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Objectives: The objective of this web-based study is to analyze the attributes of bariatric surgery cases ensuing health implications. Additionally, the study seeks to delve into the factors influencing post-bariatric psychological evaluations and the impact of various bariatric surgeries on weight loss and psycho-social assessment scores for patients who had undergone bariatric surgeries within a specific bariatric surgery center in Egypt between January 2017 and January 2024., Methods: An analytical cross-sectional study recruited 411 adults who had undergone different bariatric procedures by the same surgical team. We collected the data using a validated self-administered questionnaire that included the Body Image Scale (BIS), the Rosenberg Self-Esteem Scale (RSES), the quality-of-life score (QOLS), and the modified General Patient Satisfaction Score after Bariatric Surgeries (GSABS)., Results: The most commonly performed bariatric surgery was sleeve gastrectomy (SG), accounting for 82.7% of the procedures. The majority of the patients (78%) were female, with a mean age of 35.8. Among the participants, 32.4% reported experiencing complications, and 21.2% of those individuals were still experiencing complications at the time of assessment. The BIS had a mean score of 16.54 ± 6.27, indicating an average body image perception. The RSES yielded a mean score of 20.11 ± 4.63, indicating average self-esteem, while the GSABS had a mean score of 8.08 ± 2.39, indicating an overall average level of patient satisfaction. No statistically significant differences were found between the various types of bariatric surgeries in terms of total body weight loss percentage, excess body weight loss percentage, or the timing of the intervention. However, increased time intervals from surgeries noted a significant reduction in the BIS., Conclusion: The majority of patients who underwent SG and Roux-en-Y gastric bypass (RYGB) surgeries exhibited high GSABS scores. SG patients also had high BIS scores. However, all other interventions showed normal GSABS and BIS scores. All types of surgeries resulted in normal RSES and QOLS. Furthermore, the BIS score increases with the intervention's recentness, but it significantly decreases after the second-year post-surgery. Conversely, the older the timing of the intervention, the higher the RSES score after surgery., Competing Interests: Declarations. Competing interest: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Mood and anxiety disorders affect one in five perinatal individuals and are undertreated. While professional organizations and policy makers recommend that obstetric practices screen for, assess and treat mood and anxiety disorders, multi-level barriers to doing so exist. To help obstetric practices implement the recommended standard of care, we developed implementation assistance, an approach to guide practices on how to integrate screening, assessment, and treatment of mood and anxiety disorders into the obstetric practice workflow. To teach obstetric care clinicians how to treat perinatal mood and anxiety disorders, we also developed an e-learning course and toolkit., Objective(s): Evaluate the extent to which 1) implementation assistance + e-learning/toolkit, and 2) e-learning/toolkit alone improved the rates and quality of care for perinatal mood and anxiety disorders in obstetric practices, as compared to usual care., Study Design: We conducted a cluster randomized controlled trial involving 13 obstetric practices across the United States (US). Using 2:2:1 randomization, 13 obstetric practices were assigned to 1) implementation assistance + e-learning/toolkit (n=5), 2) e-learning/toolkit alone (n=5), or 3) usual care (n=3). We measured obstetric care clinicians' quality of care for perinatal mood and anxiety disorders (as measured by medical record documentation of screening, assessment, treatment initiation, and monitoring) documented in patient charts (n=1,040). Effectiveness was assessed using multilevel generalized linear mixed models, accounting for clustering of repeated measurements (n=2, i.e., pre and post) within obstetric care clinicians' patient charts (n=40) nested within practices (n=13). Intention-to-treat and per-protocol analyses were conducted., Results: At baseline, no significant differences were observed among the three groups regarding documented mental health screening. Chart extraction at eight months post-training revealed a significant increase in recommended bipolar disorder screening only among the practices that received the implementation plus e-learning/toolkit (from 0.0% to 30.0%; p = 0.017). Practices receiving the e-learning/toolkit alone or usual care continued to not screen for bipolar disorder. Documented screening for anxiety also increased in the implementation + e-learning/toolkit group (from 0.5% to 40.2%), however, did not reach statistical significance when compared to the other groups (p = 0.09). A significant increase in documented post-traumatic stress disorder (PTSD) screening was observed among practices receiving the implementation plus e-learning/toolkit (0.0% to 30.0%; p = 0.018). The quality-of-care score in the implementation + e-learning toolkit group increased from 20.5 at baseline to 42.8 at follow-up and was significantly different from both the e-learning/toolkit alone group (p = 0.02) and the usual care group (p = 0.03). At eight months post-training, the implementation + e-learning/toolkit group had higher mean provider readiness scores than the other two groups for documentation of screening, assessment, and monitoring. However, documentation of treatment was the only component that reached statistical significance (p =0.025)., Conclusion(s): Among the practices that followed the implementation protocols, implementation assistance + e-learning/toolkit was effective in improving rates of screening for bipolar disorder, anxiety, and PTSD. However, three of the five practices did not follow the implementation protocols, suggesting that the intensity of the implementation needs to be tailored based on practice readiness for implementation., (Copyright © 2025. Published by Elsevier Inc.)

Background.: Intervention effectiveness in a randomized controlled trial is attributed to intervention fidelity. Measuring fidelity has increasing significance to intervention research and validity. The purpose of this article is to describe a systematic assessment of intervention fidelity for VITAL Start (Video intervention to Inspire Treatment Adherence for Life)-a 27-minute video-based intervention designed to improve antiretroviral therapy adherence among pregnant and breastfeeding women., Method.: Research Assistants (RAs) delivered VITAL Start to participants after enrolment. The VITAL Start intervention had three components: a pre-video orientation, video viewing, and post-video counseling. Fidelity assessments using checklists comprised self (RA assessment) and observer (Research Officers, also known as ROs) assessment. Four fidelity domains (adherence, dose, quality of delivery, and participant responsiveness) were evaluated. Score scale ranges were 0 to 29 adherence, 0 to 3 dose, 0 to 48 quality of delivery and 0 to 8 participant responsiveness. Fidelity scores were calculated. Descriptive statistics summarizing the scores were performed., Results.: In total, eight RAs delivered 379 VITAL Start sessions to 379 participants. Four ROs observed and assessed 43 (11%) intervention sessions. The mean scores were 28 ( SD = 1.3) for adherence, 3 ( SD = 0) for dose, 40 (SD = 8.6) for quality of delivery, and 10.4 ( SD = 1.3) for participant responsiveness., Conclusion.: Overall, the RAs successfully delivered the VITAL Start intervention with high fidelity. Intervention fidelity monitoring should be an important element of randomized control trial design of specific interventions to ensure having reliable study results.

