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Background: Nursing students are faced with multiple challenges and have a higher probability of suffering from anxiety. The current study aims to explore the relation between empathy and anxiety, examining the mediation and moderation effects of insomnia and self-compassion, respectively. Methods: This study employed a convenient sampling method, recruiting 1,161 nursing students (female = 923, male = 238, Meanage = 18.37, SDage = 2.38) from three universities in China. These students completed the questionnaires online, including General Anxiety Disorder -7 (GAD-7), Jefferson Scale of Physician Empathy-Nursing student (JSPE-NS), Youth Self-rating Insomnia Scale -8 (YSIS-8), and Self-Compassion Scale (SCS). The study employed latent variable structural equation models to analyze the relation and mechanisms between empathy and anxiety. Then, the mediated role of insomnia and the moderated role of self-compassion were examined. Results: The prevalence rates of anxiety and insomnia in the current sample are 18.24% and 26.76%, respectively. The results showed that empathy could negatively predict anxiety, with a significant mediating effect of insomnia between them (B = -0.081, p < 0.05, 95% CI [-0.197, -0.063]). Additionally, it was proven that self-compassion moderated the positive relation between insomnia and anxiety. With a higher level of self-compassion, the indirect effect of empathy on anxiety through insomnia was weaker (B = -0.053, p < 0.01, 95% CI [-0.095, -0.019]). When individuals showed a lower level of self-compassion, the indirect effect of empathy on anxiety through insomnia was stronger (B = -0.144, p < 0.01, 95% CI [-0.255, -0.059]). Conclusion: The analysis of this research proved that empathy was negatively related to anxiety, and insomnia served as a mediator between empathy and anxiety. Besides, the protective role of self-compassion on individuals' mental health was identified. The findings of the study suggest that the education of nursing students should highlight the significance of fostering empathy and self-compassion. The intervention on insomnia may be helpful in reducing the levels of anxiety since insomnia is a risky factor for anxiety. [ABSTRACT FROM AUTHOR]

Background: The accuracy of artificial intelligence (AI) and experts in diagnosing early esophageal cancer (EC) and its infiltration depth was summarized and analyzed, thus identifying the advantages of AI over traditional manual diagnosis, with a view to more accurately assisting doctors in evaluating the patients' conditions and improving their cure and survival rates. Methods: The PubMed, EMBASE, Cochrane, Google, and CNKI databases were searched for relevant literature related to AI diagnosis of early EC and its invasion depth published before August 2023. Summary analysis of pooled sensitivity, specificity, summary receiver operating characteristics (SROC) and area under the curve (AUC) of AI in diagnosing early EC were performed, and Review Manager and Stata were adopted for data analysis. Results: A total of 19 studies were enrolled with a low to moderate total risk of bias. The pooled sensitivity of AI for diagnosing early EC was markedly higher than that of novices and comparable to that of endoscopists. Moreover, AI predicted early EC with markedly higher AUCs than novices and experts (0.93 vs. 0.74 vs. 0.89). In addition, pooled sensitivity and specificity in the diagnosis of invasion depth in early EC were higher than that of experts, with AUCs of 0.97 and 0.92, respectively. Conclusion: AI‐assistance can diagnose early EC and its infiltration depth more accurately, which can help in its early intervention and the customization of personalized treatment plans. Therefore, AI systems have great potential in the early diagnosis of EC. [ABSTRACT FROM AUTHOR]

Few methods have been used to characterize repeatedly measured biomarkers of chemical mixtures. We applied latent profile analysis (LPA) to serum concentrations of 4 perfluoroalkyl and polyfluoroalkyl substances (PFAS) measured at 4 time points from gestation to age 12 years. We evaluated the relationships between profiles and z scores of height, body mass index, fat mass index, and lean body mass index at age 12 years (n  = 218). We compared LPA findings with an alternative approach for cumulative PFAS mixtures using g-computation to estimate the effect of simultaneously increasing the area under the receiver operating characteristic curve (AUC) for all PFAS. We identified 2 profiles: a higher PFAS profile (35% of sample) and a lower PFAS profile (relative to each other), based on their average PFAS concentrations at all time points. The higher PFAS profile had generally lower z scores for all outcomes, with somewhat larger effects for males, though all 95% CIs crossed the null. For example, the higher PFAS profile was associated with a 0.50-unit lower (β = −0.50; 95% CI, −1.07 to 0.08) BMI z score among males but not among females (β = 0.04; 95% CI, −0.45 to 0.54). We observed similar patterns with AUCs. We found that a higher childhood PFAS profile and higher cumulative PFAS mixtures may be associated with altered growth in early adolescence. This article is part of a Special Collection on Environmental Epidemiology. [ABSTRACT FROM AUTHOR]

