29.55 (0.19). Shopping was perceived as the most important dimension of pandemic preparedness across participating countries (mean (SE) of 3.32 (0.06) and above across all countries for online shopping), while online medical consultation was the least perceived as important (mean (SE) of 2.88 (0.08) or less in two countries for instant health advice from chatbot). In the fully adjusted model, e-Health literacy was associated with 8 out of 13 items of the perceived importance of the pandemic preparedness questionnaire. Those include online consultation with doctors (OR = 1.11, 95% CI 1.02–1.21), telephone health advice (OR = 1.07, 95%CI 1.00–1.15), medicine delivery (OR = 1.04, 95% CI 1.03–1.06), getting medicine prescribed in a hospital visit/follow-up in a community pharmacy (OR = 1.07, 95% CI 1.05–1.10), receiving health information via email (OR = 1.08, 95% CI 1.01–1.17) and via social media (OR = 1.08, 95% CI 1.03–1.14), online shopping (OR = 1.07, 95% CI 1.03–1.11) and instant streaming courses (OR = 1.09, 95% CI 1.02–1.16). Conclusions: The higher e-Health literacy scores were associated with a higher perception of most elements as important in future pandemic readiness. Strengthening e-Health literacy can be a key element of the preparation for pandemics in SSA countries. [ABSTRACT FROM AUTHOR]

Background: Malawi ranks 142 out of 170 countries on the UN's Gender Inequality Index (GII). Women and men in Malawi have unequal access to and control over resources. Previous research has primarily examined gender roles and norms from a women's perspective, but few studies have investigated men's attitudes and behaviors regarding gender equality. This study fills this gap by investigating the social factors that influence attitudes towards gender-equality and exploring the association between behaviors and attitudes in south-eastern Malawi. Methods: A cross-sectional survey was administered to adult males during a health education program (male-friendly clinics) in four healthcare facilities from August 2022 to November 2022. The validated Gender-Equitable Men (GEM) scale, was employed to quantify men's attitudes towards gender norms. Univariate and multivariable analyses were used to identify the social determinants of and the behaviors associated with gender-equitable attitudes. Results: A total of 422 men, with a median age of 46 years (IQR = 34, 55), were included in this study. The participants reported a median score of 0.53 for gender attitudes, where 0 represents the minimum score and 1 the maximum. A higher GEM score was associated with a higher educational grade and living in an urban area. In terms of decision-making, 64% and 56% of men reported that they had the final say in matters concerning women's and children's health, respectively. Higher GEM scores were associated with joint decision-making in relation to women's (0.55 vs. 0.49; p = 0.008) and children's health (0.54 vs. 0.48; p = 0.012), and spending on food and clothing (0.56 vs. 0.49; p < 0.001). On the other hand, certain activities, such as cleaning the house (64% of men reported unequal participation), and cooking (70%) were not shared among partners. An equal or greater participation from men (70%) compared to women was reported for activities related to childcare. Men who participated in the previously mentioned tasks had higher GEM scores than those who did not. Conclusions: The findings of this study shed light on the significant role of educational grade and living in an urban area as determinants of gender-equitable attitudes among men in south-eastern Malawi. More equitable perspectives towards gender norms were associated with being more involved in tasks typically assigned to women and in joint decision-making. Incorporating gender in research can contribute to the advancement of a more inclusive healthcare system. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the third most common cancer worldwide and presents a significant challenge to public health. Metabolic syndrome (MetS) is a condition that is predominantly characterized by abdominal obesity and metabolic abnormalities such as hypertension, hyperglycemia, and hyperlipidemia, and it is one of the critical risk factors for CRC. Traditional anthropometric measures have limitations in accurately assessing the risk associated with abdominal obesity. This study aimed to investigate the association between "A Body Shape Index" (ABSI) and the risk of developing CRC among individuals with MetS utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional study conducted a statistical analysis of all adult participants who met the diagnostic criteria for MetS in the NHANES data from 1999 to 2018. The ABSI was calculated to quantify abdominal obesity. ABSI is derived from a formula that incorporates waist circumference (WC), body mass index (BMI), and height, and is calculated as ABSI = WC / (BMI^(2/3) × Height^(1/2)). Multivariate logistic regression modeling was used to examine the independent association between ABSI and CRC incidence. Receiver Operating Characteristic (ROC) curves were employed to analyze the ability of ABSI compared to traditional metrics in identifying CRC risk. Results: This study involved 16,018 MetS patients with a mean age of 51.8 years, of whom 50.3% were male and 49.7% were female. Logistic regression adjusted for confounders revealed a significant association between an elevated ABSI and an increased risk of developing CRC (odds ratio (OR): 1.433, 95% confidence interval (CI): 1.116 to 1.841; P = 0.005). ROC analyses confirmed that the predictive accuracy of the ABSI for the risk of developing CRC area under the curve (AUC): (0.668, 95% CI: 0.624 to 0.713) surpassed that of traditional measurement methods. Conclusion: Among individuals with MetS, the ABSI is linked to an elevated risk of developing CRC. Compared with traditional anthropometric indices, the ABSI is a superior predictive marker for the risk of developing CRC. [ABSTRACT FROM AUTHOR]

