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Purpose: The severity of surrounding adhesions, anomalous anatomy, and technical issues are the main factors that complicate cholecystectomy. This study focused on determining the types and frequency of laparoscopic anatomical variations found during laparoscopic cholecystectomy in our limited-resources condition and on defining the safe zone of dissection., Methods: This prospective study was conducted at a single center in Aden, Yemen from 2012 to 2019. A total of 375 patients, comprising 355 females (94.7%) and 20 males (5.3%), presented with symptomatic gallbladders and underwent standard four-port laparoscopic cholecystectomy. The regional laparoscopic variations were evaluated and recorded., Results: Of the 375 patients, 26 (6.9%) had laparoscopic anatomical variations, of whom 19 (73.1%) had vascular variations and seven (26.9%) had ductal variations. The anatomical variations included the following: double cystic artery of separated origin, seven cases (26.9%); Moynihan's hump, six (23.1%); double cystic artery of single origin, four (15.4%); thin long cystic duct, four (15.4%); subvesical duct, three (11.5%); and cystic artery hocking the cystic duct, two (7.7%)., Conclusion: Biliary anatomical variations can be expected in any dissected zone. Most of the detected variants were associated with the cystic artery. An overlooked accessory cysto-biliary communication can cause complicated biliary leakage. A surgeon's skills and knowledge of laparoscopic anatomical variants are essential for performing a safe laparoscopic cholecystectomy.

To inform public health interventions, researchers have developed models to forecast opioid-related overdose mortality. These efforts often have limited overlap in the models and datasets employed, presenting challenges to assessing progress in this field. Furthermore, common error-based performance metrics, such as root mean squared error (RMSE), cannot directly assess a key modeling purpose: the identification of priority areas for interventions. We recommend a new intervention-aware performance metric, Percentage of Best Possible Reach (%BPR). We compare metrics for many published models across two distinct geographic settings, Cook County, Illinois and Massachusetts, assuming the budget to intervene in 100 census tracts out of 1000s in each setting. The top-performing models based on RMSE recommend areas that do not always reach the most possible overdose events. In Massachusetts, the top models preferred by %BPR could have reached 18 additional fatal overdoses per year in 2020-2021 compared to models favored by RMSE. In Cook County, the different metrics select similar top-performing models, yet other models with similar RMSE can have significant variation in %BPR. We further find that simple models often perform as well as recently published ones. We release open code and data for others to build upon., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Globally, binge eating behavior has emerged as a significant public health concern, especially among female adolescents. Body shape concerns in female adolescents can lead to body dissatisfaction and other mental health issues. Using a cross-sectional study design, we evaluated the frequency of binge eating behavior, body shape concerns, and associated factors among 400 female adolescents. We utilized a pretested Arabic binge eating scale (BES) and a body shape questionnaire-shorter version (BSQ-8C) to collect the required data. We performed Spearman's correlation analysis to find the strength and direction of the correlation between the BES and BSQ-8C scores. Finally, we applied binomial logistic regression analysis to identify the predictors of body shape concerns. Of the studied participants, 5.5% and 6.2% had medium and severe binge eating behavior. We found a significant positive correlation between the BES and BSQ-8C scores (rho = 0.434, p < 0.001). Also, we found that body shape concerns were significantly higher among the monthly family income category of 5000 to 7000 SAR ( p = 0.005), the severe binge eating categories ( p = 0.009), and obese adolescents ( p = 0.001). The present study results can be applied to the development of focused interventions and strategies to address these concerns in this group.

Background: Incarceration provides an opportunity for health interventions, including opioid use disorder (OUD) treatment and prevention of opioid-related overdoses post-release. All FDA-approved forms of medication for OUD (MOUD) treatment were mandated in several Massachusetts jails in 2019, with some jails offering extended-release buprenorphine (XR-Bup). Little is known about patient perspectives on and experiences with XR-Bup in carceral settings., Methods: We conducted semi-structured interviews in 2022 with community-dwelling people who received MOUD during a recent incarceration in a Massachusetts jail. We asked participants about their experiences with and perspectives on XR-Bup while in jail. Qualitative data were double-coded deductively and reviewed inductively to identify emergent themes, which were structured using the Theoretical Framework of Acceptability (TFA)., Results: Participants (n = 38) had a mean age of 41.5 years, were 86% male, 84% White, 24% Hispanic, and 95% continued to receive MOUD at the time of their interview, including 11% receiving XR-Bup. Participants who viewed XR-Bup favorably appreciated avoiding the taste of sublingual buprenorphine; avoiding procedural difficulties and indignities associated with daily dosing in carceral settings (e.g., mouth checks, stigmatizing treatment from correctional staff); avoiding daily reminders of their addiction; experiencing less withdrawal; having extra time for other activities, such as work; and reduction of diversion of MOUD within the jail setting. Participants who viewed XR-Bup less favorably preferred to maintain their daily dosing routine; liked daily time out of their housing unit; wanted to know what was "going into my body everyday"; and feared needles and adverse events. Participants also reported that jail clinicians used XR-Bup for patients who were previously caught diverting sublingual buprenorphine, suggesting limited patient participation in decision-making around XR-Bup initiation in some jails., Conclusion: People who received MOUD in Massachusetts jails had both favorable and unfavorable views and experiences with XR-Bup. Understanding these preferences can inform protocols in jails that are considering implementation of XR-Bup treatment., (© 2024. The Author(s).)

Background: Postpartum depression is a major psychiatric disorder that affects the mother-baby attachment and may impair cognitive development of the child., Objective: This study aimed to evaluate the effect of curcumax (including ginger, turmeric, and black pepper) on postpartum depression in reproductive-aged women., Material and Methods: This was a randomized controlled trial in which 124 women were recruited and randomly assigned into two groups of curcumax (n=62) and placebo (n=62) who consumed curcumax or placebo for 8 weeks (one capsule each day). Postpartum depression was measured using Edinburgh Depression Scale. Data were analyzed using Chi-square, independent t-test, and GEE., Results: The mean (SD) score of depression score was 15.83 (2.77) and 15.45 (2.97) before intervention, which reduced to 3.48 (4.29) and 7.22 (3.98) in the intervention and control groups, respectively after 4 weeks (p<0.0001). After eight weeks of intervention, these scores reduced to 1.72 (3.30) and 5.85 (3.67) in the intervention and control groups, respectively (p<0.0001)., Conclusion: The results of this study showed that curcumax significantly reduced the mean score of postpartum depression among reproductive-aged women. Because it is the first time this herb was used as an anti-depressant, its effective dose was not available. Therefore, further studies with higher doses of this herb are recommended., Clinical Trial Registration: https://irct.behdasht.gov.ir/search/result?query=IRCT20210822052254N1, identifier IRCT20210822052254N1., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nikpour, Ansari, Abedi, Jahanfar, Sharifat, Hooshmand and Maraghi.)

Anopheles jamesii, considered to be a non-malaria vector, is an abundant mosquito species found in coastal India and several countries in Asia. In Goa, western India, An. jamesii is the dominant anopheline species by numbers, and in recent epidemiological surveys, they have tested positive for Plasmodium carriage. To assess An. jamesii's capacity as a malaria vector, we carried out six controlled membrane feeding assays with the F1 generation of field-caught An. jamesii and Plasmodium vivax-infected patient blood samples. As a control, the established local vector, Anopheles stephensi, was fed in parallel to compare the oocyst and sporozoite loads. The average oocyst load of An. jamesii was 3.29, while for An. stephensi it was 10.23. Furthermore, An. jamesii's blood feeding rate (21.7% versus 85%), oocyst positivity rate (60% versus 90.6%), and sporozoite positivity (45.16% versus 83%) were significantly lower (P <0.05, unpaired t test) than those of An. stephensi, suggesting a recent adaptation to support Plasmodium sporogony.

