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Context : In March 2020, public health concerns resulted in school closure throughout the United States . The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019-2020 and 2020-2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region . Design : Historical-prospective cohort study . Methods : This historical- prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30,2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years . Results: 94, 847 and 72,521 high school athletes participated in the 2019-2020(19-20) and 2020-2021 (20-21) seasons. Knee injury risk was higher in the 20-21 season (19-20: 28.89% [27.82-29.96-]; 20-21: 33.82% [32.50-35.14]). Risk increased for male athletes from 2019- 2020 to 2020-2021 (19-20: 29.42% [28.01-30.83]; 20-21 : 40.32% [38.89-41.75]). Female knee injury risk was similar between years (19-20: 25.78% [24.29-27.27]; 20-21: 26.03% [24.31-27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1- 1.3], P <.001) during 2020-2021. Conclusions,· Knee injury risk and relative risk increased among males in 2020-2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk. [ABSTRACT FROM AUTHOR]

Context: Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures. Design: Cross- sectional study. Methods: We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance. Results: Athletes with and without a histoiy of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = 19). Conclusions: Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments. [ABSTRACT FROM AUTHOR]

Purpose: Laboratory-based indicators are commonly used for performance assessment in young cyclists. However, evidence supporting the use of these indicators mostly comes from cross-sectional research, and their validity as predictors of potential future performance remains unclear. We aimed to assess the role of laboratory variables for predicting transition from U23 (under 23 y) to professional category in young cyclists. Methods: Sixty-five U23 male road cyclists (19.6 [1.5] y) were studied. Endurance (maximal graded test and simulated 8-min time trial [TT]), muscle strength/power (squat, lunge, and hip thrust), and body composition (assessed with dual-energy X-ray absorptiometry) indicators were determined. Participants were subsequently followed and categorized attending to whether they had transitioned ("Pro") or not ("Non-Pro") to the professional category during the study period. Results: The median follow-up period was 3 years. Pro cyclists (n = 16) showed significantly higher values than Non-Pro riders (n = 49) for ventilatory thresholds, peak power output, peak oxygen uptake, and TT performance (all P <.05, effect size > 0.69) and lower levels of fat mass and bone mineral content/density (P <.05, effect size > 0.63). However, no significant differences were found for muscle strength/power indicators (P >.05, effect size < 49). The most accurate individual predictor was TT performance (overall predictive value = 76% for a cutoff value of 5.6 W·kg−1). However, some variables that did not reach statistical significance in univariate analyses contributed significantly to a multivariate model (R2 =.79, overall predictive value = 94%). Conclusions: Although different "classic" laboratory-based endurance indicators can predict the potential of reaching the professional category in U23 cyclists, a practical indicator such as 8-minute TT performance showed the highest prediction accuracy. [ABSTRACT FROM AUTHOR]

Context: Different resistance exercise determinants modulate the musculotendinous adaptations following eccentric hamstring training. The Nordic Hamstring Exercise (NHE) can be performed 2-fold: the movement velocity irreversibly increases toward the end of the range of motion or it is kept constant. Design: This cross-sectional study aimed to investigate if the downward acceleration angle (DWAangle) can be used as a classification parameter to distinguish between increasing and constant velocity NHE execution. Furthermore, the kinetic and kinematic differences of these 2 NHE execution conditions were examined by analyzing the DWAangle in relation to the angle of peak moment. Methods: A total of 613 unassisted NHE repetitions of 12 trained male sprinters (22 y, 181 cm, 76 kg) were analyzed. Results: The majority of analyzed parameters demonstrated large effects. NHEs with constant velocity (n = 285) revealed significantly higher impulses (P <.001; d = 2.34; + 61%) and fractional time under tension (P <.001; d = 1.29; +143%). Although the generated peak moments were significantly higher for constant velocity (P =.003; d = 0.29; +4%), they emerged at similar knee flexion angles (P =.167; d = 0.28) and revealed on average just low relationships to the DWAangle ( R mean 2 = 22.4 %). DWAangle highly correlated with the impulse ( R mean 2 = 60.8 %) and δ (DWAangle–angle of peak moment; R mean 2 = 83.6 %). Conclusions: Relating DWAangle to angle of peak moment assists to distinguish between significantly different NHE execution, which will potentially elicit different musculotendinous adaptations. These insights are essential for coaches and athletes to understand how to manipulate eccentric hamstring training to change its purpose. [ABSTRACT FROM AUTHOR]