Background: Asthma is a chronic inflammatory disease. Currently, contradictory findings exist regarding the association between food folate and asthma. Therefore, we hypothesize a positive correlation between food folate and asthma. Purpose: To investigate the possible relationship between food folate intake and the development of asthma in children and adolescents in the United States. Methods: Data from the U.S. National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018 were analyzed cross-sectionally by covariate adjustment using multivariate logistic regression, restricted triple spline curves, threshold effects, and stratified analyses. Results: There were 8,821 participants, of whom 1,697 (19.2%) self-reported having received a diagnosis of asthma from a physician or other health professional. After accounting for potential confounders, the adjusted odds ratios (ORs) for asthma in the second (T2, 111–178 µg/day) and third (T3, >178 µg/day) groups were 1.15 (1–1.33) and 1.23 (1.04–1.46), respectively, compared with the group with the lowest food folate intake (T1, <111 µg/day). In addition, the association between food folate intake and asthma showed an inverse L-shaped curve (non-linear relationship, p = 0.003), and stratified analysis further validated the robustness of the results. The OR of asthma in subjects with food folate intake less than 263.9 µg/day was 1.002 (1.001–1.004). Conclusion: In children and adolescents in the United States, there is a non-linear association (inverted "L" shape) between food folate intake and asthma, with an inflection point at 263.9 micrograms per day. [ABSTRACT FROM AUTHOR]

Hypertrophic burn scars can occur due to imbalances in the healing process and affect quality of life. They can be assessed with the Patient and Observer Scar Assessment Scale (POSAS). This is an assessment instrument with both a patient scale and an observer scale. This study aimed to assess the reliability and validity of the POSAS score to measure the quality of scars in evaluating burns that produce scar tissue. It also aimed to determine similarities in the assessment of scar tissue using the POSAS score according to observers and patients. This cross-sectional study had a sample of 30 patients, including 19 women (63%). Assessments were performed before the initial treatment procedure and 1 and 6 months after. The post-incision scar tissue assessment results using the POSAS instrument were expressed as a score: 5-50 (observer), 6-60 (patient), or 11-110 (both total). The highest degree of burns was superficial-mid-dermal (20 patients; 67%). The POSAS assessment by doctors and patients tended to be the same and decreased at both months 1 and 6 after the treatment procedure. The mean total score was 51.3 ± 12.1 before treatment, 44.2 ± 9.5 at month 1, and 30.3 ± 5.9 at month 6. This study shows that in evaluating burns that produce hypertrophic scars, similarities exist in the POSAS score according to observers and patients. Precautions at the beginning of the observation will affect the POSAS score. [ABSTRACT FROM AUTHOR]

Aims: To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community‐dwelling older adults aged 55 and above using the protection motivation theory scale. Design: A cross‐sectional study. Methods: The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy‐five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non‐faller', employing IBM SPSS version 26.0 for descriptive, independent t‐test, chi‐square, bivariate correlation and linear regressions. Results: A total of 375 older participants were included in the study. Fallers (n = 82) and non‐fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self‐rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. Conclusion: Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non‐preventive behaviours, leading to a decline in fall protection motivation. Implications for the profession and/or patient care: These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. Patient or Public Contribution: Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty‐five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis. [ABSTRACT FROM AUTHOR]