Background: Healthcare workers face burnout from high job demands and prolonged working conditions. While mental health services are available, barriers to access persist. Evidence suggests digital platforms can enhance accessibility. However, there is a lack of systematic reviews on the effectiveness of digital mental health interventions (DMHIs) for healthcare professionals. This review aims to synthesize evidence on DMHIs' effectiveness in reducing burnout, their acceptability by users, and implementation lessons learned., Method: This Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)-guided review included 12 RCTs on DMHIs for healthcare professionals, published before 31 May 2024. The primary focus was on burnout, with secondary outcomes related to mental health and occupation. Quality appraisal used Cochrane risk of bias tools. A narrative synthesis explored DMHIs' effectiveness, acceptability, utilization, and implementation lessons., Results: Significant improvements in mental health outcomes were observed in 10 out of 16 RCTs. Burnout and its constructs showed significant improvement in five RCTs. Studies that measured the acceptability of the interventions reported good acceptability. Factors such as attrition, intervention design and duration, cultural sensitivities, flexibility and ease of use, and support availability were identified as key implementation considerations., Conclusions: Web-based DMHIs positively impact burnout, mental health, and occupational outcomes among healthcare professionals, as shown in most RCTs. Future research should enhance DMHIs' effectiveness and acceptability by addressing identified factors. Increasing awareness of DMHIs' benefits will foster acceptance and positive attitudes. Lessons indicate that improving user engagement and effectiveness requires a multifaceted approach., (© The Author(s) 2024.)

Background: Childbirth constitutes a significant milestone in a woman's life, influencing both her physical and mental well-being as well as her relationship with the child. Employing a birth plan (BP) can contribute positively to obstetric outcomes, enhancing the overall birthing experience for women. BPs are not universally embraced in many countries, and there is limited research on women's experiences with BP in Iran. This study seeks to explore and understand the perspectives of women who have utilized a BP during their delivery., Methods: This qualitative study included 14 women who had BP and experienced delivery. Data was collected through in-depth, semi-structured individual interviews. The sample selection followed a purposive approach, and data analysis utilized content analysis with a conventional approach facilitated by MAXQDA software version 2020., Results: The examination of pertinent data concerning women's experiences identified five key themes: preparation, participation, support, emotional well-being, and unmet expectations., Conclusions: This study's findings indicate that BPs enhance the overall birthing experience, suggesting their potential utility in improving the quality of obstetric care. Nevertheless, additional studies are essential to validate these results on a broader scale and facilitate the nationwide implementation of BPs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Context: The COVID-19 pandemic led to the closure of prekindergarten to grade 12 schools and an inequitable return to full-time in-person learning., Objective: To explore how ethnic and racial differences across school districts in Massachusetts correlate with parents' attitudes, beliefs, and trusted sources of information about COVID-19 and mitigation strategies., Design: An electronic survey was distributed by school administrators to parents and guardians in November and December 2021 using existing school district contact lists and established methods of communication (email in 2 school districts; email and text message in 1 district)., Setting: Three school districts in Massachusetts (Chelsea, Medford, and Somerville)., Participants: Parents of prekindergarten to grade 12 school students attending public schools., Main Outcome Measures: Parental attitudes and beliefs regarding mitigation strategies for COVID-19 (surveillance testing, masking, and vaccination); trusted information sources about COVID-19; preferred methods of communication from schools., Results: A total of 1496 survey responses were analyzed. Chelsea respondents were predominantly Hispanic/LatinX (88%); Medford and Somerville were predominantly White/non-Hispanic (80% and 68%, respectively). Testing, masks, and vaccination were supported by >80% of parents/guardians across districts. However, there were statistically significant differences between school districts regarding participation in testing programs, implications of a child testing positive, vaccination of young children, communication preferences, and trusted sources of information., Conclusions: Although primarily focused on COVID-19, these results highlight opportunities for public health personnel and school administrators to work directly with parents and guardians in their school districts to improve communication strategies and be a trusted source of information for a variety of public health issues., Competing Interests: The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: The type I interferon (IFN) signature has been found to be overactivated in many systemic autoimmune diseases. This may be explained by impaired regulation of interferon-stimulated genes (ISGs) as well as interferon-induced protein 44 (IFI44) expression via their regulatory mechanisms via interferon regulatory factors (IRFs)., Patients and Methods: This case-control study includes two groups: 50 RA patients and 50 healthy controls. The quantification of IFI44 and IRF4 expression levels by the real-time PCR technique was estimated. Disease Activity Score-28 (DAS-28) was estimated for RA patients only., Results: Among the RA patients, there were statistically significant increased ESR, CRP, TLC, RF, and anti-CCP levels ( p value < 0.001) and significant increased expression of the IFI44 and IRF4 genes ( p value < 0.001). There was a significant positive correlation between the IFI44 and IRF4, and there was a significant correlation between both and ESR and anti-CCP among RA patients. At a cutoff point of 1.95, IFI44 shows higher sensitivity and specificity values than IRF4 for the diagnosis of RA., Conclusion: IFI44 was more sensitive for RA diagnosis than IRF4. IFI44 and IRF4 overexpression could be promising predictors of RA diagnosis and might become useful clinical tools to guide therapeutic strategies.

Painful defecation, the passage of hard stools, unpleasant or irregular bowel deviation/movements from regular rate, and/or the feeling of not enough elimination of stool are common symptoms of functional constipation. The goals in treating constipation are to produce soft, painless stools and to prevent the re-accumulation of feces. This study looked at how the telerehabilitation home program (TRP) affected the symptoms of FC and the children who were constipated in terms of their quality of life. A randomized controlled trial included 400 children aging 4-18 years with functional constipation distributed in two groups: control group consisted of 200 children receiving pharmaceutical treatment and the intervention group consisted of 200 children receiving the telerehabilitation home program in addition to pharmaceutical treatment. Both groups received the interventions for 6 months. The outcomes in terms of functional constipation symptoms and quality of life are measured and compared pre- and post-interventions. Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in the condition; there is a significant difference between the intervention and control group in all Rome criteria which assess symptoms of functional constipation except rush to the bath-room to poop which showed non-significant difference; there is also a significant difference between the intervention and control group in all domains of the SF-36 questionnaire which assess quality of life except the mental health domain which showed non-significant difference., Conclusion: Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in symptoms of functional constipation and quality of life., Trial Registration: Our study was registered retrospectively with Clinicaltrials.gov under the identifier NCT06207721 on 5 January 2024., What Is Known: • Painful defecation, passage of hard stools, unpleasant or irregular bowel movements, feeling of incomplete stool elimination are common symptoms of functional constipation. • Goals in treating constipation include producing soft, painless stools and preventing re-accumulation of feces., What Is New: • Adding telerehabilitation home program to pharmaceutical treatment resulted in significant improvement in functional constipation symptoms and quality of life. • Significant differences between intervention group (200 children receiving telerehabilitation home program in addition to pharmaceutical treatment) and control group (200 children receiving pharmaceutical treatment) were observed in all Rome criteria except for rush to the bathroom to poop, and in all domains of SF36 questionnaire except for the mental health domain., (© 2024. The Author(s).)