Results of toxicological studies indicate that phthalates and per-/polyfluoroalkyl substances (PFAS), 2 classes of endocrine-disrupting chemicals, may alter the functioning of the hypothalamic-pituitary-adrenocortical (HPA) axis. We evaluated the associations of urinary phthalate metabolites and serum PFAS during gestation and childhood with adolescent hair cortisol concentrations (pg/mg hair) at age 12 years, an integrative marker of HPA axis activity (n  = 205 mother-child pairs; Cincinnati, Ohio; enrolled 2003–2006). We used quantile-based g-computation to estimate associations between mixtures of urinary phthalate metabolites or serum PFAS and hair cortisol. We also examined whether associations of individual phthalate metabolites or PFAS with cortisol varied by the timing of exposure. We found that a 1-quartile increase in all childhood phthalate metabolites was associated with 35% higher adolescent hair cortisol (phthalate mixture ψ = 0.13; 95% confidence interval: 0.03, 0.22); these associations were driven by monoethyl phthalate, monoisobutyl phthalate, and monobenzyl phthalate. We did not find evidence that phthalate metabolites during gestation or serum PFAS mixtures were related to adolescent hair cortisol concentrations. We found suggestive evidence that higher childhood concentrations of individual PFAS were related to higher and lower adolescent hair cortisol concentrations. Our results suggest that phthalate exposure during childhood may contribute to higher levels of chronic HPA axis activity. [ABSTRACT FROM AUTHOR]

Telemedicine has expanded due to the COVID-19 pandemic. However, the health care usage after telemedicine visits compared with similar in-person visits is not known. This study compared the 72-hour health care reutilization after telemedicine visits and in-person acute encounters in a pediatric primary care office. A retrospective cohort analysis was performed in a single quaternary pediatric health care system between March 1, 2020, and November 30, 2020. Reutilization information was collected for 72 hours following the index visit and included subsequent encounters within the health care system. The 72-hour reutilization rate for telemedicine encounters was 4.1% compared with 3.9% for in-person acute visits. Of revisits, patients who had a telemedicine visit most often sought additional care at the medical home, and patients with an in-person visit most often sought additional care to the emergency department or urgent care. Telemedicine does not result in higher total health care reutilization. [ABSTRACT FROM AUTHOR]

Aim. To evaluate volume and strain of the left atrium (LA) in people suffering from paroxysmal atrial fibrillation which is not valvular (NVPAF) using the new technology of left atrial automatic myocardial function imaging (AFILA) and to analyze prognostic factors in patients with NVPAF by follow-up. Methods. Between August 2019 and August 2022, a total of 80 NVPAF patients and 60 normal control patients who were hospitalized in the Department of Cardiology were included in the study. The LA volume and strain parameters of the two groups were analyzed. The differences in LA function (LAF) parameters were compared between the two groups to generate the receiver operating characteristic curve (ROC) and calculate the area under the curve (AUC), sensitivity, and specificity of each parameter. Follow-up was conducted on the 80 NVPAF patients included, their treatment methods after admission and their rehospitalization due to heart events were recorded, and independent risk factors influencing the prognosis of NVPAF were obtained. Results. A total of 140 patients participated in the study, including 80 in the NVPAF group and 60 in the normal control group. There was no statistically significant difference in age and sex between the two groups. Compared to the normal group, the LA minimum volume (LAVmin), LA maximum volume (LAVmax), and volume at onset of LA contraction (LAVpreA) in the NVPAF group were significantly increased. The LA emptying fraction (LAEF) was significantly decreased, and LA reservoir strain (S_R), LA conduit strain (S_CD), and LA contractile strain (S_CT) were significantly compromised (P < 0.05). There was no significant difference in LA evacuation volume (LAEV) reduction (P > 0.05). Logistic regression analysis of LAF parameters in NVPAF patients showed that LAEF and S_R were independently correlated with NVPAF (odds ratio values: 0.883 (0.827–0.943), P < 0.001; 0.916 (0.569–1.474), P = 0.047). The ROC curve results showed that LAEF had a high efficiency in the diagnosis of NVPAF, with P < 0.001, AUC of 0.843, sensitivity of 0.788, and specificity of 0.867. For the LA strain parameters, the S_R test efficiency was higher, with P < 0.001, AUC of 0.762, sensitivity of 0.713, and specificity of 0.783. There was a strong correlation between S_R and LAEF in patients with no end event and those with end event. The ROC curve revealed that the S_R was better than LAEF in predicting prognosis of patients with AF (AUC = 0.914, P < 0.0001 vs. AUC = 0.876, P < 0.0001). S_R of 10.5 and LAEF of 21 were the cut-off values for endpoint events in NVPAF patients, with sensitivity of 0.909 and 0.727 and specificity of 0.904 and 0.901, respectively. Conclusions. AFILA ultrasound technology comprehensively evaluated the LA size and function in patients with NVPAF. The LAEF and S_R were independently correlated with NVPAF and can determine the prognosis of patients with NVPAF. [ABSTRACT FROM AUTHOR]