To describe current food insecurity (FI)-related training among nutrition/dietetics, public health, and social work students. A cross-sectional online survey was used among students (n = 306) enrolled in health-related programs at 12 US universities. Participants reported FI-related course-based and extracurricular experiences and rated confidence to address FI on a scale of 1–3. Open-ended questions investigated perceived definitions of FI and impactful course activities. Descriptive statistics and thematic analysis were used for data analysis. Participants' FI definitions were multifaceted. Most (80.6%) reported FI being covered in at least 1 course. The overall mean confidence to address FI was 2.2 ± 0.48. Participants suggested increasing application-based opportunities and skills training. Most students have a basic understanding of FI and report high confidence to address it in the future. Impactful FI-related experiences and participants' suggestions guide developing an FI training resource to enhance student FI competency and sensitivity. [ABSTRACT FROM AUTHOR]

Background Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care. Objectives This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes. Methods A cross-sectional study of adults (n = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI. Results A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (r = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance. Conclusions SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Editors‐in‐Chief (EiC) play a key role as gatekeepers in academic medicine, often shaping research agendas. Women have historically been underrepresented in editorial leadership roles in academic medicine. The purpose of this study was to examine gender representation among EiC of contemporary transplantation and nephrology journals. Methods: This cross‐sectional study evaluated gender disparities among EiC of transplantation and nephrology medical journals. The study population was drawn from journals in two subject categories (1) 'Transplantation' and (2) 'Urology and Nephrology' in the 2023 Journal Citation Reports. Binary gender classification (woman/man) was determined by the names/pronouns used to describe the EiC on the journal or institutional webpage. The primary outcome was the proportion of women EiC. Secondary outcome was the proportion of women EiC based on journal topic, location and metrics. Descriptive statistics were used. Gender differences were compared using students t‐test or Fisher's exact test. Results: A total of 79 EiC were identified of which 16 (20%) were women and 63 (80%) were men (p <.001). Transplantation and nephrology journals had 21% and 20% women EiC, respectively. The proportion of women to men EiC was not impacted by journal category (p =.93), journal location (p =.61), journal impact factor (p =.71) or quartile (p =.59). Conclusion: There was a disparity in gender representation in EiC in nephrology and transplantation journals, with men holding 80% of all positions. These findings, among growing evidence of gender disparity, highlight a need for targeted efforts to promote gender equity in academic medicine. [ABSTRACT FROM AUTHOR]

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Objective: Individuals with disabilities face elevated risks of adverse oral health outcomes compared with the general population, including worse periodontal health, increased edentulism, and untreated dental decay. Given the varied impacts of different disabilities on people's health and well‐being, this study aims to investigate diverse associations between untreated decay and cognitive, physical, emotional, and sensory disabilities among US adults. Methods: This cross‐sectional study analyzed questionnaire and clinical examination data on 7084 adults (≥20 years) from the 2015–18 National Health and Nutrition Examination Survey cycles. Sociodemographics, oral health behaviors, health conditions, and disability were all examined. The prevalence of tooth decay was calculated as the proportion of adults with untreated decay. Survey‐weighted multivariable logistic regression was used to assess associations between disability and untreated decay. Results: In general, untreated decay was more than twice as prevalent in individuals with three or more disabilities as in those without any disabilities (34.5% vs. 13.2%, p < 0.001). After adjusting for confounders, lack of functional dentition was the most significant predictor of untreated decay prevalence (adjusted odds ratio: 2.97, 95% CI: 2.37–3.72). Other significant factors were younger age (20–44), non‐Hispanic black race or ethnicity, low‐income status, having an underlying chronic condition, not having a past‐year dental visit, symptomatic dental visits, and current tobacco use. Conclusion: No associations were found between disability type (cognitive, emotional, physical, and sensory) and untreated decay among community‐dwelling US adults. Several health‐related, social, and behavioral factors emerged as primary predictors of untreated decay. Further research is needed to explore disability types and dental caries determinants. [ABSTRACT FROM AUTHOR]