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 =.250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P =.018) and horizontal adduction (R2 =.200, β [95% CI] = 0.447 [0.051 to 1.499], P =.019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 =.189, β [95% CI] = 0.435 [0.019 to 1.137], P =.022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 =.243, β [95% CI] = 0.493 [0.139 to 1.438], P =.010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Kidney transplantation with minimal or no dialysis exposure provides optimal outcomes for children with end-stage kidney disease. We sought to understand disparities in timely access to transplant waitlisting. METHODS: We conducted a retrospective, registry-based cohort study of candidates ages 3 to 17 added to the US kidney transplant waitlist 2015 to 2019. We defined "preemptive waitlisting" as waitlist addition before receiving dialysis and compared demographics of candidates based on preemptive status. We used competing risk regression to determine the association between preemptive waitlisting and transplantation. We then identified waitlist additions age >18 who initiated dialysis as children, thereby missing pediatric allocation prioritization, and evaluated the association between waitlisting with pediatric prioritization and transplantation. RESULTS: Among 4506 pediatric candidates, 48% were waitlisted preemptively. Female sex, Hispanic ethnicity, Black race, and public insurance were associated with lower adjusted relative risk of preemptive waitlisting. Preemptive listing was not associated with time from waitlist activation to transplantation (adjusted hazard ratio 0.94, 95% confidence interval 0.87-1.02). Among transplant recipients waitlisted preemptively, 68% had no pretransplant dialysis, whereas recipients listed nonpreemptively had median 1.6 years of dialysis at transplant. Among 415 candidates initiating dialysis as children but waitlisted as adults, transplant rate was lower versus nonpreemptive pediatric candidates after waitlist activation (adjusted hazard ratio 0.54, 95% confidence interval 0.44-0.66). CONCLUSIONS: Disparities in timely waitlisting are associated with differences in pretransplant dialy- sis exposure despite no difference in time to transplant after waitlist activation. Young adults who experience delays may miss pediatric prioritization, highlighting an area for policy intervention. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) may be at a high risk of neurodevelopmental and mental health conditions given disease comorbidities and lived experiences. Little is known about the prevalence of these conditions at a population level. In this study, we estimated the prevalence of neurodevelopmental and mental health diagnoses in CMC relative to children without medical complexity and measured associations between these diagnoses in CMC and subsequent health care utilization and in-hospital mortality. METHODS: We applied the Child and Adolescent Mental Health Disorders Classification System to identify neurodevelopmental and mental health diagnoses using all-payer claims data from three states (2012-2017). Poisson regression was used to compare outcomes in CMC with neurodevelopmental and mental health diagnoses to CMC without these diagnoses, adjusting for sociodemographic and clinical characteristics. RESULTS: Among 85 581 CMC, 39 065 (45.6%) had ≥1 neurodevelopmental diagnoses, and 31703 (37.0%) had ≥1 mental health diagnoses, reflecting adjusted relative risks of 3.46 (3.42-3.50) for neurodevelopmental diagnoses and 2.22 (2.19-2.24) for mental health diagnoses compared with children without medical complexity. CMC with both neurodevelopmental and mental health diagnoses had 3.00 (95% confidence interval [CI]: 2.98-3.01) times the number of ambulatory visits, 69% more emergency department visits (rate ratio = 1.69, 95% CI: 1.66-1.72), 58% greater risk of hospitalization (rate ratio = 1.58, 95% CI: 1.50-1.67), and 2.32 times (95% CI: 2.28-2.36) the number of hospital days than CMC without these diagnoses. CONCLUSIONS: Neurodevelopmental and mental health diagnoses are prevalent among CMC and associated with increased health care utilization across the continuum of care. These findings illustrate the importance of recognizing and treating neurodevelopmental and mental health conditions in this population. [ABSTRACT FROM AUTHOR]

Objective: To synthesize the effects of educational intervention on the screening rate of first-degree relatives of cancer patients. Methods: A total of eight Chinese and English databases were searched (PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, Medline and China Biology Medicine disc) from the time of library establishment to June 2023, for randomized controlled trials investigating the effects of educational intervention on screening rate of first-degree relatives of cancer patients. Two researchers independently screened and evaluated the quality of studies. RevMan 5.3 software was used to calculate the pooled effect size. Results: Thirteen studies involving 5628 participants were chosen to include in the meta-analysis. The results revealed that health education can increase screening rate of first-degree relatives of cancer patients (RR = 1.39, 95% CI = 1.16–1.65, P = 0.0002). The effect shown after short-term follow-up (≤6 months) was insignificant in terms of improving screening rate (RR = 1.46, 95% CI = 0.94–2.26, P = 0.09), but after long-term follow-up (＞6 months) the improvement was greater (RR = 1.37, 95% CI = 1.13–1.65, P = 0.002). Conclusion: Health education is effective in increasing the screening rate of first-degree relatives of cancer patients. The effect is more evident after long-term than short-term follow-up. [ABSTRACT FROM AUTHOR]