This study examines the relationship between religious and spiritual (R/S) struggle and religiosity with depression and anxiety in adolescents admitted to inpatient psychiatric units of a pediatric hospital in the Midwest of the United States. We administered four self-reported scales to 71 adolescents (ages 13–17) to assess religiosity, R/S struggle, depression, and anxiety. The prevalence of R/S struggle among this population was high (88.73%). Significant associations were found between R/S struggle and depression and anxiety, linking greater R/S struggles with more severe depression or anxiety. However, no significant associations between religiosity and depression and anxiety were noted. By examining the prevalence of R/S struggle among this population and its relationship to depression and anxiety, this study contributes to the expanding research on the impact of religion and spirituality on the psychological well-being of adolescents. [ABSTRACT FROM AUTHOR]

Primary care centers are trialing open access scheduling models to expand access. Given evidence linking irregular caregiver work schedules with adverse child developmental outcomes, we hypothesized that children presenting for unscheduled "walk-in" visits would have higher odds of developmental concerns than those presenting for scheduled visits. We conducted a retrospective review of electronic health record data for children aged 6 to 66 months visiting an academic pediatric primary care center between July 1, 2013 and February 1, 2019. Our primary outcome was presence of developmental concerns, defined by results below cutoff on a child's Ages & Stages Questionnaire, Third Edition (ASQ-3). We examined associations between visit stream (unscheduled vs scheduled; time of day) and ASQ-3 using multivariable logistic regression, adjusting for child demographics, visit type (well-child vs ill), and responses to a standardized social history questionnaire. Of 11,169 eligible total encounters each for a unique child, 8% were unscheduled (n = 848); 19% had developmental concerns in at least one domain (n = 2100). Twenty-eight percent of children presenting for unscheduled visits had developmental concerns compared to 18% of those presenting for scheduled visits (P <.0001). Compared to those presenting for scheduled well-child visits, children presenting for unscheduled ill visits had a higher odds of an ASQ-3 score below cutoff (adjusted odds ratio 2.02; 95% confidence interval, 1.54–2.65). As pediatric primary care centers implement open access scheduling models, they should be prepared to identify and respond to developmental concerns at a rate that may be higher than what is typically seen during scheduled visits. [ABSTRACT FROM AUTHOR]

Telemedicine, more novel in provision of pediatric care, rapidly expanded due to the recent coronavirus disease 2019 pandemic. This study aimed to determine the feasibility of telemedicine for acute and chronic care provision in an underserved pediatric primary care center. Items assessed included patient demographic data, chief complaint, and alternative care locations if telemedicine was not available. In our setting, 62% of telemedicine visits were for acute concerns and 38% for chronic concerns. Of acute telemedicine visits, 16.5% of families would have sought care in the Emergency Department/Urgent Care, and 11.3% would have opted for no care had telemedicine not been offered. The most common chronic issues addressed were attention deficit hyperactivity disorder (80.3%) and asthma (16.9%). Racial disparities existed among our telemedicine visits with Black patients utilizing telemedicine services less frequently than non-Black patients. Telemedicine is feasible for pediatric acute and chronic care, but systems must be designed to mitigate widening racial disparities. [ABSTRACT FROM AUTHOR]