Christian Maihöfner,1 Theresa Mallick-Searle,2 Jan Vollert,3 Pranab Kalita,4 Vidhu Sood Sethi5 1Department of Neurology, General Fürth Hospital, University of Erlangen, Fürth, Germany; 2Division of Pain Medicine, Stanford Health Care Pain Management Clinic, Palo Alto, CA, USA; 3Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; 4Global Category Medical Affairs, Haleon Plc, Weybridge, England, UK; 5Global Medical Affairs, GSK Consumer Healthcare Singapore Pte. Ltd, SingaporeCorrespondence: Vidhu Sood Sethi, GSK Consumer Healthcare Singapore Pte Ltd (Co Regn No. 201309040M), 23 Rochester Park &num;03-02, 139234, Singapore, Tel +6596447203, Email vidhu.x.sethi@haleon.comAbstract: In recent years, regulatory authorities have signaled a willingness to consider real-world evidence (RWE) data to support applications for new claims and indications for pharmaceuticals. Historically, RWE studies have been the domain of prescription drugs, driven by the fact that clinical data on patients are routinely captured in medical records, claims databases, registries, etc. However, RWE reports of nonprescription drugs and supplements are relatively sparse due to methodological gaps in this area. The objective of this narrative review is to identify which RWE methodologies have been used to study nonprescription products. A total of 49 articles were included based on literature searches. Label comprehension studies, used to support prescription-to-nonprescription switches, are useful in determining how nonprescription products will be used; however, they provide no actual clinical data. The most common RWE studies of nonprescription products were cross-sectional surveys, which investigated a broad range of indications and were conducted in an array of settings, including online, by phone, point-of-sale (pharmacy), outpatient clinics, and shopping malls. However, while this type of study is effective for identifying use patterns and attitudes in the general population, recall bias limits the ability to collect safety and effectiveness data. Studies of electronic medical records and claims databases are hampered by incomplete or absent capturing of data on nonprescription products. As a result, most RWE studies to date have provided limited useful information. Although case reports and expert opinion should not be discounted, in the absence of other information they provide few actual data. Novel approaches using smartphone apps and artificial intelligence may provide new opportunities to collect RWE for nonprescription products, but these areas of research are in their infancy. Overall, there is a need to develop standards for execution of RWE studies of nonprescription products in terms of endpoints, study design, and study quality.Keywords: cross-sectional studies, dietary supplements, evidence-based practice, nonprescription drugs, research design

Abstract Background Endoplasmic reticulum stress (ERS) and the unfolded protein response (UPR) are adaptive mechanisms for conditions of high protein demand, marked by an accumulation of misfolded proteins in the endoplasmic reticulum (ER). Rheumatic autoimmune diseases (RAD) are known to be associated with chronic inflammation and an ERS state. However, the activation of UPR signaling pathways is not completely understood in Sjögren’s disease (SD). This study evaluated the expression of ERS-related genes in glandular tissue of patients with primary SD (pSD), associated SD (aSD) with other autoimmune diseases, and non-Sjögren sicca syndrome (NSS). Methods In a cross-sectional study, minor salivary gland biopsies were obtained from 44 patients with suspected SD and 13 healthy controls (HC). Patients were classified as pSD, aSD, or NSS based on clinical, serological, and histological assessment. Histopathological analysis and mRNA expression analysis of genes associated with ERS and UPR (PERK, XBP1, ATF-6, ATF-4, CANX, CALR, CHOP, and BIP) were performed on the samples. Differences between groups (pSD, aSD, NSS, and HC) were assessed. The influence of chloroquine (CQ) on the ER was also investigated. Results Twenty-eight SD patients showed increased expression of PERK (p = 0.0117) and XBP1 (p = 0.0346), and reduced expression of ATF-6 (p = 0.0003) and CHOP (p = 0.0003), compared to the HC group. Increased expression of BIP (p

Background: The increasing prevalence of smartphone use has been associated with musculoskeletal pain; however, the specific roles of demographic factors, smartphone usage time, posture, contents and state of addiction on pain in the upper-body regions remain unclear. Objects: This study investigated the influence of smartphone usage characteristics, including age, occupation, visual condition, duration, content, and posture, as well as smartphone addiction, on musculoskeletal pain in upper-body regions. This study aimed to comprehensively elucidate the factors contributing to the pain associated with smartphone use. Methods: A cross-sectional survey was conducted with 316 participants aged 20–59 years. Data on personal characteristics, smartphone use patterns, state of addiction (measured using the Smartphone Addiction Scale-Short Version), and musculoskeletal discomfort (Cornell Musculoskeletal Discomfort Questionnaire and Cornell Hand Discomfort Questionnaire) were collected. Binary logistic regression analysis identified significant predictors of pain in different body regions. Results: Younger age (20–30 years), being housewives or students, and vision impairment (shortsightedness) significantly increased the likelihood of neck, shoulder, and hand pain. Prolonged smartphone use (7–10 hours daily) and gaming were strongly associated with elevated pain risk, whereas moderate usage (1–4 hours daily) may be protect against lumbar pain. Non-neutral postures, especially side lying, have emerged as critical risk factors, with left-side lying linked to hand pain and right-side lying linked to upper back pain. Smartphone addiction consistently predicted pain across all regions by amplifying physical strain through prolonged engagement and poor posture. Conclusion: This study highlighted the multifactorial nature of smartphone-related musculoskeletal pain, emphasizing the roles of demographic characteristics, usage patterns, and addiction. These findings provide a foundation for developing tailored ergonomic and behavioral interventions to mitigate pain risks, particularly in high-use populations. Future research should validate these findings through longitudinal studies and objective measures.