Background: Causal graphs are an important tool for covariate selection but there is limited applied research on how best to create them. Here, we used data from the Coronary Drug Project trial to assess a range of approaches to directed acyclic graph (DAG) creation. We focused on the effect of adherence on mortality in the placebo arm, since the true causal effect is believed with a high degree of certainty., Methods: We created DAGs for the effect of placebo adherence on mortality using different approaches for identifying variables and links to include or exclude. For each DAG, we identified minimal adjustment sets of covariates for estimating our causal effect of interest and applied these to analyses of the Coronary Drug Project data., Results: When we used only baseline covariate values to estimate the cumulative effect of placebo adherence on mortality, all adjustment sets performed similarly. The specific choice of covariates had minimal effect on these (biased) point estimates, but including nonconfounding prognostic factors resulted in smaller variance estimates. When we additionally adjusted for time-varying covariates of adherence using inverse probability weighting, covariates identified from the DAG created by focusing on prognostic factors performed best., Conclusion: Theoretical advice on covariate selection suggests that including prognostic factors that are not exposure predictors can reduce variance without increasing bias. In contrast, for exposure predictors that are not prognostic factors, inclusion may result in less bias control. Our results empirically confirm this advice. We recommend that hand-creating DAGs begin with the identification of all potential outcome prognostic factors., Competing Interests: Disclosure: The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Postpartum contraception plays a critical role in reducing the occurrence of rapid subsequent pregnancy, offering individuals reproductive choice, and promoting overall reproductive planning and well-being. In this study, we investigated the relationship between psychosocial stress during pregnancy, postpartum depressive symptoms (PDS), and postpartum contraceptive use. Materials and Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System (2012-2019), which included comprehensive information about maternal experiences, views, and needs before, during, and after pregnancy from four states and a large city, with a total sample size of N  = 36,356. We conducted descriptive analyses as well as adjusted multivariable logistic regression models. Main Findings: Our findings demonstrate significant negative associations between partner-related (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [95% CI]: 0.76-0.89, p  ≤ 0.001) and trauma-related (aOR = 0.83, 95% CI: 0.75-0.92, p  ≤ 0.001) stressors and postpartum contraceptive use. Additionally, we observed a negative association between PDS and postpartum contraceptive use (OR = 0.88, 95% CI: 0.80-0.97, p  ≤ 0.01), indicating that individuals experiencing PDS are less likely to utilize contraception after giving birth. Furthermore, our study highlights racial/ethnic, socioeconomic, and parity postpartum contraceptive use disparities. Conclusions: Our findings emphasize the importance of incorporating psychosocial stressors and mental health into the promotion of effective postpartum contraception practices. These results have valuable implications for health care providers, policymakers, and researchers as they can guide the development of targeted interventions and support systems to contribute to improved reproductive health outcomes.

Introduction: The emergence of the COVID-19 pandemic has served as a call for enhanced global cooperation and a more robust pandemic preparedness and response framework. As a result of this pressing demand, dialogues were initiated to establish a pandemic treaty designed to foster a synchronized global strategy for addressing forthcoming health emergencies. In this review, we discussed the main obstacles to this treaty., Results: Among several challenges facing the pandemic treaty, we highlighted (1) global cooperation and political will, (2) equity in access to resources and treatments, (3) sustainable financing, (4) compliance and enforcement mechanisms, (5) sovereignty concerns, and (6) data sharing and transparency., Conclusion: Navigating the hurdles facing the development of the pandemic treaty requires concerted efforts, diplomatic finesse, and a shared commitment to global solidarity. Addressing challenges in global cooperation, equitable access, transparency, compliance, financing, and sovereignty is essential for forging a comprehensive and effective framework for pandemic preparedness and response on the global stage., (© 2024. The Author(s).)

Objectives: Among those with a severe maternal morbidity (SMM) event and a subsequent birth, we examined how the risk of a second SMM event varied by patient characteristics and intrapartum hospital utilization., Methods: We used a Massachusetts population-based dataset that longitudinally linked in-state births, hospital discharge records, prior and subsequent births, and non-birth-related hospital utilizations for birthing individuals and their children from January 1, 1999, to December 31, 2018, representing 1,460,514 births by 907,530 birthing people. We restricted our study sample to 2,814 people who had their first SMM event associated with a singleton birth and gave birth a second time within the study period. Our outcome measure was recurrence of SMM in the second birth. We calculated the prevalence of SMM at second birth, compared SMM conditions between births, and estimated the adjusted risk ratios and 95% confidence intervals for having an SMM event at second birth among those who had an SMM at the first birth. We also examined overall hospital utilization including inpatient admissions, emergency room visits, and observational stays, and hospital utilization by interpregnancy intervals (IPIs) between the first and second birth., Results: There were 2,814 birthing people with at least one birth after the first SMM singleton birth. Among those, 198 (7.0%) had a subsequent SMM. The percentage of people with a second SMM event varied by age, race/ethnicity, insurance, IPI, and history of hypertension at first case of SMM (all p < .05). Between births, people with a second SMM event had significantly higher proportions of inpatient admissions (60.1% vs. 33.2.0%; p < .001), emergency room visits (71.7% vs. 57.7%; p < .001), and observational stays (35.4% vs. 19.5%; p < .001) compared with those who did not experience a second SMM event., Conclusion: Hospital utilization after a birth with SMM might indicate an elevated risk of a second SMM event. Providers should counsel their patients about prevention and warning signs., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Child physical abuse, a type of child maltreatment (CM), poses a significant global public health concern. Nonaccidental fractures and soft tissue injuries, which encompass any action that directly or indirectly harms a child, are the primary indicators of physical abuse in children., Objective: This study aimed to investigate the prevalence, risk factors, and outcomes of accidental and nonaccidental skeletal fractures in a sample of Egyptian children., Methods: A cross-sectional analytical study was conducted between March 2022 and August 2022. A total of 156 children who presented with skeletal injuries and attended Mobarak Central Hospital were enrolled. Patients were subjected to full history taking, complete examination, and investigations. A structured questionnaire was administered to all the legal guardians., Results: Physical abuse was reported in 22.4 % of cases, while medical neglect was reported in 19.9 % of cases. The incidence of physical abuse was notably higher among children whose fathers were smokers and/or drug addicts (p ≤ 0.05). The most common form of physical abuse was hitting (94.3 %). Among skeletal injuries, fractures were predominant (94.3 %), primarily closed fractures associated with contusions. Fractures of the upper limb accounted for the highest incidence (94.3 %) of skeletal injuries, and 60 % of physically abused children experienced moderate-severity injuries., Conclusion: The most common fracture observed in abused children is the upper limb fracture, typically involving a single bone. Clinicians should be more vigilant in suspecting abuse, even in cases where there is an isolated fracture, and advocate for the development of parental training programs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact., Design: Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level., Setting: PCCs in Region Västra Götaland, Sweden, with care manager organisation., Participants: Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder ( n  = 142 intervention, n  = 116 control PCCs)., Intervention: Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs., Main Outcome Measures: 12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months., Results: There were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 - 138.8); control, mean = 99.1 days (95% CI 73.9 - 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%., Conclusion: Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation. Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017.

Background: The current study sets out to develop and validate a robust machine-learning model utilizing electronic health records (EHR) to forecast the risk of hypoglycemia among ICU patients in Jordan., Research Design and Methods: The present study drew upon a substantial cohort of 13,567 patients admitted 26,248 times to the intensive care unit (ICU) over 10 years from July 2012 to July 2022. The primary outcome of interest was the occurrence of any hypoglycemic episode during the patient's ICU stay. Developing and testing predictor models was conducted using Python machine-learning libraries., Results: A total of 1,896 were eligible to participate in the study, 206 experienced at least one hypoglycemic episode. Eight machine-learning models were trained to predict hypoglycemia. All models showed predicting power with a range of 74.53-99.69 for AUROC. Except for Naive Bayes, the six remaining models performed distinctly better than the basic logistic regression usually used for prediction in epidemiological studies. CatBoost model was consistently the best performer with the highest AUROC (0.99), accuracy and precision, sensitivity and specificity, and recall., Conclusions: We used machine learning to anticipate the likelihood of hypoglycemia, which can significantly decrease hypoglycemia incidents and enhance patient outcomes.