Respiratory virus infections are related to over 80% of childhood asthma exacerbations. They enhance pro-inflammatory mediator release, especially for sensitized individuals exposed to pollens/molds. Using a time-series study design, we investigated possible effect modification by respiratory virus infections of the associations between aeroallergens/PM2.5 and asthma exacerbation rates. Outpatient, emergency department (ED), and inpatient visits for asthma exacerbation among children with asthma (28,540/24,444 [warm/cold season]), as well as viral infection counts were obtained from electronic health records of the Children's Hospital of Philadelphia from 2011 to 2016. Rate ratios (RRs, 90th percentile vs. 0) for late-season grass pollen were 1.00 (0.85–1.17), 1.04 (0.95–1.15), and 1.12 (0.96–1.32), respectively, for respiratory syncytial virus (RSV) counts within each tertile. However, similar trends were not observed for weed pollens/molds or PM2.5. Overall, our study provides little evidence supporting effect modification by respiratory viral infections. [ABSTRACT FROM AUTHOR]

BACKGROUND: The emergence of COVID‐19 resulted in a substantial loss of education because of global school closures. Face masks are a potential measure to restrain the COVID‐19 spread; therefore, this paper evaluated the effectiveness of face masks in reducing COVID‐19 incidence in school settings. METHODS: A systematic review was conducted by searching the literature in the Cochrane COVID‐19 Study Register and the World Health Organization COVID‐19 global literature. Data were summarized in tabular forms, and the findings were presented as narrative synthesis. RESULTS: A total of 15,709 records were retrieved. The screening and selection led to the inclusion of 12 observational and 2 quasi‐experimental studies. Nine studies were conducted in different states, counties, or districts of the United States, and the remaining 5 were reported from Germany, Finland, Spain, and the United Kingdom. The results of 10 out of 14 studies favored mask use in reducing school COVID‐19 incidence. Three studies found no link between mask use and COVID‐19 incidences, whereas 1 quasi‐experimental study noted a higher COVID‐19 incidence with mask use in students aged 6‐11 years than no use of mask among preschool children aged 3‐5 years. CONCLUSION: Mask mandates may lessen the incidence of respiratory infectious diseases in school settings during a pandemic; more well‐designed studies are warranted to clarify further the evidence regarding mask use in school settings. [ABSTRACT FROM AUTHOR]

Background: Standardization of health systems often hinders client‐centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home‐based postpartum care service improves its quality of care, as innovative approach to client‐centered care. Methods: A randomized controlled trial was conducted (2017–2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th‐day postpartum, instead of the first 8–10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so‐called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self‐care experience, overall care experience, and exclusive breastfeeding duration rate. Results: Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98–1.07). Both groups showed similar self‐care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. Conclusions: This study found no effect on the quality of care when allowing more flexibility in the planning range of home‐based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home‐based postpartum care. [ABSTRACT FROM AUTHOR]

Background: Women with diabetes in pregnancy have decreased exclusivity and duration of breastfeeding compared with women without diabetes, and their infants are at increased risk of hypoglycemia. Clinicians often suggest pregnant women with diabetes to express breastmilk, and studies have reported increased breastfeeding exclusivity in the early postnatal period for patients who have expressed. Little is known about longer term outcomes. We investigated whether advising low‐risk women with diabetes in pregnancy to express beginning at 36 weeks of pregnancy increased exclusivity and maintenance of breastfeeding at 3 months. Methods: We conducted a multicenter, two‐group, randomized controlled trial at six hospitals in Melbourne, Australia, between 2011 and 2015. Women were randomized to either standard maternity care or advised to hand express for 10 min twice daily, in addition to standard care. Women were telephoned at 12–13 weeks postpartum and asked a series of questions about feeding their baby, perceptions of their milk supply, and other health outcomes. Results: Of 631 women in the study, data for 570 (90%) were analyzed at 12–13 weeks. After adjustment, we found no evidence that women allocated to antenatal expressing were more likely to be giving only breastmilk (aRR 1.07 [95% CI 0.92–1.22]) or any breastmilk (aRR 0.99 [95% CI 0.92–1.06]) at 12–13 weeks postpartum compared with women in the standard care group. Conclusion: While the practice of antenatal expression for low‐risk women with diabetes during pregnancy is promising for increasing exclusivity of breastmilk feeding in hospital, at 12–13 weeks, there was no association with breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