Background: In rural area like Warananagar-Kodoli, Maharashtra, India, workers, handlers, and rag pickers lack awareness about health and cleanliness. Ignorance about the handling and management of biomedical waste (BMW) has led to a high number of fatalities. BMW is a type of infectious waste that harms the environment. It is essential to dispose of BMW properly, following the rules and laws set by the government. BMW contains infections, dangerous bacteria, blood, sharp objects, and remnants of feces and urine, which can contaminate the environment. It is important to handle BMWs intelligently and hygienically by storing, transporting, and disposing of them according to the regulations of the Ministry of Government of India. Methods: In this cross-sectional study, the focus was on eight village hospitals. We used quantitative analysis methods and weighing scales to examine the data. Microsoft PowerPoint, Word, and Excel software were used for data analysis. Results: The study involved both qualitative and quantitative analysis of BMW. We observed and monitored waste samples twice a week. We used a weight measuring instrument to measure the weight of BMW, sharp waste, chemical waste, municipal solid waste (MSW), and infectious waste. After measuring the waste, a sample analysis was conducted. Conclusion: The collected data are related to BMW and responsible for the spread of infections. This study deals with managing hospital waste, including collection, separation, infectious waste treatment, temporary storage, timely transmission, and healthcare waste disposal.

Objectives It is important to assess healthcare providers (HCPs) knowledge, attitudes, perceptions, and preferences towards new pneumococcal vaccines for adults.Methods HCPs who met eligibility criteria completed an online survey between March – May 2024 that included a discrete choice experiment (DCE) to elicit preferences.Results Among 340 participating HCPs, the average age was 44.9 years old, and the majority were male (55.6%), and White (85.3%). Most HCPs reported that they would support (90.3%) and implement (91.5%) a lower age-based recommendation for pneumococcal vaccines (from adults 65+ years to adults 50+ years). A majority of HCPs would offer a supplemental dose of a pneumococcal vaccine to high-risk adults 19–49 years, at-risk or high-risk adults 50–64 years, and adults 65+ years regardless of risk status to increase protection after completing the recommended series. DCE results showed that coverage of pneumococcal pneumonia and invasive pneumococcal disease (IPD) in adults 65+ years were the two most important attributes in evaluating pneumococcal vaccines.Conclusions HCPs preferred a pneumococcal vaccine with increased coverage against pneumococcal pneumonia and IPD, and they supported lowering the age recommendation for pneumococcal vaccination as well as a supplemental vaccine dose to provide additional coverage for adults.

The study was aimed to assess mental health of the older adults who did not participate in the three stages of national vaccination program. As a descriptive-analytical study, about 285 Iranian older people were interviewed in 2022. Data collection tools included demographic characteristics, conspiracy scale, superstitious beliefs instrument, and Templer death anxiety. The convenience sampling method was used and data were analyzed using BIM-SPSS version 28. Death anxiety statistically effect on conspiratory and superstitions with scores 0.190 and 0.320 using adjusted Eta squared, respectively and superstitious beliefs effected 81% of conspiracy as well (p = 0.001). Using ROC analysis, the cutoff points for conspiracy of men and women and final SEM model were extracted too. Interaction of conspiracy illusion, superstitions with death anxiety during the pandemic time among vulnerable groups i.e ageing community can shape a decision line in health policy making. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of peri-implantitis and identify risk and protective indicators of peri-implantitis in a population that underwent implant therapy in a university dental clinic. Method and materials: Randomly selected patients from a postgraduate university dental clinic were invited to participate. Clinical and radiographic examinations were recorded. Peri-implantitis was defined as the presence of bleeding and/or suppuration on probing, probing depths of >6 mm, and bone loss > 3 mm. Patient-, implant-, and bone-related factors were recorded and analyzed using a multivariate logistic regression analysis. Results: A total of 355 dental implants placed in 108 patients and exhibiting at least lyear loading time were included. The prevalence of peri-implantitis was 21.3% at patientlevel, while 10.7% at implant-level. Simultaneous guided bone regeneration (OR 2.76, 95% Cl 1.07-7.12, P = .O35), recurrent periodontitis (OR 3.11, 95% Cl 1.02-9.45, P= .045) and significant medical history (OR 2.86, 95% Cl 1.08-7.59, P = .034) were identified as risk indicators for peri-implantitis. The mean peri-implant bone loss was estimated to be 2.18 ± 1.57 mm for the total number of implants, whereas implants diagnosed with peri-implantitis demonstrated 4.42±1.12mm in a time period between 12 to 177 months. Conclusion: Within the limitations of the study, the prevalence of peri-implantitis in a cohort receiving dental implant therapy at a university dental clinic was 10.7% at implant level and 21.3% at patient level. Patient-reported systemic comorbidities and recurrent periodontitis as well as implants placed in ridge augmented sites were associated with greater risk of peri-implantitis. [ABSTRACT FROM AUTHOR]