In forensic medicine, estimating the postmortem interval (PMI) is of great importance for the timeline and the reconstruction of the events surrounding death. Bone marrow (BM) is one of the largest organs in the body, with good resistance to autolysis and contamination. Therefore, the present study aims to correlate different postmortem intervals and bone marrow antioxidant enzyme levels using an Enzyme-linked immunosorbent assay (ELISA). In addition, detection of the changes in the histological structure of human bone marrow in relation to the time passed since death. BM samples from 20 forensic autopsy cadavers were obtained from cases referred to the Department of Forensic Medicine in the Ministry of Justice, Dakahlia Governorate, processed for histopathological examination as well as estimation of reduced glutathione (GSH), glutathione peroxidase (GPX), and glutathione reductase (GRX) using ELISA. Results of ELISA analysis showed a significant decrease in the level of antioxidant enzymes with increasing PMI; regarding histopathological examination, from 6 to > 18 h PMI, the changes in morphology after death were gradual, progressive, and regular, indicating great value in PMI determination. Also, 18 h of PMI showed loss of cellular details, absence of fat cells, and necrosis of BM with the nucleus dispersed as eosinophilic debris. Estimation of antioxidant enzymes level in human bone marrow using ELISA and detection of the changes in the histological structure of human bone marrow in relation to time passed since the death, either separately or in combination, can be used to estimate PMI accurately., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Fatal opioid-related overdoses (OOD) continue to be a leading cause of preventable death across the US. Opioid Overdose Education and Naloxone Distribution programs (OENDs) play a vital role in addressing morbidity and mortality associated with opioid use, but access to such services is often inequitable. We utilized a geographic information system (GIS) and spatial analytical methods to inform prioritized placement of OEND services in Massachusetts., Methods: We obtained addresses for OEND sites from the Massachusetts Department of Public Health and address-level fatal OOD data for January 2019 to December 2021 from the Massachusetts Registry of Vital Records and Statistics. Using location-allocation approaches in ArcGIS Pro, we created p-median models using locations of existing OEND sites and fatal OOD counts to identify areas that should be prioritized for future OEND placement. Variables included in our analysis were transportation mode, distance from public schools, race and ethnicity, and location feasibility., Results: Three Massachusetts communities - Athol, Dorchester, and Fitchburg - were identified as priority sites for new OEND locations using location-allocation models based on capacity to maximize OOD prevention. Communities identified by the models for OEND placement had similar demographics and overdose rates (42.8 per 100,000 vs 40.1 per 100,000 population) to communities with existing OEND programs but lower naloxone kit distribution rates (2589 doses per 100,000 vs 3704 doses per 100,000). Further models demonstrated differential access based on location and transportation., Conclusion: Our analyses identified key areas of Massachusetts with greatest need for OEND services. Further, these results demonstrate the utility of using spatial epidemiological methods to inform public health recommendations., Competing Interests: Declaration of competing interest Dr. Kimmel is supported by K23DA054363 from the National Institute on Drug Abuse., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Following the implementation of the Movement Control Order (MCO) during the coronavirus disease 2019 (COVID-19) pandemic, academicians from the universities in Malaysia needed to ensure that the quality-of-service delivery to the stakeholders is undisturbed by adopting new challenging norms. This compromises the work-life balance (WLB), causes more stress and potentially affects their quality of life (QoL)., Aim: This study investigates how perceived stress (PS) impacts the QoL of Malaysian academicians during the COVID-19 pandemic, focusing on the mediating role of WLB., Setting: Academics working in Malaysia during COVID-19 pandemic., Methods: A cross-sectional study, using a voluntary response sampling method, was conducted among 417 academicians from universities in Malaysia in September 2021. A self-reported online questionnaire, measuring PS, WLB and QoL, was distributed., Results: The QoL scored a mean of 50 (standard deviation [s.d.] = 9.84), PS scored a mean of 24.26 (s.d. = 8.19) and WLB had a mean score of 51.12 (s.d. = 18.73). Work-life balance was a significant mediator of PS and QoL (β = -0.43, 95% confidence interval [CI] = -0.52 to -0.35, p = 0.0001). Perceived stress was a significant predictor of WLB (β = 1.62, p = 0.0001)., Conclusion: Institutions should consider implementing flexible working arrangements, and providing workshops on crisis management, time management, and resilience. Stress coping methods are recommended for enhancing WLB among academicians., Contribution: This study contributes to the pool of evidence to support intervention strategies and policy recommendations aimed to enhance well-being., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Hepatitis C virus (HCV) disproportionately affects people who inject drugs (PWID). Although HCV has become universally curable since the arrival of direct-acting antivirals, barriers exist to facilitating care and cure in this historically hard-to-reach population, including limited testing and healthcare services and healthcare stigma, issues that are compounded in rural areas. Telehealth is effective in increasing access to HCV care and cure, but innovative approaches of testing and care are required to fully address the need among rural PWID, which led to our study examining a mobile telehealth model for treating HCV. In this commentary, we discuss lessons learned delivering telehealth on a mobile unit, important factors for consideration when designing a mobile intervention, and we suggest an ideal model to increase access to HCV testing and treatment and other services for rural PWID.

Objective: Given their vulnerable health status and resource constraints, the perspectives of women with criminal-legal involvement (WCLI) are important but not usually represented in the literature on vaccine interest and vaccine hesitancy. This study aims to examine how the COVID-19 pandemic and vaccine affected the influenza vaccine uptake among WCLI., Methods: A cross-sectional secondary analysis was conducted using data collected from the Tri-City study, which followed WCLI in three U.S. cities from 2019 to 2023. We mapped the distribution of influenza vaccine uptake in 2019-2023 and developed a composite outcome that reflected participants' patterns of Y/N to influenza vaccine, which were categorized into four groups: Influenza Vaccine Supportive, Influenza Vaccine Adaptive, Influenza Vaccine Discontinued, and Influenza Vaccine Resistant., Results: Out of 507 people: 23.7% were Supportive, 8.5% Adaptive, 15.2% Discontinued and 38.3% Resistant. People who received the COVID vaccine had significantly lower odds of being identified as Discontinued (OR = 0.42, 95%CI = 0.20-0.87, p = .020) and Resistant (OR = 0.23, 95%CI = 0.13-0.43, p < .001), compared to the Supportive group. Mistrust toward COVID-19-related information was a significant independent predictor of being Adaptive (OR = 1.59, 95%CI = 1.08-2.35, p = .019), Discontinued (OR = 1.61, 95%CI = 1.15-2.25, p = .006), and Resistant (OR = 1.54, 95%CI = 1.19-2.00, p < .001) relative to Supportive., Conclusions: Vaccine hesitancy poses significant challenges to public health efforts, with apparent dampening effect across vaccines. Public health messaging and clinical interactions informed by best practices in communication tailored to the lived experience of all people, including women with criminal-legal system involvement, will be necessary to inform future interventions aimed at increasing vaccine uptake., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Sleep deprivation (SD), defined as an inability to get a minimum of 7 hours of regular sleep at night is a serious health problem that impacts the performance of medical professionals. This study aims to determine the impact of sleep deprivation on perceived performance among medical officers (MOs). A cross-sectional study design involved 231 MOs from six disciplines in Hospital Tuanku Ja'afar, a tertiary center in the south of Malaysia. A self-administered questionnaire was introduced in the English language. The questionnaire involved the sociodemographic characteristics; job-related factors, and the Sleep Deprivation Impact Scale (SDIS). The SDIS is a 12-question scale, rated on a 5-point Likert scale from strongly disagree to strongly agree. A higher SDIS score reflected a higher impact of sleep deprivation. A total of 206 MOs returned the completed questionnaire yielding a response rate of 89.17%. The mean age of respondents was 31.68 (±3.49) years. Most of the respondents were female, of Malay ethnicity, and married. More than three-quarters (78.64%) reported sleep deprivation. Being less effective in communication and formulating diagnosis (3 (1.01) vs 2.5 (1.15),p = 0.005); taking longer time to do things (3.44 (1.07) vs 2.8 (1.34),p = 0.001); and feeling unsafe while driving (3.56 (1.25) vs 2.93 (1.55),p = 0.006) manifested significantly higher mean among sleep-deprived respondents. In conclusion, sleep deprivation is a prevalent problem; that adversely affects crucial functioning domains that may endanger patients and healthcare providers alike. Radical countermeasures are required to ensure satisfactory sleep duration and address areas jeopardizing MO safety., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Daher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The ongoing hepatitis C virus (HCV) epidemic in the United States disproportionately affects rural people who inject drugs (PWID). This study explores the HCV risk environment in rural northern New England by examining PWID experiences and perceptions of HCV and injection equipment-sharing practices. We performed a thematic analysis on semi-structured interviews conducted with 21 adults with a history of injection drug use from rural New Hampshire, Vermont, and Massachusetts between April 2018 and August 2019. Salient themes included: (1) limited and varied access to sterile syringe sources; (2) syringe scarcity contributing to the use of informal syringe sources (e.g., secondary syringe exchange or syringe sellers who purchased syringes from out-of-state pharmacies); (3) syringe scarcity contributing to syringe sharing; (4) linkages among decisions about syringe sharing and perceptions of HCV risk, HCV status, and interpersonal trust; and (5) confusion and misconceptions about HCV, including difficulty learning one's HCV status, inadequate HCV education, and misconceptions regarding HCV transmission and treatment. Efforts to prevent and eliminate HCV among rural PWID should expand syringe access, increase awareness of HCV as a serious but preventable risk, and acknowledge social connections as potential influences on syringe access and syringe-sharing decisions.