Production of organophosphate esters (OPEs), which represent a major flame-retardant class present in consumer goods, has increased over the past 2 decades. Experimental studies suggest that OPEs may be associated with thyroid hormone disruption, but few human studies have examined this association. We quantified OPE metabolites in the urine of 298 pregnant women from Cincinnati, Ohio, in the Health Outcomes and Measures of the Environment Study (enrolled 2003–2006) at 3 time points (16 and 26 weeks' gestation, and at delivery), and thyroid hormones in 16-week maternal and newborn cord sera. Urinary bis(1,3-dichloro-2-propyl)-phosphate concentrations were generally associated with decreased triiodothyronine and thyroxine levels and increased thyroid-stimulating hormone levels in maternal and newborn thyroid hormones in quartile dose–response analyses and multiple informant models. There was weaker evidence for thyroid hormone alterations in association with diphenyl-phosphate and di- n -butyl-phosphate. Bis-2-chloroethyl-phosphate was not associated with alterations in thyroid hormones in any analyses. We did not observe any evidence of effect modification by infant sex. These results suggest that gestational exposure to some OPEs may influence maternal and neonatal thyroid function, although replication in other cohorts is needed. [ABSTRACT FROM AUTHOR]

We examined the association between prenatal fish intake and child autism-related traits according to Social Responsiveness Scale (SRS) and cognitive development scores in two US prospective pregnancy cohorts. In adjusted linear regression analyses, higher maternal fish intake in the second half of pregnancy was associated with increased child autism traits (higher raw SRS scores; ß = 5.60, 95%CI 1.76, 12.97). Differences by fish type were suggested; shellfish and large fish species were associated with increases, and salmon with decreases, in child SRS scores. Clear patterns with cognitive scores in the two cohorts were not observed. Future work should further evaluate potential critical windows of prenatal fish intake, and the role of different fish types in association with child autism-related outcomes. [ABSTRACT FROM AUTHOR]

Background: Female athletes are at an increased risk of developing patellofemoral pain (PFP) relative to male athletes. The unique effects of maturation may compound that risk. Hypothesis/Purpose: The purpose was to evaluate the neuromuscular control mechanisms that are adaptive to pubertal maturation and determine their relative contribution to PFP development. It was hypothesized that aberrant landing mechanics (reduced sagittal-plane and increased frontal- and transverse-plane kinematics and kinetics) would be associated with an increased risk for PFP. Study Design: Cohort study; Level of evidence, 2. Methods: There were 506 high school female athletes who completed a detailed medical history, the Anterior Knee Pain Scale, and a knee examination for the diagnosis of PFP and attended follow-up appointments. Athletes performed a drop vertical jump task instrumented with force plates, and biomechanical measures generated from standard 3-dimensional biomechanical analyses were used to classify participants into high- or low-risk knee and hip landing profiles for the development of PFP. The biomechanical measures used in the knee landing profile included sagittal-plane knee range of motion, peak knee abduction angle, peak knee abduction moment, and peak-to-peak transverse-plane knee moment. The biomechanical measures used in the hip landing profile included sagittal-plane hip range of motion, peak hip extensor moment, peak abductor moment, and peak hip rotator moment. Testing was conducted at sport-specific preseason appointments over the course of 2 years, and changes in pubertal status, landing profile, and PFP development were documented. Results: Female athletes with high-risk hip landing profiles experienced increased hip flexion and decreased abductor, rotator, and extensor moments. Participants with high-risk hip landing profiles who transitioned to postpubertal status at follow-up had higher odds (odds ratio, 2.1 [95% CI, 1.1-4.0]; P = .02) of moving to a low-risk hip landing profile compared with those who had not reached postpubertal status at follow-up. Participants with high-risk knee landing profiles experienced decreased knee flexion and increased knee abduction, external abductor, and external rotator moments. Pubertal maturation was not associated with a change in the high-risk knee landing profile at follow-up. Conclusion: The progression from prepubertal to postpubertal status may have a protective effect on high-risk hip mechanics but no similar adaptations in high-risk knee mechanics during maturation. These data indicate that before puberty, maladaptive hip mechanics may contribute to PFP, while aberrant knee mechanics associated with PFP are sustained throughout the maturational process in young female athletes. [ABSTRACT FROM AUTHOR]