Background: This study investigates the relationship between male sexual dysfunction, such as erectile dysfunction, decreased libido, premature ejaculation, and alcohol dependence syndrome (ADS). Methods: This cross-sectional study evaluated sexual dysfunction in 260 married patients with an ADS diagnosis based on CONSORT standards. Participants were chosen from an outpatient psychiatry department. The Arizona Sexual Experience Scale and the Severity of Alcohol Dependence Questionnaire Scale were among the instruments utilized. Results: We found a strong link between sexual dysfunction and the severity of ADS. A smaller but statistically significant percentage (16.15%) of the subjects showed signs of severe alcohol dependence compared to half (50%) who showed mild dependence. Conclusions: The results highlight the connection between sexual dysfunction and the severity of alcohol dependence, indicating the necessity for focused therapies. Sexual dysfunction was more common as ADS severity grew, indicating the need for more treatment options and raising awareness.

Abstract Light profoundly impacts many aspects of human physiology and behaviour, including the synchronization of the circadian clock, the production of melatonin, and cognition. These effects of light, termed the non-visual effects of light, have been primarily investigated in laboratory settings, where light intensity, spectrum and timing can be carefully controlled to draw associations with physiological outcomes of interest. Recently, the increasing availability of wearable light loggers has opened the possibility of studying personal light exposure in free-living conditions where people engage in activities of daily living, yielding findings associating aspects of light exposure and health outcomes, supporting the importance of adequate light exposure at appropriate times for human health. However, comprehensive protocols capturing environmental (e.g., geographical location, season, climate, photoperiod) and individual factors (e.g., culture, personal habits, behaviour, commute type, profession) contributing to the measured light exposure are currently lacking. Here, we present a protocol that combines smartphone-based experience sampling (experience sampling implementing Karolinska Sleepiness Scale, KSS ratings) and high-quality light exposure data collection at three body sites (near-corneal plane between the two eyes mounted on spectacle, neck-worn pendant/badge, and wrist-worn watch-like design) to capture daily factors related to individuals’ light exposure. We will implement the protocol in an international multi-centre study to investigate the environmental and socio-cultural factors influencing light exposure patterns in Germany, Ghana, Netherlands, Spain, Sweden, and Turkey (minimum n = 15, target n = 30 per site, minimum n = 90, target n = 180 across all sites). With the resulting dataset, lifestyle and context-specific factors that contribute to healthy light exposure will be identified. This information is essential in designing effective public health interventions.

Abstract Background Considering the widespread use of social media, it is unsurprising that dentists are increasingly drawn to these platforms as a means of connecting with patients and sharing valuable insights. The aim of this research is to examine the influence of social media on the selection of dentists among residents of the Vojvodina province in the Republic of Serbia. Methods This cross-sectional study surveyed residents of Vojvodina, Serbia, aged 18 years and above, with an account on at least one social media platform. Dentists and dental students were excluded. The questionnaire was divided into three sections: sociodemographic information, social media usage habits, and the influence of social media on the selection of dentist/dental clinic. Descriptive statistics and chi-squared test were used for categorical variables. Binary logistic regression analysis was used to determine the associations between sociodemographic characteristics and the decision to select a dentist based on social media presence. Results In this study, 983 participants were involved, with the majority being female (79.5%) and aged between 18 and 25 years (46.7%). Over half of the respondents (60.3%) stated that they would not select dentists based on their social media profiles, with a significant difference across age groups (p