Background: Over the last two decades, houselessness and drug-related epidemics both have expanded from urban to rural regions across the United States (US). However, our understanding of the relationship between rural houselessness, drug use, and drug-related harms has not kept pace. The current study addresses this gap by describing houselessness among a large cohort of people who use drugs (PWUD) from rural communities across 10 states., Design: PWUD were recruited using modified chain-referral sampling for a cross-sectional survey capturing houselessness in the prior six months, drug use, drug-related harms, stigma, health service access, and sociodemographic characteristics. Using bivariate logistic regressions, we assessed associations between houselessness and participant characteristics. We also compare site-specific houselessness prevalence to Housing and Urban Development Point-in-Time (PIT) estimates, which are based on counts of sheltered and unsheltered people experiencing houselessness on a single night., Results: Among 3000 PWUD, 53.7 % reported experiencing houselessness. Houselessness was associated with multiple drug-related behaviors that increase the risk of overdose and acquisition of bloodborne infections. Houselessness prevalence was comparable and exceeded PIT estimates for several sites, even though study participants constituted <1 % of each site's adult population and were restricted to PWUD., Conclusions: Our findings highlight that houselessness - historically considered an urban issue - is a significant public health concern for PWUD in rural areas. This demonstrates that addressing drug-related HIV, hepatitis C, and overdose epidemics, among others, in the rural US will require the provision of stable housing and harm reduction services as a pathway to treatment and recovery., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare. The authors also state that the work described has not been published previously nor is it under consideration for publication elsewhere., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Competing Interests: Competing interests: None declared.

Background: Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda., Objective: We aimed to investigate the association between Rwandan women's exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age., Methods: In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women's Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy., Results: Of 601 women, 47.4% ( n  = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01-2.03) and 1.25 (95% CI, 1.04-2.01), respectively., Conclusion: Women's exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women's exposure to IPV and adverse effects on child growth.

Background: The postpartum period is a vital time for women, infants, spouses, parents, caregivers and families. Considering the importance of postpartum care and the necessity of using comprehensive and up-to-date clinical guidelines in Iran, this study was designed to implement a indigenized clinical guideline in Iran on maternal outcomes, including maternal functioning, postpartum depression and postpartum specific anxiety (primary outcomes) as well as infant care, maternal health problems, experiencing violence, feeding method and contraception use (secondary outcomes)., Methods: This randomized controlled trial was conducted with 272 postpartum women in Taleghani and Alzahra hospitals in Tabriz in 2023. Participants were randomly allocated to intervention and control groups. The intervention group received care and training based on clinical guideline while the control group received routine care and training. Both groups were followed up by telephone at the second and sixth week after delivery. Questionnaires assessing maternal health problems and postpartum depression were completed in the second and sixth weeks and while assessments of maternal functioning, postpartum depression, postpartum specific anxiety, infant care behavior, and experiences of violence were conducted in the sixth week after delivery. ANCOVA, independent-t tests, and Mann-Whitney U tests were used for data analysis., Results: There was no significant difference between the two groups regarding of socio-demographic characteristics (P < 0.05). Additionally, there were no significant differences in the mean score of maternal functioning, anxiety, depression, infant care behavior or experiences of violence after the intervention between the intervention and control groups based on ANCOVA or Mann-Whitney U tests (P < 0.05). However, the rate of infant formula use was significantly lower in the intervention group (12.9%) compared to the control group (23.4%) (P = 0.027). In terms of contraceptive methods used, 24.3% of the intervention group and 22.2% of the control group reported using reliable contraceptive methods )P = 0.035(. Furthermore, 98.5% of participants in the intervention group expressed satisfaction with the education and recommendations provided, compared to 88.2% in the control group (P = 0.002)., Conclusion: Providing clinical guideline-based care was associated with increased breastfeeding rates, greater use of reliable contraception methods, and higher levels of maternal satisfaction. However, it did not have a significant impact on other maternal outcomes., Trial Registration: Iranian Registry of Clinical Trials (IRCT) IRCT20120718010324N76 Date of registration 27/1/2023. URL: https://trialsearch.who.int/Trial2.aspx?, Trialid: IRCT20120718010324N76 DATE OF FIRST REGISTRATION: 27/3/2023., Competing Interests: Deceleration. Ethics approval and consent to participate: Written informed consent will be obtained from each participant. This protocol has been approved by the Ethics Committee of the Tabriz University of Medical Sciences, Tabriz, Iran (code number: IR.TBZMED.REC.1401.661). All the steps/ methods will be performed in accordance with the relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Globally, dozens of COVID-19 vaccines are licensed under emergency or conditional authorization, but especially in low and middle-income countries, their availability varies. Indonesia decided to become independent and produce its own vaccines locally. This study investigated the safety and immunogenicity of a SARS-CoV-2 recombinant protein subunit vaccine adjuvanted with Alum + CpG 1018. This study involved 360 adults aged 18 years and above. It compared two vaccine dosages, a-12.5 µg and a 25-µg dose of receptor binding domain protein, to a placebo (1:1:1). A total of 40.6% of participants in this study experienced at least one adverse event (AE), with most being mild. There was no statistically significant difference in AEs between the groups. The microneutralization test showed the highest neutralizing antibody titer (IU/mL) in the 25 µg dose vaccine group at day 28 after the second dose (3,300 95%CI 2,215-4,914), although it was not statistically different from the 12.5 µg dose group (3,157 95%CI 2,135-4,669). Similarly, IgG antibody concentrations in the 25 µg dose vaccine group at day 28 were the highest compared to the 12.5 µg dose and placebo. According to protocol, only the formulation with the better antibody profile and comparable reactogenicity was further evaluated at months three and six. Thus, follow-up was only performed for the 25 µg dose vaccine, demonstrating antibody persistence at month six and had a favorable safety profile. These results position this SARS-CoV-2 recombinant protein subunit vaccine adjuvanted with Alum + CpG 1018 as a promising candidate to fight against COVID-19.

Background: Osteocalcin is a metabolic active hormone, which correlates positively with bone formation and inversely with body mass index and waist circumference in adults., Objectives: To investigate whether osteocalcin in infancy and early childhood were related to childhood growth or body composition., Methods: A Swedish longitudinal birth cohort with blood samples from 551 children from birth until 5 years of age. Regular anthropometric measurements were carried out up to 8 years of age and dual-energy X-ray absorptiometry (DXA) scans were also performed at 8 years. The results included p-values and Spearman's rho (ρ)., Results: Osteocalcin at 4 months of age correlated inversely and consecutively with weight from 4 to 24 months and to waist circumference from 6 to 24 months in boys. The correlations for girls were limited to weight at 4 months and waist circumference at 6 and 18 months (ρ < 0.3, p = 0.001 to 0.048). The boys' osteocalcin levels at 5 years correlated positively with their height and weight at 5 and 6.5 years (ρ < 0.3, p < 0.01). Meanwhile, the girls' osteocalcin at 3 years showed positive correlations to all weight and height measurements until 8 years of age (ρ < 0.3, p = 0.003 to 0.023). DXA data showed that the boys' osteocalcin at 5 years correlated with the fat-free mass index (FFMI) (ρ 0.212, p = 0.026) but not the fat mass index (FMI) at 8 years. The opposite was seen for the girls' osteocalcin at 3 years, which correlated with FMI (ρ 0.222, p = 0.020) but not FFMI., Conclusion: Early levels of osteocalcin showed inverse correlations with later weight, height and body composition in infancy and positive correlations during childhood. The weak but consistent correlations suggest that osteocalcin carries information about future growth. Girls with high osteocalcin at 3 and 5 years had a larger fat mass at 8 years, while boys, in contrast, had a larger lean mass. These sex differences need to be further explored., (© 2024 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd.)