Background: The effects of targeted neuromuscular training (TNMT) on movement biomechanics associated with the risk of anterior cruciate ligament (ACL) injuries are currently unknown. Purpose/Hypotheses: To determine the effectiveness of TNMT specifically designed to increase trunk control and hip strength. The hypotheses were that (1) TNMT would decrease biomechanical and neuromuscular factors related to an increased ACL injury risk and (2) TNMT would decrease these biomechanical and neuromuscular factors to a greater extent in athletes identified as being at a high risk for future ACL injuries. Study Design: Controlled laboratory study. Methods: Female athletes who participated in jumping, cutting, and pivoting sports underwent 3-dimensional biomechanical testing before the season and after completing TNMT. During testing, athletes performed 3 different types of tasks: (1) drop vertical jump, (2) single-leg drop, and (3) single-leg cross drop. Analysis of covariance was used to examine the treatment effects of TNMT designed to enhance core and hip strength on biomechanical and neuromuscular characteristics. Differences were also evaluated by risk profile. Differences were considered statistically significant at P < .05. Results: TNMT significantly increased hip external rotation moments and moment impulses, increased peak trunk flexion, and decreased peak trunk extension. Athletes with a high risk before the intervention (risk profile III) had a more significant treatment effect of TNMT than low-risk groups (risk profiles I and II). Conclusion: TNMT significantly improved proximal biomechanics, including increased hip external rotation moments and moment impulses, increased peak trunk flexion, and decreased peak trunk extension. TNMT that focuses exclusively on proximal leg and trunk risk factors is not, however, adequate to induce significant changes in frontal-plane knee loading. Biomechanical changes varied across the risk profile groups, with higher risk groups exhibiting greater improvements in their biomechanics. [ABSTRACT FROM AUTHOR]

Background: The widespread use of anterior cruciate ligament (ACL) injury prevention interventions has not been effective in reducing the injury incidence among female athletes who participate in high-risk sports. Purpose/Hypothesis: The purpose of this study was to determine if biomechanical and neuromuscular factors that contribute to the knee abduction moment (KAM), a predictor of future ACL injuries, could be used to characterize athletes by a distinct factor. Specifically, we hypothesized that a priori selected biomechanical and neuromuscular factors would characterize participants into distinct at-risk profiles. Study Design: Controlled laboratory study. Methods: A total of 624 female athletes who participated in jumping, cutting, and pivoting sports underwent testing before their competitive season. During testing, athletes performed drop-jump tasks from which biomechanical measures were captured. Using data from these tasks, latent profile analysis (LPA) was conducted to identify distinct profiles based on preintervention biomechanical and neuromuscular measures. As a validation, we examined whether the profile membership was a significant predictor of the KAM. Results: LPA using 6 preintervention biomechanical measures selected a priori resulted in 3 distinct profiles, including a low (profile 1), moderate (profile 2), and high (profile 3) risk for ACL injuries. Athletes with profiles 2 and 3 had a significantly higher KAM compared with those with profile 1 (P < .05). Conclusion: This is the first study to use LPA of biomechanical landing data to create ACL injury risk profiles. Three distinct risk groups were identified based on differences in the peak KAM. Clinical Relevance: These findings demonstrate the existence of discernable groups of athletes that may benefit from injury prevention interventions. Study Registration: ClinicalTrials.gov NCT identifier: NCT01034527. [ABSTRACT FROM AUTHOR]

Background: Bisphenol A (BPA), an endocrine-disrupting chemical that is routinely detected in > 90% of Americans, promotes experimental asthma in mice. The association of prenatal BPA expo­sure and wheeze has not been evaluated in humans. Objective: We examined the relationship between prenatal BPA exposure and wheeze in early childhood. Methods: We measured BPA concentrations in serial maternal urine samples from a prospective birth cohort of 398 mother-infant pairs and assessed parent-reported child wheeze every 6 months for 3 years. We used generalized estimating equations with a logit link to evaluate the association of prenatal urinary BPA concentration with the dichotomous outcome wheeze (wheeze over the previous 6 months). Results: Data were available for 365 children; BPA was detected in 99% of maternal urine samples during pregnancy. In multivariable analysis, a one-unit increase in log-transformed creatinine-standardized mean prenatal urinary BPA concentration was not significantly associated with child wheeze from birth to 3 years of age, but there was an interaction of BPA concentration with time (p = 0.003). Mean prenatal BPA above versus below the median was positively associated with wheeze at 6 months of age [adjusted odds ratio (AOR) = 2.3; 95% confidence interval (CI): 1.3, 4.1] but not at 3 years (AOR = 0.6; 95% CI: 0.3, 1.1). In secondary analyses evaluating associations of each prenatal BPA concentration separately, urinary BPA concentrations measured at 16 weeks gestation were associated with wheeze (AOR = 1.2; 95% CI: 1.0, 1.5), but BPA concentrations at 26 weeks of gestation or at birth were not. Conclusions: Mean prenatal BPA was associated with increased odds of wheeze in early life, and the effect diminished over time. Evaluating exposure at each prenatal time point demonstrated an association between wheeze from 6 months to 3 years and log-transformed BPA concentration at 16 weeks gestation only [ABSTRACT FROM AUTHOR]