Competing Interests: The authors report no conflicts of interest in this communication.

Objectives: This study aims to address the significant knowledge gap in the literature on the implementation of Casemix system in total hospital information systems (THIS). The research focuses on validating a quantitative instrument to assess medical doctors' acceptance of the Casemix system in Ministry of Health (MOH) Malaysia facilities using THIS., Designs: A sequential explanatory mixed-methods study was conducted, starting with a cross-sectional quantitative phase using a self-administered online questionnaire that adapted previous instruments to the current setting based on Human, Organisation, Technology-Fit and Technology Acceptance Model frameworks, followed by a qualitative phase using in-depth interviews. However, this article explicitly emphasises the quantitative phase., Setting: The study was conducted in five MOH hospitals with THIS technology from five zones., Participants: Prior to the quantitative field study, rigorous procedures including content, criterion and face validation, translation, pilot testing and exploratory factor analysis (EFA) were undertaken, resulting in a refined questionnaire consisting of 41 items. Confirmatory factor analysis (CFA) was then performed on data collected from 343 respondents selected via stratified random sampling to validate the measurement model., Results: The study found satisfactory Kaiser-Meyer-Olkin model levels, significant Bartlett's test of sphericity, satisfactory factor loadings (>0.6) and high internal reliability for each item. One item was eliminated during EFA, and organisational characteristics construct was refined into two components. The study confirms unidimensionality, construct validity, convergent validity, discriminant validity and composite reliability through CFA. After the instrument's validity, reliability and normality have been established, the questionnaire is validated and deemed operational., Conclusion: By elucidating critical success factor and acceptance of Casemix, this research informs strategies for enhancing its implementation within the THIS environment. Moving forward, the validated instrument will serve as a valuable tool in future research endeavours aimed at evaluating the adoption of the Casemix system within THIS, addressing a notable gap in current literature., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Illicitly manufactured fentanyl and its analogs are the primary drivers of opioid overdose deaths in the United States (U.S.). People who use drugs may be exposed to fentanyl or its analogs intentionally or unintentionally. This study sought to identify strategies used by rural people who use drugs to reduce harms associated with unintentional fentanyl exposure., Methods: This analysis focused on 349 semi-structured qualitative interviews across 10 states and 58 rural counties in the U.S conducted between 2018 and 2020. Interview guides were collaboratively standardized across sites and included questions about drug use history (including drugs currently used, frequency of use, mode of administration) and questions specific to fentanyl. Deductive coding was used to code all data, then inductive coding of overdose and fentanyl codes was conducted by an interdisciplinary writing team., Results: Participants described being concerned that fentanyl had saturated the drug market, in both stimulant and opioid supplies. Participants utilized strategies including: (1) avoiding drugs that were perceived to contain fentanyl, (2) buying drugs from trusted sources, (3) using fentanyl test strips, 4) using small doses and non-injection routes, (5) using with other people, (6) tasting, smelling, and looking at drugs before use, and (7) carrying and using naloxone. Most people who used drugs used a combination of these strategies as there was an overwhelming fear of fatal overdose., Conclusion: People who use drugs living in rural areas of the U.S. are aware that fentanyl is in their drug supply and use several strategies to prevent associated harms, including fatal overdose. Increasing access to harm reduction tools (e.g., fentanyl test strips, naloxone) and services (e.g., community drug checking, syringe services programs, overdose prevention centers) should be prioritized to address the polysubstance-involved overdose crisis. These efforts should target persons who use opioids and other drugs that may contain fentanyl., (© 2024. The Author(s).)

Background: Video gaming is a popular leisure activity among adolescents. Those who play excessively are in danger of educational and social drawbacks and may become addicted to video gaming. Several published studies determined the prevalence of GD among children in specific Saudi regions. However, the current study assessed the national prevalence of video gaming disorder (GD) and its risk factors among school students in Saudi Arabia., Methods: A school-based survey was conducted among adolescents in all regions of Saudi Arabia during the academic year 2021-2022. A multistage stratified cluster sampling technique was used to select the school students. An Arabic-validated version of the 9-item dichotomous (yes/no) GD Scale based on the DSM-5 criteria was used to determine GD prevalence among the students. The score ranged from zero to nine (0-9). Participants who scored five or more were deemed as having GD. Students who scored less than five were classified as normal gamers (score 0-1) or risky gamers (score 2-4)., Results:  We recruited 5332 school students. Their mean age was 15.5 ± 1.7 years, and almost half of them were males (50.7%). According to the GD score, the prevalence of normal gamers was 39.08% (N = 1714), risky gamers 40.47% (N = 1775), and those with GD was, 20.45% (N = 897). Logistic regression was performed to determine the association between video gaming disorder and all the gathered variables, which include age, educational grade, sex, types of video gaming, and categories of video games played. The results showed that nationality, age, educational grade, sex, using only mobile devices to play, and playing puzzle and sports games were not associated with video gaming disorder. On the other hand, it was revealed that using tablets, game consoles, PCs; having multiple devices; and playing online, fighting, car racing, war, and adventure games were significantly linked to GD., Conclusion: The prevalence of GD was 20.45% among Saudi school students who play video games. Utilizing more than one type of gaming device and playing games in the fighting, war, and multiplayer categories via an online connection were significantly linked to having GD. To limit video gaming addiction, we encourage screening, diagnosing, and treating disordered video gamers early. In addition, governmental authorities and video game companies should discuss and revise numerous policy measures to minimize the accessibility of video games, limit the harms and risks related to them, and assist video gamers in becoming effective members of society., (© 2024. The Author(s).)

Background: The United States' (US) opioid overdose epidemic has evolved into a combined stimulant/opioid epidemic, a pattern driven in part by mitigating opioid overdose risk, variable substance availability, and personal preferences. This study aimed to investigate the association between self-reported substance preference (heroin or methamphetamine) and behavioral/health outcomes among individuals who used both heroin and methamphetamine in the rural US., Methods: The Rural Opioid Initiative is a consortium of 8 research cohorts from 10 states and 65 rural counties that recruited individuals reporting past 30-day injection of any substance or opioid substance use by any route from 1/2018 to 3/2020. Analyses were restricted to participants ⩾18 years, who self-reported either heroin or methamphetamine as their preferred substance and past 30-day use of both heroin and methamphetamine. We examined cross-sectional associations between preferred substance (heroin versus methamphetamine) and behavioral and health outcomes using random effects meta-analysis with adjusted regression models., Results: Among 1239 participants, 61% (n = 752) reported heroin as their preferred substance. Adjusting for age, sex, and race/ethnicity, methamphetamine preference was associated with lower prevalence ratios for current naloxone possession (adjusted prevalence ratio [aPR] = 0.68; 95% Confidence Interval [95% CI] = 0.59-0.78; P -value ⩽ .001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95% CI: 0.61-0.85; P -value ⩽ .001) and a personal history of overdose (aPR = 0.81; 95% CI = 0.73-0.90; P -value ⩽ .001)., Conclusion: In our study analyzing associations between preferred substance and various behavioral and health outcomes amongst people who use both heroin and methamphetamine, a majority of participants preferred heroin. Methamphetamine preference was associated with lower prevalence of naloxone possession, ever being told they had HCV, and prior history of an overdose. This study underscores the need for targeted harm reduction services for people who prefer methamphetamine in rural areas., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background and Aim: Traffic-related ultrafine particle pollution near highways is associated with adverse health. Reducing exposure by use of portable air purifiers in homes is one approach to reducing this risk. However, the reaction of residents to having air purifiers in homes is not well studied., Methods: Within the framework of our randomized crossover trial of air purifiers in homes near a major highway, we collected data about participants' use and reactions to air purifiers using questionnaires at their 30-day and 90-day home visits, recorded electricity consumption using HOBO monitors, and conducted structured interviews with participants., Results: Nearly all 150 participants reported running the air purifiers virtually 24 h every day in both their living room and their bedroom in the prior month. The units' HOBO electricity use, from a subset of 45 participants, supported the participants' responses from the questionnaire. Approximately 80% of participants reported setting their air purifier on the medium setting. Tolerance to air purifier noise increased significantly between the 30-day and 90-day home visits, with approximately two thirds reporting not being bothered at all by the noise. The qualitative interviews in a subset of 26 participants yielded consistent responses to those from the questionnaires. Size of unit, airflow, and energy consumption were additional concerns that emerged during the interviews., Conclusions: Results from the questionnaires, HOBO data, and structured interviews all suggest participants had positive reactions towards the presence of in-home APs, and therefore may be receptive to using air purifiers in their homes on a regular basis., Trial Registration: ClinicalTrials.gov, NCT04279249 . Registered 09 October 2019., (© 2024. The Author(s).)