Introduction: In order to assess patient experiences of telemedicine, researchers and administrators use the net promoter score (NPS), based on a likelihood to recommend (LTR) question. However, there is reason to doubt validity of this metric for this purpose. We assessed the degree to which the LTR question reflects actual patient preferences about telemedicine. Methods: Using data from a patient experience survey collected in Spring 2020, we compared LTR responses to open comments. Through content analysis, we transformed comments into categorical variables and used those variables in a multiple logistic regression model to predict LTR responses. We also thematically analyzed comments to further elucidate our results. Results: Only about half the comments mentioned telemedicine at all. Around 6% of comments were wholly incongruent with LTR responses. In many comments, ideas about telemedicine were semantically entangled with ideas about providers. Our logistic regression found strong associations between sentiments expressed in comments and LTR responses. However, comments about telemedicine were relatively poor predictors for LTR compared to comments about the provider. Discussion: NPS, which is included on many patient experience surveys used by health systems across the United States, has limitations for use as a measure of the acceptability of telemedicine for patients. Patients have more than telemedicine in mind when responding to the LTR question, and ratings conflate attitudes about providers, office policies, and staff with the telemedicine modality. More direct measures are necessary for meaningful research on the acceptability and usability of telemedicine for patients.

Objective: Controversy exists regarding treatment of symptomatic low-grade spondylolisthesis (LGS). Both one- and two-stage fusions are commonly performed, but it is unclear if one approach is superior. We aim to compare the satisfaction rates and patient-reported outcomes (PROs) in patients with LGS undergoing one- versus two-stage lumbar spine surgery., Methods: The Quality Outcomes Database was queried for patients with Grades I and II spondylolisthesis who underwent one- (n = 3223) or two-stage (n = 325), 1-2 level lumbar fusion. Demographics, comorbidities, symptom burden, and PROs were extracted and compared. Outcomes included Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), Quality-Adjusted Life Year (QALY), and satisfaction index. Minimal clinically important difference (MCID) values for VAS back pain, VAS leg pain, ODI, and QALY were 1.6, 1.7, 14.3, and 0.2, respectively. Patients with pre-existing scoliosis or kyphosis, missing data, and revision procedures were excluded. Categorical variables were compared with a Chi-square test; continuous variables were assessed for normality with a Shapiro Wilk test and compared with a Mann-Whitney U or Student's t-test., Results: No significant differences were noted for baseline characteristics, except for a lower mean age, percentage of female patients, and prevalence of osteoporosis in the two-stage cohort (58 ± 12.4 vs 62 ± 11.6 years; 50 % vs 62 %; 3.0 % vs 7.1 %, respectively; p < 0.01). The average surgery length was longer in the two-stage cohort (p < 0.01). A significantly higher percentage of patients returned to baseline activities within 3 months postoperatively following one-stage procedures (43 % vs. 29 %, p < 0.01), irrespective of whether they had Grade 1 or Grade 2 spondylolisthesis. Comparable proportions of patients achieved the MCID for PROs, with no significant differences in satisfaction indices observed at 3, 12, and 24 months postoperatively, regardless of preoperative spondylolisthesis grade., Conclusions: Patients receiving one and two-stage procedures for symptomatic LGS had similar rates of satisfaction and PROs. More research is necessary to define the benefits of two-stage approaches given their increased time, cost, and risk profile., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Primary dysmenorrhea (PD) is associated with decreased performance and reduced quality of life in young adults. This study aims to evaluate the effectiveness of implementing Arogya Rakshak Panchatantra (ARP), a naturopathic lifestyle practice, among young female adults with PD. Method: This open-label, parallel-arm, randomized controlled trial included 52 young female adults with PD aged between 16 and 25 years. They were randomly assigned to the ARP group practicing the ARP module for 2 months or the control group maintaining their routine lifestyle. The primary outcome was changes in heart rate variability (HRV), while secondary outcomes included menstrual distress, quality of life, pain, and daytime sleepiness, all evaluated at baseline and during the first three menstrual cycles in both groups. To evaluate the feasibility, the study also monitored self-reported symptoms, emotions, adverse events, calorie intake, and adherence to the intervention. The effectiveness of ARP was evaluated using repeated measures analysis of variance and a generalized linear model. Results: In the intervention group, we observed significant improvements in the high frequency component of HRV ( p = 0.007), as well as reductions in weight ( p = 0.017), visual analog scale pain ( p = 0.000), and retrospective symptom scale score ( p < 0.011). There were no significant changes in other HRV metrics, quality of life, or daytime sleepiness. Participants reported mild symptoms such as headaches, colds, body pain, diarrhea, constipation, fever, and weakness, with no serious adverse events. Discussion: This trial is the first to examine the long-term impact of ARP on young females with PD, suggesting it could be an effective and feasible management option. Further research with larger sample sizes is needed to confirm these findings.

Background: Autism Spectrum Disorder (ASD) is a complex lifelong neurodevelopmental disorder with a high and increasing global prevalence. Although the precise causes are unknown, both genetic and environmental factors, including maternal ones during pregnancy, significantly influence its development. Therefore, this study endeavors to explore the potential causes of autism, including maternal and paternal prenatal risk factors, as well as antenatal and natal maternal risk factors, and their associations with the severity of ASD in mothers of children with ASD, from February to May 2024., Methods: At an autism center in Saudi Arabia, this cross-sectional study enrolled 168 mothers of children diagnosed with ASD. The web-based survey employs a structured questionnaire to gather comprehensive prenatal, natal, and demographic data. The collected data was coded and analyzed using suitable tests., Results: The majority of the surveyed 168 mothers with autistic children reported having autism spectrum disorder (43.8%), moderate autism (31.9%), mild autism (15.6%), and severe autism (8.8%). Most autistic children had a history of one or both maternal and/or paternal antenatal exposures: 79.2% had soft drink consumption, 35.1% smoked, 24.4% had chronic physical diseases, and 20.8% had psychological disease. Regarding maternal antenatal conditions , 37% had a history of recurrent infection, 29.2% had anemia, 15.5% had a history of threatened abortion or bleeding, as well as exposure to air pollution, and 22 (13.1%) had a history of gestational diabetes. Significant ( p < 0.05) predictors of severe autism were gestational diabetes aOR 4.553 (95% CI: [1.518, 14.25], birth oxygen desaturation 4.142 (95% CI: [1.437, 12.45]. Furthermore, the likelihood of classifying a child's ASD as severe increases by 7.1% with each year of age1.071 (95% CI: [1.002, 1.15]., Conclusion: ASD is a prevalent health condition that has many interrelationships with prenatal, maternal (medical, environmental, and psychosocial factors), and natal conditions. Prospective studies are essential for understanding and addressing these ASD risk factors., 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 Abdelkader, AlRadini, Alosaimi, Abbas, Judeh, Emy Abu Esaid, Saleh, Shah and Amer.)