Background: Prescribing of recommended medications for heart failure (HF) is suboptimal, leaving patients at a high risk of death or rehospitalization post discharge. Nurse-led titration (NLT) clinics are one strategy that could potentially improve the prescription of these medications. Objective: The aim of this article was to determine the effect of NLT clinics on all-cause mortality, all-cause or HF rehospitalizations, and adverse effects in patients with HF. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, International Clinical Trials Registry Platform, and ClinicalTrials. gov to identify randomized controlled trials comparing NLT of β-blocking agents, angiotensin receptor--neprilysin inhibitors, angiotensin-converting enzyme inhibitors, and/or angiotensin receptor blockers to optimization by another health professional in patients with HF. We used the fixed-effects Mantel-Haenszel method or meta-analyses. We assessed heterogeneity between studies using χ² and I². Results: Eight studies with 2025 participants were included. Participants in the NLT group experienced a lower rate of all-cause rehospitalizations (relative risk, 0.76, 95% confidence interval, 0.68-0.85; moderate quality of evidence) and less HF-related rehospitalizations (relative risk, 0.47; 95% confidence interval, 0.33-0.66; high quality of evidence) compared with the usual care group. All-caus emortality was lower in the NLT group (relative risk, 0.67; 95% confidence interval, 0.48-0.92; moderate quality of evidence) compared with the usual care group. Authors of one study reported no adverse events, and another study found one adverse event. Conclusion: This meta-analysis indicates that NLT clinics may improve optimization of guideline-recommended medications with the potential to reduce rehospitalization and improve survival in a cohort of patients known for their poor outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Health literacy (HL) is correlated with the risk of mortality and readmission during cardiac rehabilitation. However, the correlation between HL and utility-based health-related quality of life (HRQOL) scores has been poorly documented. Therefore, we examined the correlation between HL and utility-based HRQOL scores in participants undergoing cardiac rehabilitation. Methods: The data of 448 participants undergoing cardiac rehabilitation from the Kobe-Cardiac Rehabilitation Project for People Around the World (K-CREW) clinical trial were analyzed. Participants were divided into low and high HL cohorts. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire to assess HRQOL at discharge. The utility scores of the EQ-5D-5L questionnaire were calculated. The median age was 71.0 [61.0–78.0] years, 75.7% of participants were male, and 60% had a low HL. Results: Median utility score was 0.88 [0.75–1.00]. Regarding the dimensions of the EQ-5D-5L questionnaire, more than 60% of participants responded positively to the severity level of "no problem." In the comparative analysis, the low HL cohort had a statistically significantly lower utility score than that of the high HL cohort (p-value = 0.03). The multivariate analysis revealed that the HLS-14 scores were not statistically significantly correlated with the utility scores. Conclusion: Participants with low HL had lower HRQOL in the comparative analysis. However, multivariate analysis revealed that HL was not statistically significantly correlated with utility-based HRQOL scores. Future studies should explore the influence of confounding or intermediate variables on the correlation between HL and HRQOL. [ABSTRACT FROM AUTHOR]

Background: To evaluate the causal relationship between abdominal multiorgan iron content and PD risk using publicly available genome-wide association study (GWAS) data. Methods: We conducted MR analysis to assess the effects of iron content in various abdominal organs on PD risk, followed by reverse analysis. Additionally, MVMR analysis evaluated the independent effects of organ-specific iron content on PD. We utilized genetic variation data from the UK Biobank, including liver iron content (n = 32,858), spleen iron content (n = 35,324), and pancreas iron content (n = 25,617), as well as summary-level data for Parkinson's disease from the FinnGen (n = 218,473) and two other large GWAS datasets of European populations (First dataset n = 480,018; Second dataset n = 2,829). The primary MR analysis used the inverse variance-weighted (IVW) method, confirmed by MR-Egger and weighted median methods. Sensitivity analysis was performed to address potential pleiotropy and heterogeneity. Observational cohort results were validated through replication cohort analysis, followed by meta-analysis. Results: IVW analysis revealed a causal relationship between increased liver iron content and elevated risk of PD (OR = 1.27; 95% CI: 1.05-1.53; p = 0.015). No significant causal relationship was observed between spleen (OR = 1.00; 95% CI: 0.76-1.32; p = 0.983) and pancreatic (OR = 0.93; 95% CI: 0.72-1.20; p = 0.573) iron content and increased risk of PD. Meta-analysis of GWAS data for PD from three different sources using the random-effects IVW method showed a statistically significant causal relationship between liver iron content and the occurrence of PD (OR = 1.17, 95% CI: 1.01-1.35; p = 0.012). Conclusion: This study presents evidence from Mendelian randomization (MR) analysis indicating a significant causal link between increased liver iron content and a higher risk of Parkinson's disease (PD). These findings suggest that interventions targeting body iron metabolism, particularly liver iron levels, may be effective in preventing PD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Simple Summary: Socioeconomic inequalities in cancer incidence and mortality have been studied extensively, but there has been no investigation of the spatial distribution of incidence and mortality within a country to see if they are consistent with each other and with deprivation. To fill this gap, we examined the spatial distribution of cancer incidence and mortality and their association with each other and with socioeconomic deprivation at the municipal level in Hungary, one of the countries with the most unfavourable cancer burden in the world. For different types of cancer, while mortality always showed positive associations with deprivation, there was only partial overlap between areas of high incidence and mortality across the country, with clusters often independent of deprivation. Even where incidence and mortality overlapped geographically, there were often significant differences in mortality risk. Discrepancies in the spatial distribution of cancer incidence and mortality are indicators of an unmet need for cancer prevention and/or treatment. There is a rich body of literature on the distribution of cancer incidence and mortality in socioeconomically different world regions, but none of the studies has compared the spatial distribution of mortality and incidence to see if they are consistent with each other. All malignant neoplasms combined and cervical, colorectal, breast, pancreatic, lung, and oral cancers separately were studied in the Hungarian population aged 25–64 years for 2007–2018 at the municipality level by sex. In each case, the spatial distribution of incidence and mortality were compared with each other and with the level of deprivation using disease mapping, spatial regression, risk analysis, and spatial scan statistics. A positive association between deprivation and mortality was found for each type of cancer, but there was no significant association for male colorectal cancer (relative risk (RR) 1.00; 95% credible interval (CI) 0.99–1.02), pancreatic cancer (RR: 1.01; 95%CI 0.98–1.04), and female colorectal cancer incidence (RR: 1.01; 95%CI 0.99–1.03), whereas a negative association for breast cancer (RR: 0.98; 95%CI 0.96–0.99) was found. Disease mapping analyses showed only partial overlap between areas of high incidence and mortality, often independent of deprivation. Our results highlight not only the diverse relationship between cancer burden and deprivation, but also the inconsistent relationship between cancer incidence and mortality, pointing to areas with populations that require special public health attention. [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP. Methods: BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions. Results: Results in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06–2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk. Conclusions: The interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP. Trial registration: Prospectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212. [ABSTRACT FROM AUTHOR]