Background: Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is a complex disease with increasing global incidence and prevalence. Although dairy consumption has been linked to various chronic diseases, its relationship with IBD remains uncertain. Additionally, there is a lack of data on this topic from Arab countries. This study aimed to investigate the association between dairy consumption and IBD through a case-control study among Arab populations, followed by a meta-analysis of available studies., Method: First, we used data from 158 UC patients, 244 CD patients, and 395 controls attending a polyclinic in Riyadh, Saudi Arabia. All participants were aged ≥ 18 years. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of UC and CD for individuals who reported the highest versus the lowest frequencies of dairy consumption. Next, we conducted a meta-analysis, combining our results with those from other eligible studies after searching several databases. We used the I statistics to examine statistical heterogeneity across studies and the regression test for funnel plot asymmetry to assess publication bias.2 statistics to examine statistical heterogeneity across studies and the regression test for funnel plot asymmetry to assess publication bias., Results: The case-control study showed a negative association between frequent dairy consumption and UC (OR (95% CI) = 0.64 (0.41, 1.00)) but not CD (OR (95% CI) = 0.97 (0.65, 1.45)). In the meta-analysis, the highest frequencies of dairy consumption were negatively associated with both UC and CD: ORs (95% CIs) = 0.82 (0.68, 0.98) and 0.72 (0.59, 0.87), respectively. A moderate heterogeneity across studies was noticed in the UC meta-analysis ( I = 59.58%) and the CD meta-analysis ( 2 = 59.58%) and the CD meta-analysis ( I 2 = 41.16%). No publication bias was detected., Conclusions: Frequent dairy consumption could protect against the development of UC and CD, suggesting potential dietary recommendations in the context of IBD prevention.

Purpose: Diabetes Mellitus (DM) is a common metabolic disorder with negative impacts on brain functions. Social cognition and vicarious experience impairments are features of DM. This research aimed to estimate the social cognition and vicarious experience among Jordanian people with diabetes., Patients and Methods: Cognitive abilities were assessed using the Vicarious Pain Questionnaire (VPQ) and the Mirror Touch Questionnaire (MTQ). Data on disease history, medications, routine laboratory measurements, and anthropometric indices., Results: Patients had lower pain responses and intensity scores, and higher unpleasantness scores than the control group (p < 0.05). Most of the VPQ and MTQ measures were mainly impaired among study participants who had higher education, were not practicing exercises, and were not consuming healthy diets (p < 0.05). The number of responses to the VPQ and average pain intensity were negatively correlated with age and positively correlated with both the serum aminotransferase (AST) concentration and the serum urea concentration (p < 0.05). The average unpleasantness score was positively correlated with the duration of therapy, serum creatinine, and albumin concentrations (p < 0.05). The final regression models for the number of pain responses and localized-generalized included group, practicing exercise, and AST, while the model for the average pain intensity included only the grouping variable. The model for average unpleasantness included grouping, AST, Albumin, consuming a healthy diet, and duration of therapy., Conclusion: The Jordanian diabetic patients who participated in the study had impaired social cognition and vicarious experience. A healthy lifestyle had a significant effect on the scores of the vicarious experience in addition to the level of education. Despite being the first study in Jordan to assess vicarious experience in DM, further studies are needed considering imaging and electrophysiological workup. Besides, further prospective studies are needed to determine the significance of the current study., Competing Interests: Regarding this paper, the authors disclose no conflicts of interest., (© 2024 Amin et al.)

Respiratory cryptosporidiosis is considered an occasional, late-stage complication of HIV/AIDS. This study aimed to assess the clinical importance of respiratory cryptosporidiosis in children with diarrhea and respiratory symptoms at Mulago Hospital, Kampala, Uganda. Children aged 9 to 36 months presenting with diarrhea and cough or unexplained tachypnea (N = 1,918) were screened for fecal Cryptosporidium using polymerase chain reaction (PCR). Children with positive stool samples were eligible for further diagnostic tests, including sputum induction. Sputum samples were subjected to PCR for Cryptosporidium, as well as routine microbiology (culture and gram stain) and auramine stain for tuberculosis. Regression analyses were used to investigate 1) factors associated with respiratory cryptosporidiosis and 2) whether respiratory cryptosporidiosis was independently associated with hospitalization. Prevalence of enteric cryptosporidiosis was 260/1,918 (13.6%) (>80% Cryptosporidium hominis). Of the 236 children who had sputum available for analysis, 62 (26.3%) had Cryptosporidium in the sputum, only two of whom had HIV infection. Children with Cryptosporidium in the sputum were more likely to have abnormal oxygen saturation at presentation (SpO2 <96%; P = 0.053); no other differences in frequency or severity of respiratory signs were noted. No alternative bacterial cause of respiratory symptoms was identified in 37.7% of children with respiratory cryptosporidiosis, compared with 23.6% of children without (P = 0.04). Sputum-positive children had twice the odds of hospitalization compared with children without Cryptosporidium infection at this site (adjusted odds ratio = 2.08, 95% confidence interval: 1.02-4.22; P = 0.043). Respiratory tract involvement is common in children with intestinal cryptosporidiosis who are experiencing respiratory symptoms. Such children may experience some degree of respiratory compromise and may be at increased risk for hospitalization.

Gestational trophoblastic diseases (GTDs) encompass a spectrum of conditions characterized by abnormal trophoblastic cell growth, ranging from benign molar pregnancies to malignant trophoblastic neoplasms. This systematic review explores the molecular underpinnings of GTDs, focusing on genetic and epigenetic factors that influence disease progression and clinical outcomes. Based on 71 studies identified through systematic search and selection criteria, key findings include dysregulations in tumor suppressor genes such as p53 , aberrant apoptotic pathways involving BCL-2 (B-cell lymphoma), and altered expression of growth factor receptors and microRNAs (micro-ribose nucleic acid). These molecular alterations not only differentiate molar pregnancies from normal placental development but also contribute to their clinical behavior, from benign moles to potentially malignant forms. The review synthesizes insights from immunohistochemical studies and molecular analyses to provide a comprehensive understanding of GTD pathogenesis and implications for personalized care strategies.