Introduction: The present paper aimed to conduct an updated systematic review and meta-analysis to evaluate the safety and efficacy of crisaborole, delgocitinib, and ruxolitinib in treating mild-to-moderate atopic dermatitis (AD)., Methods: MEDLINE and Google Scholar databases were utilized to search articles published during the years 2015-2024. The review was limited to randomized controlled studies that measured specific outcomes for safety and efficacy aspects, including adverse events (AEs) or treatment-emergent adverse events (TEAEs) to evaluate safety and Investigator's static global assessment (ISGA) or improvement of at least 75% of Eczema Area and Severity Index (EASI-75) to evaluate efficacy., Results: The review included 17 articles in the analysis. The safety odds ratios (ORs) among participants using crisaborole, delgocitinib, and ruxolitinib were 1.14, 95% CI [0.97-1.36], 1.18, 95% CI [0.84-1.67], and 0.72, 95% CI [0.55-0.94], respectively, when compared to control groups. The three studied topical AD treatments were found to be significantly more effective compared to control groups (crisaborole, OR = 1.78, 95% CI [1.51-2.10], delgocitinib, OR = 6.34, 95% CI [3.57-11.27], and ruxolitinib, OR = 7.30, 95% CI [5.10-10.44])., Conclusion: Delgocitinib and ruxolitinib demonstrated favorable safety and effectiveness profiles across various age cohorts, whereas crisaborole raised concerns over its safety and efficacy, particularly in children.

Background: The adoption of integrated curricula in medical schools has grown globally, emphasizing the need to understand academic medical staff satisfaction as a crucial factor influencing successful implementation., Aim: This study aimed to assess satisfaction levels among academic medical staff with integrated medical curricula, identifying socio-demographic and work-related predictors of dissatisfaction., Methods: A cross-sectional, online multinational survey was conducted from December 2023 to April 2024 among 525 academic medical staff. A structured, self-reported questionnaire was used to assess satisfaction levels, demographic characteristics, and work-related factors. The data were analyzed using descriptive and inferential statistics, including logistic regression analysis, to identify predictors of dissatisfaction., Results: The study revealed a low satisfaction rate (44.2%) among medical staff, with significant dissatisfaction influenced by nationality (Jordanian: OR = 7.74, and Egyptian: OR = 4.68), male gender (OR = 3.27), over ten years of teaching experience in integrated curricula (OR = 4.25), and employment in governmental universities (OR = 4.23). Dissatisfaction was particularly high with aspects such as the integration of basic and clinical sciences, assessment methods, and implementation schedules. Faculty from private universities demonstrated significantly higher satisfaction (65.1%) compared to those in governmental institutions (41.3%). Younger staff < 45 years reported higher satisfaction rates (50.9%) compared to their older counterparts ≥ 45 years (39.1%), reflecting greater adaptability to curriculum changes., Conclusions: The findings highlight substantial dissatisfaction among academic medical staff with the design and implementation of integrated curricula, particularly in governmental institutions and among senior faculty. Institutions must address challenges in curriculum design, resource allocation, and faculty support to enhance satisfaction. Revisiting conventional curriculum components or adopting a hybrid approach may help balance innovation with faculty preferences, fostering a more conducive educational environment., Competing Interests: Declarations. Ethics approval and consent to participate: Approval to conduct the survey was obtained by Ibn Sina University for Medical Sciences Institution’s Review Board (Approval Number: ISUMS-IRB# 1006/8-11-2023). Consent to participate was verbal and participation was based on voluntary base. The participants were guaranteed anonymity and confidentiality. We obtained an informed verbal consent from all the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background & Objectives: Postpartum depression is a debilitating mental health condition that consequently can negatively impact the mother/infant unit. This study aimed to screen for postpartum depression among women with epilepsy (WWE) versus healthy women and its consequences on establishing a proper mother-infant bonding., Methods: A group of WWE (n = 102) and a control group of healthy women (n = 119) were evaluated 4-6 weeks postpartum. The Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire (PBQ) were used., Results: The median scores of EPDS did not significantly differ between WWE and the control group (P = 0.077). The median scores of infant-focused anxiety of PBQ were significantly lower in WWE than in the control group, while the median scores of risk of abuse were significantly higher in the former than in the latter group. Scores of EPDS and PBQ didn't significantly differ between groups of different seizure types, etiologies, and ASMs regimens. However, the EPDS scores were significantly higher in WWE, who experienced seizure exacerbation, than in others (P = 0.049). Also, EPDS scores were significantly correlated with PBQ scores. By linear regression analysis, the only independent predictor of EPDS score was seizure exacerbation during pregnancy., Conclusion: The current postpartum screening report revealed that WWE are not at an increased risk of postpartum depression than healthy women. However, WWE who experience seizure exacerbations during their pregnancy need to be cautiously screened for postpartum depression, which may negatively impact mother-infant bonding. Strenuous efforts should be made to improve the mental health services for those women., 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 Inc.)

Purpose: It is assumed that sensory taste perception shapes food choices and impacts dietary intake. However, this has rarely been studied in free living subjects of different age-groups with standardised methods. The present study investigated the association of the ability to rank sweet and fat taste intensities with consumption frequency of sweet and fatty foods in children, adolescents and adults from eight European countries., Methods: In total, 461 children, 421 adolescents and 612 adults from the IDEFICS/I.Family cohort participated in sensory sweet and fat intensity rating tests. Sweet and fatty food consumption frequencies were assessed using a food frequency questionnaire. The association between the ability to rank sweet and fat intensity with sweet and fatty food consumption frequencies was estimated using linear mixed regression models adjusting for weight status, country, sex, age and family affiliation., Results: Across all age groups, the largest proportion of participants had medium sweet and fat taste intensity ranking abilities. The next largest proportion had low sweet and fat taste intensity rating abilities, while the smallest proportion had high intensity rating abilities to sweet and fat taste. A negative association of sweet and fat taste intensity ranking ability with sweet and fatty food consumption frequencies was found for children. In adolescents, the association was positive. In adults, there was no association., Conclusion: It seems that the association of taste intensity ratings with food consumption frequencies during adolescence differs from the associations in children and adults. This could be due to hormonal changes during puberty, growth and maturation. Thus, further research focussing on maturation processes in association with taste perception during adolescence may be required., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest.  Ethics approval and consent to participate : Each study centre obtained ethical approval from the local institutional review board; Belgium: Ethics Committee of the Gent University Hospital, 15/10/2007, ref: No. EC UZG 2007/243 and 19/02/2013, No. B670201316342, Cyprus: Cyprus National Bioethics Committee, 12/07/2007, ref: No. EEBK/EM/2007/16 and 21/Feb/2013, No. EEBK/ETI/2012/33, Estonia: Tallinn Medical Research Ethics Committee (TMREC), 14/06/2007, ref: No. 1093 and 17/January 2013, No. 128, Germany: Ethic Commission of the University of Bremen, 16/01/2007 and 11/12/2012, Hungary: Medical Research Council, 21/Jun/2007, ref: 22-156/2007-1018EKU and 18/12/2012, 4536/2013/EKU, Italy: Ethics Committee of the Local Health Authority (ASL) in Avellino, 19/06/2007, ref: No. 2/CE and 18/Sep/2012, No. 12/12, Spain: Ethics Committee for Clinical Research of Aragon (CEICA), 20/06/2007, ref:No. PI07/13 and 13/Feb/2013, No. PI13/0012, Sweden: Regional Ethics Research Board in Gothenburg, 30/07/2007, ref: No. 264-07 and 10/Jan/2013, No. 927-12. The ISRCTN reference is: ISRCTN62310987. Besides the oral information given, all participants above 12 years gave a written consent and parents gave a written consent on behalf of their children below 12 years in addition to the oral consent of their children., (© 2024. The Author(s).)