Objective: Microaggressions are brief verbal, behavioral, or environmental indignities toward people of color. Methods: Cross-sectional study examining the association between demographics, alcohol culture, and witnessing or experiencing microaggressions among undergraduate students. Analysis based on the "Color of drinking" study data collected at University of Wisconsin-Madison, WI between November 2017 and January 2018. Results: African-American/Black students significantly witnessed and experienced more microaggressions than other students, with a Relative Risk Ratio (RRR) of 9.5 (CI 95%: 4.7–19.1) and a RRR of 7 (CI 95%: 3.4–14.3). For students of color, experiencing microaggressions was associated with considering leaving (RRR = 3.5, CI 95%: 2–6.2). Additionally, the witnessing and experiencing of microaggressions appears to be associated with the alcohol culture on campus. Conclusions: African-American/Black was the racial group that witnessed and suffered more microaggressions. The percentage of students witnessing microaggressions increased with the year in school. Alcohol use in the last 30 days, feeling impacted by other's use of alcohol, and avoiding certain areas due to alcohol consumption were associated with experiencing microaggressions among students of color. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is often linked to chronic inflammation, which can be influenced by both lifestyle and dietary choices. However, the relationship between the inflammatory potential of diet and lifestyle factors and the risk of developing T2DM remains unclear. The present study aimed to investigate the associations of the empirical dietary inflammatory index (EDII), dietary inflammatory score (DIS), and lifestyle inflammatory score (LIS) with the risk of T2DM among Iranian adults. Methods: The current study was conducted on 5714 individuals from Yazd Health Study (YaHS) who were followed up for a mean period of six years. YaHS is a prospective cohort study which has been conducted since 2014. Dietary intakes were collected at baseline using the food frequency questionnaire. The relative risk (RR) of T2DM was calculated by Cox regression analysis across tertiles of EDII, DIS, and LIS, adjusted for potential confounders. Results: The mean ± SD for the age and body mass index of the study population were 47.0 ± 9.2 years and 26.7 ± 5.1 Kg.m2, respectively. A significant association between LIS and the risk of T2DM was observed (RR: 4.05, 95% CI: 2.61–6.27 P-trend < 0.001). Individuals in the highest compared to the lowest tertile of EDII-LIS (RR: 3.07, 95%CI: 2.01–4.68; P for trend < 0.001) and DIS-LIS (RR: 2.42, 95%CI: 1.69–3.49; P for trend < 0.001) had a higher risk of T2DM. However, no significant association was found between EDII and DIS scores and the risk of T2DM. Conclusion: Greater adherence to LIS, EDII-LIS, and DIS-LIS scores was associated with a higher risk of T2DM, while no significant association was found between EDII and DIS with T2DM risk. [ABSTRACT FROM AUTHOR]

Climate change's impact on health, specifically increasing temperatures, has become a prominent field of study worldwide. Although its importance is growing, decision makers still have little knowledge on the subject. Developing indicators to monitor spatial and temporal trends of health impacts due to climate change is a vital advancement needed to encourage policy adaptations. This research proposes an approach to producing annual estimates for heat-related mortality as an indicator to support these policies. The first step was to develop temperature-mortality relationships for each of the 96 metropolitan French departments, for the summer months (June–September) between 2014 and 2022. Several approaches were tested to control for a possible influence of the COVID-19 pandemic since 2020. The temperature-mortality relationships were used to compute the annual mortality attributable to heat for the same years, and for 2023. Heat-related risks were slighly higher after the pandemic; an increase from 19.8 °C to 28.5 °C was associated with a relative risk of 1.25 [CI 95% 1.21:1.30] in 2004–2019, and 1.31 [1.24:1.38] in 2020–2022. Between 2014 and 2023, 37,825 deaths [IC 95% 34,273: 40,483] were attributable to heat. The largest impacts were observed in 2022 (6,969 [6277: 7445]), 2023 (5167 [4587; 5551]), and 2019 (4441 [4086: 4717]). The annual indicator of heat-related mortality documents the mortality impact of heat during the summer and during extreme heat waves. It shows that the impact is increasing, despite major prevention efforts. This call for a more ambitious, transformative adaptation to climate change. [ABSTRACT FROM AUTHOR]

