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Background: There is little consensus regarding the indications and utility of urinary tract imaging and type of imaging to perform in patients presenting with acute pyelonephritis (APN). Aims: The aims of this systematic review were to, among patients with APN, (i) identify the proportion of patients investigated with ultrasound (US), (ii) identify the proportion of abnormal US and (iii) identify the proportion of patients with a change in management resulting from abnormal US. Methods: A comprehensive search covered two electronic databases (Medline and EMBASE), with selection of studies performed independently by two investigators. Inclusion criteria were English language APN diagnosis and quantification of patients assessed with US or abnormal US results. Quality appraisal used the Newcastle–Ottawa instrument. Results: There were 35 studies included. The proportion of patients assessed with US was reported in 16 manuscripts and ranged from 20% to 94%, with significant heterogeneity and publication bias. The proportion of abnormal US was reported in 31 manuscripts and ranged from 7% to 79%. The proportion of abnormal US leading to change in management was reported in five studies and ranged from 7% to 59%. There was marked heterogeneity among studies included in all three subgroups. Conclusions: Patients with APN are commonly investigated with US, but only a small proportion have abnormalities and appear to be associated with changes in clinical management. The use of routine US for APN is therefore questioned. The identification of clinical variables for appropriate selection of patients to investigate with US requires further research. [ABSTRACT FROM AUTHOR]

Medical training occurs during peak childbearing years for most medical students. Many factors influence specialty selection. The aims of this study were (i) to determine whether being a parent is a major deciding factor when picking a specialty and (ii) whether parents are more drawn to family-friendly specialties than non-parents. The authors performed a multicenter web-based survey study of medical students enrolled in Oregon Health and Science University, Dartmouth's Geisel School of Medicine, and University of Michigan Medical School. The 27-item instrument assessed parenthood status, specialty preference, specialty perceptions, and factors influencing specialty choice. A total of 537 out of 2236 (24.0%) students responded. Among respondents, 59 (10.9%) were current or expecting parents. The majority (359, 66.8%) were female and 24–35 years old (430, 80.1%). Of the students who were parents or expecting, 30 (50.9%) were female, and the majority (55, 93.2%) were partnered. Top specialties preferred by both parents and non-parents were family medicine, emergency medicine, obstetrics and gynecology (OB/GYN), internal medicine, psychiatry, and pediatrics. Specialties rated most family-friendly included family medicine, dermatology, pediatrics, psychiatry, radiology, emergency medicine, and pathology. The specialties rated least family-friendly were surgery, neurosurgery, orthopedic surgery, plastic surgery, and OB/GYN. These rankings were the same between groups. Passion for the field, culture of the specialty, and quality of life were the top three factors students considered when choosing a specialty. Being a parent or future parent ranked more highly for parents than non-parents, but was not in the top three factors for either group. US Medical School parents report that being a parent influenced their medical specialty choice "strongly" or "very strongly." However, being a parent was not weighed as heavily as passion for the field, culture of the specialty, and quality of life. These student-parents are entering perceived "non-family friendly" specialties at similar rates as their peers. US Medical school training and simultaneous parenting is daunting, yet student parents are putting their passion first when making a career choice. They must be supported. [ABSTRACT FROM AUTHOR]

Simple Summary: The sociodemographic characteristics of a parent and child may predispose young children to excessive dietary sugar intake; however, there is limited research available on this topic. The aim of this cross-sectional analysis was to examine the impact of sociodemographic characteristics such as child age, child sex, child ethnicity, parent number of years living in Canada, annual household income, parent education and parent marital status on total, free and added sugar intake in young children. Dietary and sociodemographic data including 267 children from 210 families participating in the Guelph Family Health Study were examined. The results indicate that child age, child ethnicity and annual household income can play a crucial role in shaping sugar intake in young children. This research may help inform future research and program interventions early in life along with guiding parents to decrease sugar intake in young children. Background: It is crucial to develop strategies targeted to promote healthy eating patterns in vulnerable populations, especially young children from diverse sociodemographic groups. Thus, the study objective was to investigate the associations between child age, child sex, child ethnicity, parent number of years living in Canada, annual household income, parent education and parent marital status with total, free and added sugar intakes in young children. Methods: This cross-sectional study was a secondary analysis of data gathered in the Guelph Family Health Study. The study included 267 children (129M; 138F) from 210 families aged 1.5 to 5 years. Parents completed questionnaires for children on sociodemographic characteristics and an online 24-hour diet recall. The associations between sociodemographic characteristics and sugar intakes were determined using generalized estimating equations applied to linear regression models. Results: The mean age of the children was 3.5 ± 1.2 years (mean ± std dev.). As children's age increased, there was a greater intake of free and added sugar ( β ^ = 8.6, p = 0.01, 95% CI = 2.4 to 14.7 and β ^ = 6.5, p = 0.03, 95% CI = 0.8 to 12.2, respectively). Those children who identified as white had a higher total sugar intake than children of other ethnicities ( β ^ = 31.0, p = 0.01, 95% CI = 7.2 to 54.7). Additionally, higher annual household income was associated with lower was free sugar intake in children ( β ^ = −2.4, p = 0.02, 95% CI = −4.5 to −0.4). Conclusions: This study underscores the significant influence of multiple sociodemographic characteristics on sugar intake in young children, providing valuable insights for public health policy and nutrition interventions. Moreover, this study highlights the need for early behaviour interventions focusing on reducing sugar intake in young children, while considering sociodemographic factors. [ABSTRACT FROM AUTHOR]