Background/Objectives : Orthoebolaviruses and orthomarburgviruses are filoviruses that can cause viral hemorrhagic fever and significant morbidity and mortality in humans. The evaluation and deployment of vaccines to prevent and control Ebola and Marburg outbreaks must be informed by an understanding of the transmission and natural history of the causative infections, but little is known about the burden of asymptomatic infection or undiagnosed disease. This systematic review of the published literature examined the seroprevalence of antibodies to orthoebolaviruses and orthomarburgviruses in sub-Saharan Africa. Methods : The review protocol was registered on PROSPERO (ID: CRD42023415358) and previously published. Eighty-seven articles describing 85 studies were included, of which seventy-six measured antibodies to orthoebolaviruses and forty-one measured antibodies to orthomarburgviruses. Results : The results highlight three central findings that may have implications for vaccine development and deployment. First, substantial antibody seropositivity to Ebola virus (EBOV) and Sudan virus (SUDV) was observed in populations from outbreak-affected areas (≤33% seroprevalence among general populations; ≤41% seroprevalence among healthcare workers and close contacts of disease cases). Second, antibody seropositivity to EBOV, SUDV, and Marburg virus (MARV) was observed among populations from areas without reported outbreaks, with seroprevalence ranging from <1 to 21%. Third, in Central and East Africa, MARV antibody seroprevalence was substantially lower than EBOV or SUDV antibody seroprevalence, even in outbreak-affected areas and in populations at a moderate or high risk of infection (with MARV seroprevalence mostly ranging from 0 to 3%). Conclusions : Whilst gaps remain in our understanding of the significance of antibody seropositivity in some settings and contexts, these findings may be important in considering target indications for novel filovirus vaccines, in defining study designs and strategies for demonstrating vaccine efficacy or effectiveness, and in planning and evaluating vaccine deployment strategies to prevent and control outbreaks.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates., Competing Interests: The authors declare no conflict of interest.

Background: Sexual dysfunction is prevalent among breastfeeding women., Objective: This study was designed to evaluate the effect of Rose damascene extract on sexual function and anxiety of breastfeeding women., Materials and Methods: This was a randomized controlled trial. This study was conducted on 87 breastfeeding women who received either Rose damascene ( n  = 44) or placebo ( n  = 43) for eight weeks. The primary outcomes were sexual function and anxiety. A demographic questionnaire, and obstetric questionnaire, the Female Sexual Function Scale (FSFI), and the Spielberger questionnaire were used to collect the data. Chi-square test, independent t -test, and ANCOVA were used to analyze the data., Results: In the intervention group, there was a significant increase in the scores of sexual desire, arousal, lubrication, orgasm, and sexual satisfaction, while the score of pain reduced significantly after eight weeks of intervention ( p  < 0.001). The mean total score of sexual function prior to the intervention was 19.61 ± 5.02 and 21.46 ± 3.08 in the intervention and control groups, respectively. After intervention, this score was improved in the intervention group compared to the control group (25.21 ± 1.62 vs. 21.82 ± 3, p  < 0.001). The pre-intervention score of trait anxiety was 47.97 ± 4.68 and 48.44 ± 5.89 in the intervention and control groups, respectively, which was improved in the intervention group compared to the control group after intervention (51.63 ± 3.53 vs. 48.13 ± 5.57, p  < 0.001). Although there was an improvement in the score of state anxiety in the intervention group compared to the control group, the difference was not statistically significant (43.31 ± 6.41 vs. 44.30 ± 8.87, p  = 0.397)., Conclusion: Rose damascene could significantly improve the sexual functions of breastfeeding women. It also decreased the trait anxiety but failed to improve the state anxiety significantly. Using this herb is recommended to enhance sexual performance in breastfeeding women., Clinical Trial Registration: https://www.irct.ir/trial/61375, identifier IRCT20211015052775N1., 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 Akbarzadeh, Abedi, Jahanfar, Mansurkhani, Fakhri and Maraghi.)

Objective: To describe the use of Artificial Intelligence (AI) to automate the e-norms method, a technique used to derive normative data from patient studies, mixed datasets that contain both normal and abnormal data. Multiple studies have shown that normal values collected with the e-norms method compare favorably with those collected from healthy volunteers using traditional methods., Methods: OpenAI's ChatGPT was used by the author to build a Python script to automate the e-norms method's plateau identification, the area of the e-norms curve where a variable's normal values lie. To date, e-norms plateau identification has been done visually using an Excel Macro developed for that purpose., Results: E-norms normal values derived from the visual e-norms plateau identification with the Excel Macro compared favorably with those derived from the OpenAI's Python script developed by the author to automate the e-norms plateau identification., Conclusions: OpenAI's ChatGPT Python scripts can be developed by users with little to no experience in programming to automate the collection of e-norms normal values., Significance: A Neurologist with no experience in programming, and a limited knowledge of statistics was able to develop this on his own without the help of any programmers or statisticians., Competing Interests: The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.)

Introduction: Nurses' clinical competence is a significant concern in all healthcare settings due to the necessity of delivering high-quality patient care. Understanding and addressing the factors related to competence are crucial for promoting nurses' clinical competence and ultimately improving patient outcomes. Producing and maintaining a skilled nursing workforce is essential to protect communities., Aim: This study aimed to assess the level of self-evaluated clinical competence and its correlation with demographic and occupational variables among registered nurses employed at selected outpatient clinics in Egypt., Materials and Methods: The study utilized a descriptive cross-sectional design with a self-administered, two-part questionnaire that assessed participants' demographic and occupational variables as well as perceived clinical competence in various healthcare settings. It took place at outpatient clinics of two governmental hospitals and five primary healthcare centers in Mansoura City, Egypt between January, and June 2023. A purposive sample of 450 nurses took part in this study., Results: The average score of nurses' clinical competence was 155.3±7.2 out of 230, indicating a "moderate level". In terms of professional behaviors and general performance, the average score for clinical competence was 48.4±3.6 and 40.7±4.1 respectively. Additionally, the average score for clinical competence regarding core and advanced nursing skills were 43.4±3.0 and 22.8±1.5 respectively. Among the domains of clinical competence, the highest average score was associated with "professional behaviors" as it forms the backbone of nursing practice. There was a highly significant relationship between the average score of clinical competence and the participant's age, sex, level of education, and years of clinical work experience (P<0.001)., Conclusion: Nurses perceived their level of clinical competence as moderate. To enhance nurses' clinical competence, future studies and interventions should focus on promoting supportive work environments, providing ongoing education and training in advanced nursing skills, and the fostering development of critical thinking skills in nurses., Recommendations: Healthcare organizations should implement educational interventions to enhance nurses' clinical competence. These interventions should include continuous professional development opportunities, mentorship programs, inclusive training initiatives, and structured feedback mechanisms. These measures will help nurses stay up-to-date with the latest practices and technologies, create a supportive learning atmosphere, and address the unique needs and challenges faced by nurses of different genders and specialties., Competing Interests: NO authors have competing interests., (Copyright: © 2024 Mohamed 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.)