Summary: Background: Whilst single chemical exposures are suspected to be obesogenic, the combined role of chemical mixtures in paediatric obesity is not well understood. Objectives: We aimed to evaluate the potential associations between chemical mixtures and obesity in a population‐based sample of Canadian children. Methods: We ascertained biomonitoring and health data for children aged 3–11 from the cross‐sectional Canadian Health Measures Survey from 2007 to 2019. Several chemicals of interest were measured in blood or urine and paediatric obesity was defined based on measured anthropometrics. Using quantile‐based G computational analysis, we quantified the effects of three chemical mixtures selected a priori. Models were adjusted for sociodemographic and environmental factors identified through a directed acyclic graph. Results are presented through adjusted relative risks (RR) with 95% confidence intervals (95% CI). Results: We included 9147 children. Of these, 24.1% were overweight or obese. Exposure to the mixture of bisphenol A, acrylamide, glycidamide, metals, parabens and arsenic increased the risk of childhood overweight or obesity by 45% (95% CI 1.09, 1.93), obesity by 109% (95% CI 1.27, 3.42) and central obesity by 82% (95% CI 1.30, 2.56). Conclusions: Our findings support the role of early childhood chemical exposures in paediatric obesity and the potential combined effects of chemicals. [ABSTRACT FROM AUTHOR]

Background: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity. Methods: Retrospective cohort study of community‐dwelling Medicare Part D beneficiaries ≥66 years of age who were eligible for MTM from 2013 to 2019 based on 5% Medicare fee‐for‐service claims data linked to the 100% MTM data file. Among those using a PIM, MTM‐eligible CMR recipients were matched to non‐recipients via sequential stratification. The probability of PIM discontinuation was estimated using regression models that pooled yearly subcohorts accounting for within‐beneficiary correlations. The most common PIMs that were discontinued after CMR were reported. Results: We matched 24,368 CMR recipients to 24,368 CMR non‐recipients during the observation period. Median age was 74–75, 35% were males, most were White beneficiaries (86%–87%), and the median number of PIMs was 1. In adjusted analyses, CMR receipt was positively associated with PIM discontinuation (adjusted relative risk [aRR]: 1.26, 95% CI: 1.20–1.32). There was no evidence of differential impact of CMR by race or ethnicity. The PIMs most commonly discontinued after CMR were glimepiride, zolpidem, digoxin, amitriptyline, and nitrofurantoin. Conclusions: Among Medicare beneficiaries who are using a PIM, CMR receipt was associated with PIM discontinuation, suggesting that greater CMR use could facilitate PIM reduction for all racial and ethnic groups. [ABSTRACT FROM AUTHOR]