Background: A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital's emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. Methods: This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. Results: 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. Conclusions: Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care. [ABSTRACT FROM AUTHOR]

Summary The purpose of this study was to explore potential mediators of the relationship between depression and obesity in a sample of low-income, minority women. Data were extracted from a sample of 535 women enrolled in a weight loss intervention for the prevention of type 2 diabetes. Using a non-parametric bootstrapping procedure, the potential mediation effects of stress eating and sleep disturbance on the relationship between depression and obesity were tested. Results of a single mediation model indicated that depressive symptomatology was significantly associated with obesity ( β = 0.800, SE = 0.290, p = 0.006), and that stress eating ( β = 0.166, 95% CI [0.046, 0.328]) and sleep disturbance ( β = 1.032, 95% CI [0.612, 1.427]) were significant independent mediators of this relationship. Sleep disturbance remained a significant mediator in a combined mediation model ( β = 1.009, 95% CI [0.653, 1.399]). Findings add to the growing literature on the psychosocial factors implicated in the link between depression and obesity, particularly among disadvantaged populations. Future longitudinal research should aim to establish causal pathways between obesity, stress eating, sleep disturbance, and depression. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Change in binge eating is typically a primary outcome for interventions targeting individuals with eating pathology. A range of statistical models exist to handle these types of frequency distributions, but little empirical evidence exists to guide the appropriate choice of statistical model. Method Monte Carlo simulations were used to investigate the utility of semi-continuous models relative to continuous models in various situations relevant to binge eating treatment studies. Results Semi-continuous models yielded more accurate estimates of the population, while continuous models were higher powered when higher levels of missing data were present. Discussion The present findings generally support the use of semi-continuous models applied to binge eating data, with total sample sizes of roughly 200 being adequately powered to detect moderate treatment effects. However, models with a significant amount of missing data yielded more favorable power estimates for continuous models. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:746-758) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Adolescents who self-injure often engage in bingeing/purging (BP). Ecological momentary assessment (EMA) has potential to offer insight into the relationship between self-injury and BP. The aims of this study were to examine the frequency and context of BP using EMA in a sample of nonsuicidal self-injurious (NSSI) adolescents. Method Thirty adolescents with a history of NSSI responded to questions regarding self-destructive thoughts/behaviors using a palm-pilot device. Descriptive analyses compared thought/behavior contexts during reports of BP and NSSI thoughts/behaviors (occurring together vs. individually). Results BP thoughts were present in 22 (73%) participants, occurring on 32% of the person-days recorded; 59% of these participants actually engaged in BP behavior. Seventy-nine percent of BP thoughts co-occurred with other self-destructive thoughts. Adolescents were more often with friends/peers than alone or with family when having BP thoughts. Worry and pressure precipitated both BP and NSSI thoughts, but perceived criticism and feelings of rejection/hurt were associated more often with BP thoughts than with NSSI thoughts. Discussion BP thoughts and behaviors were common in this sample, often occurring with other self-destructive thoughts. Future EMA research is needed to address the function of BP symptoms, the contextual variables that increase risk for BP thoughts, and the factors that predict the transition of thoughts into behaviors in adolescents with and without self-injury. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:684-689) [ABSTRACT FROM AUTHOR]

To examine how different definitions of recovery lead to varying rates of recovery, maintenance of recovery, and relapse in bulimia nervosa (BN), end-of-treatment (EOT) and follow-up data were obtained from 96 adults with BN. Combining behavioral, physical, and psychological criteria led to recovery rates between 15.5% and 34.4% at EOT, though relapse was approximately 50%. Combining these criteria and requiring abstinence from binge eating and purging when defining recovery may lead to lower recovery rates than those found in previous studies; however, a strength of this definition is that individuals who meet this criteria have no remaining disordered behaviors or symptoms. [ABSTRACT FROM AUTHOR]

Mobile apps for mental health concerns are a convenient, potentially effective way for primary care patients to access resources and self-management tools. Providers' perceptions of such apps are critical to their adoption and integration into practice. This study evaluated use and perceptions of apps among Veterans Affairs Primary Care Mental Health Integration (PCMHI) providers, and identified the chal- lenges with implementation. PCMHI providers were surveyed about their use, perceptions of, and barriers to using apps in their practice with patients. Results indicated that perceptions of apps were favorable. Eighty percent of providers reported recommending or using apps with their patients. Providers viewed apps as providing accessibility to tools and improving patient engagement. Qualitative reasons for nonuse were being unfamiliar with apps and how they could be used in treatment, patients not owning smartphones, and not having time to discuss apps in care. Those who reported using apps had more favorable perceptions of them, reported more comfort using them, and were more likely to use apps for their own health than nonusers (p < .01 to p < .001). Overall, PCMHI providers are using apps across different age cohorts for diverse mental and behavioral health issues and have favorable perceptions of them. Additional implementation efforts may be needed, particularly for app nonusers to become familiar with available apps and how to efficiently use them with patients. Using peer support specialists may be one practical strategy for overcoming identified implementation challenges. [ABSTRACT FROM AUTHOR]