Objectives: As carceral settings increasingly offer medications for opioid use disorders (MOUD), community-based providers will need to navigate relationships with correctional agencies to ensure continuity of MOUD upon release. Although collaboration has been identified as critical between agencies, limited research is available that details how providers can work with jails. We describe the perspectives of MOUD providers about their experiences collaborating with jails that had recently begun to offer MOUD., Methods: We conducted hour-long interviews with 36 MOUD providers from 18 community-based agencies. Exploration, Preparation, Implementation, and Sustainment (EPIS) concepts informed data collection and analysis., Results: MOUD providers described agency-specific (inner context) factors that facilitated collaboration, including staffing (employing staff with knowledge of co-occurring conditions) and agency culture (adaptability to change, recognition of gaps in services, being judgment-free). Providers also reported external factors as facilitators, such as broad community support of MOUD services and provision of training about MOUD to jail staff. Holding regular meetings, with a dedicated contact person, helped to overcome communication problems. However, the fragmentation of in-jail treatment services, exacerbated by jails' contracting with different healthcare providers, made it difficult to coordinate re-entry and establish agency relationships. Actively and intentionally building interagency partnerships and collaborating across interagency cultural and structural differences were bridging factors that developed and sustained collaborations., Conclusions: Our findings offer promising suggestions for establishing collaborations with carceral partners, including assessing internal agency conditions, seeking external community supports, committing to actively engaging and sustaining collaborations, and using interagency differences to develop mutually beneficial relationships., Competing Interests: Conflict of interest: None., (Copyright © 2024 American Society of Addiction Medicine.)

Introduction: Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence., Methods: We analyzed data using the CDC's Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18 years, collected from 17 May 2021-30 June 2021 ( n  = 5,458) and 3 November 2022-12 December 2022 ( n  = 6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults., Results: Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03-1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01-1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%., Conclusion: This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination.

Rhinoplasty, which reconstructs the shape and size of the nose, is the most frequently performed cosmetic surgery procedure. Research indicates that social media is the leading influence motivating individuals to undergo rhinoplasty. Thus, we aimed to evaluate the effect of social media on the desire for rhinoplasty and to establish whether (and if so, how) social media enhances the recovery period after rhinoplasty. A retrospective study was conducted on 322 Saudi rhinoplasty patients through a questionnaire distributed online via specific rhinoplasty groups and accounts on different social media platforms containing rhinoplasty patients. The questionnaire included participants' demographic details, the factors behind undergoing the rhinoplasty and their belief about the effect of social media on their desire to undergo a rhinoplasty, and how social media affected their recovery period after undergoing rhinoplasty. The collected data were then analyzed statistically with SPSS. The associations of different variables were found using the Chi-square test. The study included 322 rhinoplasty patients with nearly equal gender distribution. The results indicate that social media highly (mean = 4.07 ± 1.07 out of 5.00, 81.4%) influenced participants' decision to undergo rhinoplasty, and it highly influenced the recovery period after surgery (mean = 3.59 ± 0.67 out of 5.00, 71.8%). A statistically significant association was observed between social media influence and participants' education level ( p  = 0.018) as well as place of residence ( p  = 0.002). Most participants reported following social media advice to deal with unforeseen post-rhinoplasty symptoms that may have arisen during the recovery phase, which is theorized as the mechanism driving shorter recovery times., Competing Interests: Conflict of InterestThe authors declare that there is no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: A monkeypox (MPOX) outbreak occurred in May 2022. On June 3, 2022, the WHO Blueprint organized a consultation on MPOX research knowledge gaps and priority research questions because the engagement of health care providers (HCPs) in providing accurate information and the public's motivation to adapt protective behaviour were crucial. Thus, we conducted this study to explore the knowledge issues, animal patterns, and interactions of HCPs in the context of MPOX and COVID-19 during the MPOX outbreak., Methods: We conducted a cross-sectional web-based survey among 816 HCPs working in governmental health facilities from many countries, mainly Syria, Egypt, Saudi Arabia, and Cameroon, in September 2022., Results: Four hundred and sixty (56.37%) were aged between 18 and less than 35 years old. About 34.44% were physicians, while only 37.25% worked on the frontlines with patients. 37.99% and 5.88% received vaccinations against chickenpox and MPOX, respectively. In the meantime, 55.39% had taken courses or training programmes regarding COVID-19. Regarding knowledge-seeking behaviours (KSBs) about COVID-19, 38.73% were through passive attention, while only 28.8% got their information through active search. Most of the participants (56.86%) had a moderate level of knowledge regarding COVID-19. Only 8.82% had courses or training programmes regarding MPOX. Regarding KSB about MPOX, 50.86% were obtained through passive attention, while only 18.01% and 23.04% got their information through active and passive search, respectively. Most of the participants (57.60%) had a poor level of knowledge regarding MPOX. The regression analysis of the MPOX knowledge score revealed that individuals working on the frontlines with patients and those who had training programmes or courses were shown to have a higher score by 1.25 and 3.18 points, respectively., Conclusions: The studied HCPs had poorer knowledge about the MPOX virus than they did about the SARS-CoV-2 virus. Training programmes and education courses had an impact on their knowledge.

Background: The 2018 Farm Bill led to new types of derived psychoactive cannabis products (DPCPs) being sold throughout the United States. This study describes the new types and brands of DPCPs sold online. Materials and Methods: In May 2023, data were recorded from three top-trafficked U.S.-based DPCP retail websites, including information about each product ( N =804). Results: DPCP modalities included disposable vapes (43%), edibles (29%), vape carts (18%), pre-rolls (7%), flower (2%), dabs (1%), and vape pods (<1%). Among the 118 brands, the most common were Exhale, Delta Extrax, Cake, URB, Looper, and TRE House. There were 26 different intoxicating compounds overall, the most prevalent being: Delta-8 tetrahydrocannabinol (THC), THC-P, Delta-9 THC, HHC, THC-A, Delta-10 THC, THC-H, THC-B, THC-JD, THC-X, HHC-P, and Delta-11 THC. Overall, 54% of products were blends, containing two to eight different intoxicating compounds in a single product. Discussion: This is the first study to systematically assess DPCPs sold online. Most of the DPCP market is comprised of vapes and edibles, but these products contain a wide array of compounds and blends. Data from this diverse, rapidly evolving market are needed to examine its consumer impact and inform public health policies and programs.

Introduction: Racial residential segregation has been shown to affect the absolute levels of racial disparities in a wide variety of health outcomes in the USA but it is not known whether changes in segregation also influence these racial health disparities. This study examines the relationship between changes in racial residential segregation over four decades (1980-2020) and trends in racial disparities in early mortality (under age 65) rates among non-Hispanic Black and non-Hispanic White persons across a wide range of health outcomes in 220 metropolitan statistical areas (MSAs) during the period 2001-2018., Methods: Using the CDC WONDER Underlying Cause of Death database, we derived annual estimates of race-specific death rates and rate ratios for each MSA. We used latent trajectory analysis to examine the relationship between the level of segregation and changes in segregation over time in an MSA and trends in death rate disparities in that MSA., Results: The trajectory analysis resulted in a linear, three group model in which trajectory Groups 1 and 2 had decreasing trends in the ratios of Black to White death rates over time while in Group 3, the disparity remained almost constant over time. Increases in the level of segregation in an MSA from 1980 to 2000 were significantly associated with the likelihood that the MSA was in Group 3 and experienced no improvement in racial health disparities in mortality over time., Conclusion: This paper provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time., Competing Interests: Declarations Research Involving Human Participants and/or Animals This is a secondary analysis of publicly available data obtained, analyzed, and reported at an aggregated level. No human subject or identification data is collected or analyzed in this study. Informed Consent No human subject was involved in this study. Conflict of Interest The authors declare no competing interests., (© 2023. The Author(s).)