Context A previous study showed that vitamin E is effective in reducing the incidence of myocardial infarction only when it is taken in the absence of other antioxidants. It is unclear if it also reduces the incidence of stroke. Objective The aim of this meta-analysis is to compare the effect of vitamin E supplementation alone or combined with other antioxidants on the incidence of stroke. Data Sources A search was performed in the following databases: PubMed, ISI Web of Science, SCOPUS, and Cochrane Library. Data Extraction Sixteen randomized controlled trials were selected to evaluate the effect of vitamin E supplementation on stroke. Data Analysis The range of vitamin E doses used was 33–800 IU. The follow-up period ranged from 6 months to 9.4 years. Compared with controls, when vitamin E was given alone it did not reduce the incidence of ischemic and hemorrhagic stroke. Conversely, compared with controls, supplementation of vitamin E with other antioxidants reduced ischemic stroke (random effects, RR: 0.91; 95% CI: 0.84–0.99; P = 0.02) but with a significant increase in hemorrhagic stroke (random effects, RR: 1.22; 95% CI: 1.0–1.48; P = 0.04). Conclusions Supplementation with vitamin E alone is not associated with stroke reduction. Instead, supplementation of vitamin E with other antioxidants reduces the incidence of ischemic stroke but increases the risk of hemorrhagic stroke, cancelling any beneficial effect derived. Thus, vitamin E is not recommended in stroke prevention. Systematic Review Registration PROSPERO registration no. CRD42022258259. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk of DM and evaluate the impact of SLE therapies on the risk of developing DM in patients with SLE. Methods Electronic database searches of PubMed, Embase, Cochrane Library and Web of Science were performed from inception to February 2023. Cohort and cross-sectional studies that analysed the risk of DM in patients with SLE were included. The associations between diabetes and antirheumatic agents, such as antimalarials and glucocorticoids, were analysed in cohort studies. Data were pooled using fixed- or random-effects meta-analysis to estimate pooled odd ratios (OR), relative risks (RR) and 95% confidence intervals (CIs). This study was registered with PROSPERO (CRD42023402774). Results A total of 37 studies (23 cross-sectional and 14 cohort studies) involving 266 537 patients with SLE were included. The pooled analyses from cross-sectional studies and cohort studies did not show an increased risk of DM in SLE patients (OR = 1.05, 95% CI 0.87–1.27; P  = 0.63 and RR = 1.32, 95% CI 0.93–1.87; P  = 0.12, respectively). However, several cohort studies consistently demonstrated a reduced risk of diabetes with antimalarials, while glucocorticoid use has been associated with an increased risk of developing diabetes. Age, sex, hypertension and immunosuppressants have not been identified as risk factors for DM in SLE patients. Conclusion Although there was no increased risk of DM in patients with SLE compared with controls, HCQ users or adherents had a decreased risk, whereas glucocorticoid users had an increased risk. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer is the second leading cause of death globally, and the causes of cancer are numerous and multifactorial, including genetic and environmental factors. There is a developing interest in the role of sleep and light at night (LAN) exposure in cancer development. The aim of our study is to further understand the relationship between LAN exposure and the risk of cancer by systematically reviewing existing literature assessing LAN exposure and the risk of various cancer types. We found a positive association between LAN exposure and breast cancer risk, but there was insufficient data to convincingly draw a conclusion for other cancer types. This emphasizes the need for further research not only assessing LAN exposure and the incidence of other cancers but also the pathophysiology of sleep interruption on the formation of cancer. Background: Emerging interest surrounds the role of environmental factors, notably exposure to light at night (LAN), as a potential cause of cancer. The aim of this study was to conduct a systematic review and, if possible, meta-analysis of observational studies on LAN and cancer risk of multiple types. Methods: A systematic literature search in PubMed, Web of Science, and Embase, spanning from inception to May 2023, was conducted. Studies focusing on the association between LAN exposure and cancer risk in adult populations were included. We used random effects models to calculate pooled risk estimates (RR) and 95% confidence intervals (CI). We assessed study quality using the Risk of Bias in Non-randomized Studies of Interventions. Results: Among 8492 initially identified studies, 26 met the inclusion criteria (13 were case–control and 13 were cohort studies). These studies were published from 2001 to 2023 and assessed diverse cancer types in North America, Asia, Europe, and Australia. Except for breast cancer, there was a paucity of site-specific cancer studies. In the meta-analysis of 19 breast cancer studies, higher exposure to indoor (summary RR, 1.08; 95% CI 1.01–1.15) and outdoor (summary RR, 1.10; 95% CI, 1.04–1.15) LAN were associated with increased risk. After excluding one low-quality study, the results were unchanged. Conclusions: We found a positive association between LAN exposure and breast cancer risk in women. However, data are lacking for other cancer types, and further studies are required to better understand the role of LAN on cancer. [ABSTRACT FROM AUTHOR]

Existing research documents significant racial disparities in pregnancy-related deaths in the United States. Recently, the National Center for Health Statistics (NCHS) identified inconsistencies in maternal mortality data due to irregularities in previous data collection. Yet, corrections of the data still highlight stark differences across racial identity. Additionally, data indicates that while many people die during labor and delivery, a considerable percentage of people die up to a year postpartum. To assess disparities in the timing of pregnancy-related deaths using corrected data, we analyzed aggregated vital statistics data from 2015 to 2018 (n = 4,261). We present relative risk ratios from multinomial logistic regressions to examine the association between race and ethnicity and the timing of pregnancy-related deaths (pregnant at the time of death, 42 days post pregnancy, and 43 days to one-year post pregnancy). Results highlight significant differences in the distribution of timing of pregnancy-related deaths across nativity status and geographic region. Findings document a disproportionate percentage of pregnancy-related deaths among foreign-born people who give birth. Overall, results suggest extending our framing of postpartum care beyond a hospital stay. Significance: What is already known on this subject?: Data shows that there are significant socioeconomic and racial disparities in pregnancy-related deaths, with Native American and Black women having elevated risk of mortality (Leonard et al., Health Services Research 48(2):455–475, 2019). Reduced access to affordable and adequate maternal care through closures of medical clinics, provider bias, and the rising cost of healthcare have been shown to significantly contribute to higher rates of pregnancy-related deaths, particularly among low-income and racial minority women (Lorch et al., Health Services Research 48(2):455–475, 2013). What does this study add?: This study provides assessments of racial disparities in timing of pregnancy-related deaths that emphasize important differences across nativity status to help us understand these disparities. [ABSTRACT FROM AUTHOR]