Introduction: Data on e-cigarette (EC) and heated tobacco product (HTP) use and the reasons for their use are useful for policy making. We report comparable nationally representative estimates of EC and HTP use and their associated factors., Aims and Methods: Global Adult Tobacco Survey data from Indonesia (2021), Kazakhstan (2019), and the Philippines (2021) were analyzed. The weighted prevalence rates and 95% CI of EC and HTP awareness, current use, and ever use, and their distribution by cigarette smoking status were calculated. Binary logistic regression analyses assessed socioeconomic, and tobacco control factors associated with EC and HTP use., Results: The prevalence (%) of EC awareness, ever use and current use were 48.7-69.4, 3.6-8.8, and 1.9-3.0, respectively. The prevalence(%) of HTP awareness, ever use and current use were 2.7-21.7, 0.2-2.1, and 0.1-1.2, respectively. The main reasons for EC and HTP use were attractive flavors(45.8%-73.9%), less harmful than smoking(23.0%-70.1%), and enjoyment(40.8%-76.7%). Avoiding going back to smoking(0.9%-54.4%) and quitting smoking(19.4%-49.8%) were less frequently cited reasons (except in the Philippines). EC/HTP use was associated with younger age, higher education and wealth, current/past smoking, exposure to information about the dangers of tobacco use, and advertisements about tobacco products and smoke-free rules at home., Conclusions: The prevalence of EC and HTP use was higher among younger men with higher education and wealth, and current/past smoking. EC and HTP use should be closely monitored. Regulations to restrict the widespread marketing and sales of EC and HTP are needed to prevent the escalation of their use., Implications: The population-level data provide the benchmark for future monitoring use of e-cigarettes and HTPs and identify population subgroups for future surveillance in low- and middle-income countries. The association of EC/HTP use with tobacco control-related factors provides leads for policies that should be formulated and implemented to regulate the product contents, marketing, and sales of EC and HTP., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The western districts of Mizoram (Lunglei, Mamit, and Lawngtlai) are malaria hotspots. Understanding the knowledge, attitude, and practices of the tribal communities in Mizoram's western districts will aid the development of specific interventions., Methods: An explanatory sequential mixed-method study was conducted from April to November 2023 in the Lunglei district. In a community-based cross-sectional survey of 353 participants, the knowledge, attitude, practices, and care-seeking behaviour toward malaria were assessed using a semi-structured questionnaire. Data was analysed using SPSS version 29 software; univariate variables were presented in percentage, and bivariate and multivariate variables were analysed using the chi-square test and logistic regression, respectively. This was followed by in-depth telephonic interviews of twelve participants, and the data was analysed using NVivo., Results: Out of the 353 respondents, 77.9%, 82.7%, 55.5%, and 63.2% of the participants had good knowledge, attitude, practices, and care-seeking behaviour, respectively. The in-depth qualitative interviews highlighted the villagers' good knowledge of the various aspects of malaria transmission, treatment, and prevention practices (indoor residual spraying and use of insecticide-treated nets)., Conclusion: High disease endemicity, awareness programmes and vector control interventions might be contributing to the overall good knowledge, attitude, and practices toward malaria among the villagers. In addition to vector control measures, active parasite surveillance is key to malaria control in this region., (© 2024. The Author(s).)

Background: Xylazine, an adulterant in local drug supplies, has been detected in approximately 30% of opioid samples submitted for testing in Massachusetts. A better understanding of local risks, harms, and use preferences is needed to combat xylazine-related impacts on local communities., Methods: Through the STOP-OD Lowell study, we aimed to assess local xylazine awareness through in-depth interviews with local community stakeholders (n = 15) and local people who use drugs (PWUD; n = 15) and surveys with local PWUD (n = 94). The qualitative interviews focused on the current drug landscape and knowledge of adulterants in Lowell, and the results informed subsequent survey design. Through our survey, we examined whether PWUD were aware of xylazine and their willingness to use xylazine test strips., Results: Most community stakeholders and PWUD had limited awareness about the presence and impact of xylazine as an adulterant. Forty-seven (50%) survey respondents were aware of xylazine. When provided with more information about xylazine, 65% of all respondents expressed a willingness to use xylazine test strips. PWUD who had received naloxone training, reported using with others, and using tester shots were more willing to use xylazine test strips., Conclusion: Our findings are congruent with existing literature that indicates that there is limited awareness of xylazine among PWUD, and they consider xylazine an unwanted adulterant. We also found that PWUD who use other harm reduction measures are more willing to use xylazine test strips. The increase in xylazine warrants additional community-level interventions such as wound management and local testing infrastructure. Further research is needed to understand better the impacts associated with xylazine use, effective harm reduction techniques, and perceptions of xylazine test strips., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: Local-level data are needed to understand whether the relaxation of X-waiver training requirements for prescribing buprenorphine in April 2021 translated to increased buprenorphine treatment., Objective: To assess whether relaxation of X-waiver training requirements was associated with changes in the number of clinicians waivered to and who prescribe buprenorphine for opioid use disorder and the number of patients receiving treatment., Design, Setting, and Participants: This serial cross-sectional study uses an interrupted time series analysis of 2020-2022 data from the HEALing Communities Study (HCS), a cluster-randomized, wait-list-controlled trial. Urban and rural communities in 4 states (Kentucky, Massachusetts, New York, and Ohio) with a high burden of opioid overdoses that had not yet received the HCS intervention were included., Exposure: Relaxation of X-waiver training requirements (ie, allowing training-exempt X-waivers) on April 28, 2021., Main Outcomes and Measures: The monthly number of X-waivered clinicians, X-waivered buprenorphine prescribers, and patients receiving buprenorphine were each summed across communities within a state. Segmented linear regression models to estimate pre- and post-policy change by state were used., Results: The number of individuals in 33 participating HCS communities included 347 863 in Massachusetts, 815 794 in Kentucky, 971 490 in New York, and 1 623 958 in Ohio. The distribution of age (18-35 years: range, 29.4%-32.4%; 35-54 years: range, 29.9%-32.5%; ≥55 years: range, 35.7%-39.3%) and sex (female: range, 51.1%-52.6%) was similar across communities. There was a temporal increase in the number of X-waivered clinicians in the pre-policy change period in all states, which further increased in the post-policy change period in each state except Ohio, ranging from 5.2% (95% CI, 3.1%-7.3%) in Massachusetts communities to 8.4% (95% CI, 6.5%-10.3%) in Kentucky communities. Only communities in Kentucky showed an increase in the number of X-waivered clinicians prescribing buprenorphine associated with the policy change (relative increase, 3.2%; 95% CI, 1.5%-4.9%), while communities in other states showed no change or a decrease. Similarly, only communities in Massachusetts experienced an increase in patients receiving buprenorphine associated with the policy change (relative increase, 1.7%; 95% CI, 0.8%-2.6%), while communities in other states showed no change., Conclusions and Relevance: In this serial cross-sectional study, relaxation of X-waiver training requirements was associated with an increase in the number of X-waivered clinicians but was not consistently associated with an increase in the number of buprenorphine prescribers or patients receiving buprenorphine. These findings suggest that training requirements may not be the primary barrier to expanding buprenorphine treatment.

Background: Children from families who immigrated to the United States may consume a lower-quality diet compared with their US-born peers. However, specific features of their dietary patterns, which could be a focus for improving diet quality, are not well-studied., Objective: The aim of this study was to examine dietary patterns that distinguish interpersonal variability in dietary intake and explore the association of dietary patterns with nutrient intake and weight status., Design: This study was a cross-sectional analysis of baseline data from the Live Well randomized controlled trial collected between 2009 and 2010., Participants/setting: Study participants included 313 children (3-12 years) whose mothers immigrated to the United States from Latin America and resided in Somerville, Massachusetts., Main Outcome Measures: Dietary patterns (derived using principal component analysis); nutrient intake (derived from dietary data collected using the Block Food Screener); and weight status (categorized using body mass index z score based on measured height and weight)., Statistical Analyses Performed: Nutrient intake levels were compared across quartiles for dietary patterns using analysis of covariance. Multivariable logistic or linear regression models were used to determine the associations between dietary pattern scores and odds of overweight or obesity or z scores., Results: Two dietary patterns emerged: "fruits and vegetables" and "meat and sweets." Highest adherence to the fruits and vegetables pattern was associated with more healthful nutrient intake and lower odds of having overweight or obesity (odds ratio 0.37; 95% CI 0.16 to 0.98), but not body mass index z score (β = -.07; 95% CI -.51 to 0.36) compared with the lowest adherence. Adherence to the meat and sweets pattern was associated with less healthful nutrient intake but not with the odds of experiencing overweight or obesity (odds ratio 0.48; 95% CI 0.16 to 1.46)., Conclusions: A healthful dietary pattern in children of families who immigrated to the United States from Latin America may include a variety of fruits and vegetables. Longitudinal studies should be conducted to further assess the role of dietary intake patterns on the health of these children., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Premenstrual syndrome (PMS) is a commonly underestimated disorder that negatively impacts a woman's life. Medical workers, who live a more stressful life, may report an increased rate of PMS. Studies on the relationship between PMS and work-related quality of life for medical professionals are scarce, particularly in the Arab world. This study aimed to compare the frequency of PMS among medical versus non-medical workers at Zagazig University and to assess the association between PMS and their work-related quality of life., Methods: A comparative cross-sectional study was conducted. The sample population consisted of 48 medical and 48 non-medical female workers aged 18-45 years from Zagazig University. The two groups filled out a questionnaire with 3 parts: sociodemographic and occupational data, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality of Life Scale (WRQL)., Results: Severe PMS was reported in 45.8% of medical workers versus 20.8% of non-medical workers with a statistically significant difference between both groups (p = 0.009). Binary logistic regression showed that being a medical worker, clinical specialty, ≥ 8 years of work, ≥ 24 working hours per week, and having a non-set hourly schedule were predictors for severe PMS. PMS was found to be a statistically significant predictor of poor WRQL (p < 0.001). There was a highly significant negative correlation between the PMS score and the WRQL score (r =  - 0.302, p < 0.001)., Conclusion: Among medical workers, PMS is more common and more severe, and WRQL is worse and negatively correlated with PMS. We suggest further studies with larger samples to prove this association and planning for public health programs to screen for and manage PMS among medical workers in our community., (© 2024. The Author(s).)