Objective: To use a novel measure of systemic racism to examine its relationship with Non-Hispanic Black (NHB) to Non-Hispanic White (NHW) racial disparities in infant mortality across U.S. counties., Study Design: In this cross-sectional study, a composite, multi-dimensional measure of systemic racism at the county level was developed using confirmatory factor analysis based on indicators across five dimensions of systemic racism. Using linear regression analysis, we examined the relationship between the systemic racism factor scores and the NHB to NHW racial disparities in county-level infant mortality rates. Additionally, we performed a multi-level analysis of infant mortality, with births nested within counties by running a random intercept model that controlled for factors at both the individual and county levels to take into account the clustered nature of the data., Results: There were 325 counties that met inclusion criteria for the county level analysis and 1181 counties for the individual level analysis. Each one standard deviation increase in the Systemic Racism Index was associated with an increase of 10.4% in the Non-Hispanic Black to Non-Hispanic White infant mortality rate ratio at the county level (aOR 1.104, 95% CI [1.061-1.148]). After controlling for individual level clinical factors and county level factors, each one standard deviation increase in the systemic racism index score was associated with a decrease of 3.5% in the NHW infant mortality rate (aOR 0.965, 95% CI [0.943-0.988])., Conclusion: Systemic racism is significantly associated with differences between counties in the magnitude of their Non-Hispanic Black to Non-Hispanic White racial disparities in infant mortality rates., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval: All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The rapid growth of dollar stores as retail sources of food in the United States is a phenomenon with implications for diets, nutrition, and well-being. We convened a broadly interdisciplinary group of researchers and experts from government and academia at the 2-day Food Access at Dollar Stores (FADS) workshop, held in Boston, MA in 2022. The event brought together economists, social scientists, public health researchers, and advocates to discuss the concerns and research questions raised by the growth of dollar stores and their increased role in food retail and access. In-person, moderated discussions on day 2 of the workshop generated a range of topics considered important for future research. A subsequent survey, using a modified Delphi approach, identified priority research areas. Nine research area categories emerged as a result of discussion at the FADS workshop and received prioritization from the experts: Local community impacts; Health and nutrition impacts; Policy and programs; Systemic issues - racism, poverty, and food access; Store offerings and locations; Shoppers and customers; Employees and employment; Corporate distribution, strategy, and marketing; and Dollar stores compared with other food sources. The growth of dollar stores as food retailers remains an under-researched area of study for food access and nutrition that requires interdisciplinary expertise and collaboration to understand., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: This study aimed to assess work ability score (WAS) in 2018 based on self-reported data regarding inhalable occupational exposure and data from a northern European job-exposure matrix (N-JEM) recorded in 2013., Methods: During the 5-year follow-up period of this population-based study, 4423 participants completed a postal questionnaire comprising self-reported questions regarding occupational exposure, work history, and WAS., Results: Ever, weekly, and daily exposure to vapors, gas, dust and fumes (VGDF) in the last 5 years in 2013 was associated with reduced WAS in 2018. The N-JEM data showed that exposure to irritants, wood and paper dust, and mixed agricultural agents were associated with reduced WAS., Conclusions: Exposure to several occupational inhalable substances is associated with reduced work ability. We recommend reducing inhalable occupational exposure to prevent reduced work ability., Competing Interests: Conflicts of Interest: None declared., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Introduction: Death certification is a health indicator and a public health surveillance tool. High-quality death certificate ensures reliability of mortality statistics used to direct the arranging of health-related programs and leading assessments of research and proper healthcare outcomes. The World Health Organization (WHO) puts Egypt in the group of 'low quality' death registration data. The aim of this study was to evaluate the impact of composite training and audit intervention on accurate completion of death notification forms (DNFs) in Assiut University Children Hospital (AUCH) that has an average monthly mortality of 120 children's deaths., Methods: A Quasi-experimental study design was conducted among residents of AUCH. The intervention consisted of 1- Preparing training material with basic information on how to report causes of death according to WHO criteria and case scenarios extracted from the medical records of children who died at AUCH, 2- One hundred residents of the AUCH were trained in one day workshops in 4 groups, with a pre-post knowledge assessment questionnaire. 3- A weekly audit of a sample of 10-15 DNFs was done for six months with reporting of findings to quality assurance director of the hospital., Results: Eighty- nine physicians completed the pre-post knowledge assessment with significant increase in knowledge score after the intervention (15.7 ± 3.2 vs. 11.9 ± 2.8). There was a significant decrease in the errors of reporting on the DNFs. The main improvement was in decrease from 90 to 18% in reporting the mechanism of death, and significant decline in writing cause of death in Arabic language only., Conclusion: Accurate reporting of the medical cause of death can be achieved by educational intervention targeting physicians with institutionalizing of audit system for continuous quality improvement., Competing Interests: Declarations. Ethics approval and consent to participate: The current study was conducted following approval from the Institutional Review Board (IRB) of the Faculty of Medicine, Assiut university (IRB No. 04-2023-300340). Administrative approval was obtained from the head of Assiut University children hospital before conducting the study. Participation was voluntary with confidentiality and privacy of all data was assured. Several measures were taken to ensure the protection of privacy during both data collection and analysis. Informed consent was obtained from all resident physicians, clearly outlining our commitment to protecting their privacy. The objective of the training was explained by administering the pretest to the participants to obtain their informed consent. Data was analyzed anonymously where identifiers were removed and during data collection, all data was securely entered in a separate excel sheet, with access limited to authorized research personnel only. Mortality data was handled with particular care: it was isolated from other data and entered in a separate excel sheet, and all analyses were conducted in a secure environment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background Context: Surgical site infection (SSI) is a devastating complication that greatly increases the duration of hospital stays, health care costs and morbidity/mortality rates. Therefore, early diagnosis and treatment are also very important. Postoperative inflammatory markers are usually used to screen for SSI. However, the feasibility of these markers for the early detection of SSI remains unclear since it is not ideal to use a marker for which normative reference values do not exist., Purpose: To validate the use of the e-norms method for establishing a normative reference range for acute-phase inflammatory marker levels 3 days after lumbar fusion surgery for early screening of postoperative SSI., Study Design: A retrospective analysis., Patient Sample: This study included 907 patients who underwent lumbar fusion surgery (SSI vs. non-SSI: 28 vs. 879)., Outcome Measures: White blood cell (WBC) count, neutrophils count, lymphocyte count, C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR)., Methods: We applied the e-norms method to calculate reference values for postoperative 3-day CRP, ESR, and differential WBC count in all 907 patients included in this study and compared these reference values with those calculated via conventional methods (data from non-SSI patients)., Results: According to the e-norms method, the normal WBC count was 10.8±1.2 (x10^9/L), neutrophils count was 8.7±1.1 (x10^9/L), lymphocyte count was 1.6±0.3 (x10^9/L), CRP concentration was 31.2±10.8 mg/L, and ESR was 23.6±4.7 mm/h. The mean values obtained via the e-norms and conventional methods were almost identical, but the range of normative reference values obtained via the conventional methods was relatively wider. Importantly, the frequency of SSI patients with abnormal inflammatory markers identified by the e-norms method was higher than that of patients with abnormal inflammatory markers identified by the conventional methods (21/28, 75.0% vs. 6/28, 21.4%; p<.05)., Conclusions: The results of this study demonstrated that the reference values retrieved using e-norms were more effective for screening postoperative SSI than the reference values calculated using conventional methods. Thus, e-norms may be an alternative reliable and time-saving approach to establishing reference values for acute-phase inflammatory markers after spinal surgery., 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 Inc. All rights reserved.)

Objectives: Maple syrup urine disease (MSUD) is considered one of the intoxication-type inborn errors of metabolism (IT-IEM). Patients with MSUD are afflicted with a chronic illness, and the disease and its management have both physical and psychological consequences for the patients and their families. The aim of this study was to assess the quality of life (QoL) and its main determining factors for patients with MSUD and their families under follow-up in Sohag University Hospital., Methods: Parents of 36 patients with MSUD participated in a questionnaire translated into Arabic to assess their QoL. Subsequently, a file review was conducted to identify any key factors that could potentially influence the parents' QoL., Results: The results of the study indicated that 27 (75 %) of the MSUD patients exhibited poor QoL, while only 9 (25 %) patients reported good QoL across all studied aspects. Significant differences were observed between the two groups in terms of the disease onset, whether acute or asymptomatic (diagnosed before acute metabolic decompensation) (p=0.001) and the type of screening employed (p=0.007)., Conclusions: There is a paucity of data on the QoL of pediatric patients with IT-IEM, including MSUD. The methodological approaches and assessment instruments utilized in existing studies are inconsistent. Identifying the factors that affect QoL would be beneficial for improving patient care, evaluating outcomes and treatments, and planning effective social and psychological interventions to enhance the patients' QoL., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Many parts of the USA continue to move towards tremendous societal progression of supporting LGBTQ + marriage and family planning. However, there are other areas, including many states within the southern region of the USA, which tend to be less progressive and more resistant towards this subject matter. As of now, information is limited on understanding the experiences and challenges faced by Black LGBTQ + individuals in regard to how they navigate the healthcare system for family planning purposes. Findings from this study highlight Black LGBTQ + individuals and couples' unique experiences of undergoing fear and discomfort with racial and gender bias in their pursuit of expanding their families. Highlighted findings revealed that many experienced challenges with access due to cost of health care, cost with adoption, lack of Black sperm donors, and negative experiences with their provider. It is our belief that highlighting such experiences will provide a direction for how we may work to improve the well-being of Black LGBTQ + individuals, couples, and their families for the future., Competing Interests: Declarations. Ethics Approval: Raw data were generated at Tufts University under the approval of Tufts Institutional Review Board (Study Number 00002453) prior to reaching out to study participants and seeking their consent for participation. Consent to Participate: Participants were provided with informed consent forms and verified consent via recorded interviews. Forms are available upon request from lead author, V. N. Robinson. Consent for Publication: All participants provided their consent for their information (including their recorded audio and video) to be used for publications, presentations, and educational purposes. Conflict of Interest: The authors declare no competing interests., (© 2024. W. Montague Cobb-NMA Health Institute.)

Background: The Migraine-Specific Quality-of-Life Questionnaire version 2.1 (MSQ 2.1) is one of the most frequently used tools in assessing the impact of migraine in clinical practice and in migraine research. This work aimed to examine the reliability and validity of the Arabic version of the MSQ 2.1 in Arabic-speaking patients with migraine and to assess its ability to detect subtle changes in quality of life after receiving prophylactic migraine medications., Methods: This multicenter prospective observational study was conducted with 140 patients experiencing migraine and indicated for prophylactic medications. Headache assessment was done at baseline and 3 months after receiving prophylactic medications using the Arabic version of MSQ 2.1, Headache Impact Test (HIT-6), and visual analog scale (VAS). The MSQ 2.1 was repeated 1 week after the first visit to a group of patients (n = 70) to assess test-retest reliability., Results: Cronbach's alpha for the MSQ 2.1 was 0.973, indicating excellent internal consistency. The intraclass correlation coefficient (average measure) was 0.99, indicating excellent test-retest reliability. There were statistically significant correlations between the MSQ 2.1 total score and monthly migraine days, VAS, and HIT-6 scores before and 3 months after prophylactic medications. The receiver operating characteristic curve revealed that an increase of 8.5 in the total score of the MSQ 2.1 represents the minimally important change that means significant improvement (area under the curve = 0.785, sensitivity = 0.861, specificity = 0.656, p < 0.001)., Conclusion: The Arabic version of the MSQ 2.1 is a valid, reliable, and sensitive tool that can precisely assess the impact of migraine on quality of life., (© 2024 American Headache Society.)

Background: Attention-deficit/hyperactivity disorder (ADHD) is now acknowledged as a significant public health concern, a persistent neurodevelopmental disorder. It poses challenges across various life domains, persisting into adulthood, and is often undiagnosed. From July 2023 to December 2023, this study investigated the prevalence, types, participants' knowledge and perceptions, and demographic determinants of undiagnosed adult ADHD among undergraduate medical students in Pakistan., Methods: This cross-sectional study enrolled 342 undergraduate medical students who fulfilled the selection criteria. The data was collected using an online self-administered survey consisting of three main parts using the WHO 18-question Adult ADHD Self-Report Scale, Version 1.1 (ASRS-v1.1), to assess adult ADHD symptoms. Data analysis was conducted using SPSS (version 26.0)., Results: 119 medical students, or 34.8%, had adult ADHD. Inattentive dominance was the most prevalent presentation at (86, 72.3%), followed by mixed dominance at (20, 16.8%), and hyperactive dominance at (13, 10.9%). There was a statistically significant (p < 0.05) association between individuals who screened positive for adult ADHD and had co-occurring psychological disorders (e.g., anxiety, depression) and a family history of psychiatric disorders (e.g., ADHD, generalized anxiety disorder, bipolar disorder). Additionally, these individuals perceived that individuals with adult ADHD could live a normal life despite their condition. While the type of ADHD was significantly associated with the use of medications for psychological disorders, it was significantly higher among hyperactive dominants (5,71.4%), and the family history of GAD was significantly higher (2,10.0%) among mixed dominants., Conclusion: This study reveals a significant prevalence of undiagnosed adult ADHD and an inattentive dominance among medical students in Pakistan, highlighting gaps in awareness and screening. These findings emphasize the crucial need for implementing ADHD screening programs., Competing Interests: Declarations. Consent for publication: Written informed consent for publication was obtained from all authors. Transparency statement: I affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Conflicts of interest: The authors reported no potential conflicts of interest., (© 2024. The Author(s).)