Importance: A loophole in US gun policy is that people can purchase guns from private sellers without going through any background check. Some states have addressed this loophole by requiring universal background checks for all gun sales, either at the point of sale or through a permit system; however, most studies on the effectiveness of universal background checks have not analyzed these 2 policy mechanisms separately., Objective: To assess the association of point-of-sale background check law and gun permit law, separately, with firearm homicide rates from 1976 through 2022 using the same methods and model specification., Design, Setting, and Participants: This cross-sectional study used a difference-in-differences, fixed-effects regression model to evaluate firearm laws and firearm homicide rates in 48 states from 1976 through 2022. Data were obtained for 48 states except New Hampshire and Vermont and were analyzed in January 2024., Exposures: Implementation of either the law requiring a universal background check at point of sale for all firearms without a permit or the laws combining universal background checks and a state permit requirement for all gun purchasers., Main Outcomes and Measures: Annual, state-specific rates of firearm homicide per 100 000 people., Results: From 1976 through 2022, 12 states adopted the universal background check laws without permitting requirements and 7 states implemented gun permit laws covering all firearms. The mean (SD) firearm homicide rate was 4.3 (0.1) per 100 000 people. Universal background checks for all firearms alone (without a state permitting system) were not associated with overall homicide rates (percentage change, 1.3%; 95% CI, -6.9% to 10.4%) or firearm homicide rates (percentage change, 3.7%; 95% CI, -5.3% to 13.6%). A law requiring a permit for the purchase of all firearms was associated with significantly lower overall homicide rates (percentage change, -15.4%; 95% CI, -28.5% to -0.01%) and firearm homicide rates (percentage change, -18.3%; 95% CI, -32.0% to -1.9%)., Conclusions and Relevance: This cross-sectional study found that universal background checks alone were not associated with firearm homicide rates, but a permit requirement for the purchase and possession of firearms was associated with substantially reduced rates of firearm homicide. The findings suggest that combining universal background checks and permit-to-purchase requirements is an effective strategy for firearm-related fatality reduction.

Background: Neurosurgery is a rapidly advancing surgical specialty. Social media has significantly impacted the landscape of advancements in the field of neurosurgery. Research on the subject of neurosurgery and social media plays a vital role in combating disability and mortality due to neurological diseases, especially in trauma-affected individuals by increasing cooperation and sharing of clinical experiences between neurosurgeons via social media. This study aimed to evaluate the global neurosurgery and social media research performance from 2004 to 2023., Methods: All the data for neurosurgery and social media-related research publications from 2004 to 2023 were extracted from the Web of Science database and a comprehensive analysis was performed on the R-bibliometrix package., Results: An increasing number of publications with an annual growth rate of 22.04% was observed, with >91% of total articles published in the last decade. The United States, the United Kingdom, Italy, France, Canada, and India made up of more than 67% of the global contribution. Out of 1449 authors, Chaurasia B was the most productive with 14 publications and the most globally cited document was JEAN WC, 2020 with 117 citations. The University of Cambridge was the leading institutional affiliation. World Neurosurgery was the most productive with >60 articles., Conclusions: Exploring neurosurgery on social media enhances global collaboration, utilizing dynamic platforms for real-time knowledge exchange and holds immense potential for the field's global advancement., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Health promoting university is a holistic approach to health that uses higher education settings to create a learning environment that improves the health and well-being of the campus community in a sustainable manner. The utilization of technology such as artificial intelligence (AI) could be one of the main success factors in the implementation of health-promoting universities to increase the effectiveness and efficiency of all stages of activities carried out in health promotion and prevention efforts. Integrated monitoring with the utilization of AI in this program is conducted to evaluate the health status of the students. The Syiah Kuala Integrated Medical Monitoring (SKIMM) has three components of continuous health status evaluation: vital signs, nutritional status, and burnout status. Health status monitoring was conducted continuously for three months among medical students at the Faculty of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia. This system uses the WhatsApp application as a platform to monitor health status. Student health monitoring in this program consists of two main activities: the health measurement phase and the health monitoring phase. The use of the SKIMM system to monitor students' vital signs, nutritional status and burnout status through the use of AI significantly raises students' awareness to conduct timely self-examination and enables sustainable healthy lifestyle behavior change. The adoption of AI technology allows for continuous health promotion to the entire academic community, including students in implementing the health promoting university., Competing Interests: All authors have no conflict of interested., (© 2024 The Author(s).)

Introduction: Although structural racism is strongly related to racial health disparities, we are not aware of any composite, multidimensional measure of structural racism at the city level in the United States. However, many of the policies, programs, and institutions that create and maintain structural racism are located at the city level. To expand upon previous research, this paper uses a novel measure to measure structural racism at the city level for the non-Hispanic Black population., Methods: We used confirmatory factor analysis to model the latent construct of structural racism for 776 U.S. cities. The model included six indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status. We generated factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each city. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates., Results: There were profound differences in the magnitude of structural racism across cities. There were also striking differences in the magnitude of the racial disparity in firearm homicide across cities. Structural racism was a significant predictor of the magnitude of these racial disparities in firearm homicide. Each one standard deviation increase in the structural racism factor score increased the firearm homicide rate ratio by a factor of approximately 1.2 (95% confidence interval, 1.1-1.3)., Conclusions: These new measures can be utilized by researchers to relate structural racism to racial health disparities at the city level., (© 2023. The Author(s).)

Background: Stroke-associated pneumonia (SAP) considerably burden healthcare systems. This study aimed to identify predictors of developing SAP in acute ischemic stroke patients admitted to the Stroke Unit at Manial Specialized Hospital factors with microbiological causality and impact on 30-day mortality., Methods: This was a retrospective cohort study. All patients with acute ischemic stroke admitted to the Stroke Unit at Manial Specialized Hospital (from February 2021 to August 2023) were divided into the SAP and non-SAP groups. Detailed clinical characteristics and microbiological results were recorded., Results: Five hundred twenty-two patients diagnosed with acute ischemic stroke (mean age of 55 ± 10) were included. One hundred sixty-nine (32.4%) of stroke patients developed SAP; Klebsiella pneumoniae was the most commonly detected pathogen (40.2%), followed by Pseudomonas aeruginosa (20.7%). Bacteremia was identified in nine cases (5.3%). The number of deaths was 11, all of whom were diagnosed with SAP, whereas none from the non-SAP group died (P < 0.001). The binary logistic regression model identified three independent predictors of the occurrence of SAP: previous history of TIA/stroke (OR = 3.014, 95%CI = 1.281-7.092), mechanical ventilation (OR = 4.883, 95%CI = 1.544-15.436), and bulbar dysfunction (OR = 200.460, 95%CI = 80.831-497.143)., Conclusions: Stroke-associated pneumonia was reported in one-third of patients with acute ischemic stroke, adversely affecting mortality outcomes. Findings showed that the main predictors of SAP were bulbar dysfunction, the use of mechanical ventilation and previous history of TIA/stroke. More attention to these vulnerable patients is necessary to reduce mortality., (© 2024. The Author(s).)