Background: Child and adolescent antidepressant use increased post-pandemic, but it is unknown if this disproportionally affected those who develop post-acute sequelae of coronavirus disease 2019 (COVID) or long COVID. This study compared the risk of antidepressant initiation among children and adolescents with long COVID with those who had COVID but did not have evidence of long COVID. Methods: Our retrospective cohort study of children and adolescents aged 3–17 years at the first evidence of COVID or long COVID from October 1, 2021 through April 4, 2022 was conducted within Komodo's Healthcare Map™ database. The index date was the earliest date of a medical claim associated with a COVID (COVID comparators) or long COVID diagnosis (long COVID cases). The baseline period was six months before the index date. The outcome was antidepressant initiation within twelve months after the index date. Due to the large number of COVID relative to long COVID cases, COVID comparators were randomly selected with a ratio of 2 COVID to 1 long COVID. We used propensity score matching to control for confounding due to imbalances in the baseline covariates. Log-binomial models estimated the relative risk (RR) of antidepressant initiation in the propensity score matched sample. We conducted several sensitivity analyses to test the robustness of our findings to several assumptions. Results: Our child and adolescent sample included 18 274 with COVID and 9137 with long COVID. Compared with those with COVID, a larger proportion of long COVID children and adolescents had psychiatric disorders, psychotropic use, medical comorbidities, were previously hospitalized, or visited the emergency department. In the propensity score-adjusted analysis, the long COVID group had a statistically significant higher risk of antidepressant initiation relative to the COVID comparator (adjusted-RR: 1.40, 95% CI = 1.20, 1.62). Our findings were robust across sensitivity analyses. Conclusions: The increased risk of antidepressant initiation following long COVID warrants further study to better understand the underlying reasons for this higher risk. Emerging evidence of long COVID's impact on child mental health has important implications for prevention and early interventions. [ABSTRACT FROM AUTHOR]

The well-being of individuals is influenced by their beliefs about gender roles, which are influenced by cultural factors. It is therefore important to compare links between gender role beliefs and well-being in cultures that are more or less gender equitable. This study examined links between gender role beliefs and well-being among young adults in the patriarchal culture of Pakistan and the more egalitarian culture of the United Kingdom (UK). Participants were 1141 university students aged 17–30 (mean = 21.56, SD = 2.54): 411 Pakistani women, 307 Pakistani men, 318 UK women, and 105 UK men. Analyses revealed stronger associations between gender role beliefs and well-being among respondents from Pakistan than respondents from the UK. Furthermore, whereas similar patterns of association were found among women in the two countries, the direction of some associations differed between men in Pakistan and the UK. Moderation models also highlighted variations in the links between egalitarian gender role beliefs and well-being outcomes among women and men in the two countries. Considering our results in the context of other research, there is a need to acknowledge young adults' gender identity concerns when providing, and encouraging engagement with, health care. [ABSTRACT FROM AUTHOR]

Aims: To examine whether nursing diagnoses were associated with delirium in patients with sepsis. Background: Nursing diagnosis is a nurse's clinical judgement about clients' current or potential health conditions. Delirium is regarded as an important nurse‐sensitive outcome. Nonetheless, nursing diagnoses associated with delirium have not yet been identified. Design: Retrospective correlational study. Methods: This study was carried out from December 2021 to January 2023. We analysed electronic health records of patients with sepsis admitted to the intensive care units (ICUs) of a tertiary hospital in Seoul, South Korea. Delirium was defined based on the Intensive Care Delirium Screening Checklist score. Nursing diagnoses established within 24 h of admission to the ICU were included and were based on the North American Nursing Diagnosis Association diagnostic classification. The data were analysed using logistic regression. Demographics, comorbidities, procedures and physiological measures were adjusted. Regression model was evaluated via receiver operating characteristic curve, Nagelkerke R2, accuracy and F1 score. Results: The prevalence of delirium in patients with sepsis was 51.8%. Ineffective breathing patterns, decreased cardiac output and impaired skin integrity were significant nursing diagnoses related to delirium. Age ≥ 65 years, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, continuous renal replacement therapy, physical restraint and comatose state were also associated with delirium in patients with sepsis. The area under the receiver operating characteristic curve was 0.806. Conclusion: Ineffective breathing patterns, decreased cardiac output and impaired skin integrity could manifest as prodromal symptoms of delirium among patients with sepsis. Impact: The prodromal symptoms of delirium revealed through nursing diagnoses can be efficiently used to identify high‐risk groups for delirium. The use of nursing diagnosis system should be recommended in clinical practice caring for sepsis patients. Reporting Methods: STROBE checklist. Patient or Public Contribution: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Objective Patients with severe preeclampsia (sPREX) face barriers to successful breastfeeding (BF), including an increased risk of maternal and newborn complications, prematurity, and low birth weight. Patients with early-onset sPREX (before 34 weeks' gestation) may be at even greater risk, yet there are little data available on factors associated with BF challenges in this population. We describe rates of BF initiation at hospital discharge and BF continuation at postpartum (PP) visit and identify factors associated with BF noninitiation and BF cessation among patients admitted with early-onset sPREX. Study Design Retrospective cohort study of women with sPREX admitted at less than 34 weeks' gestation to a single tertiary center (2013–2019). Demographic, antepartum, and delivery characteristics were evaluated. Factors associated with BF noninitiation at maternal discharge and with BF cessation at routine PP were assessed. Patients with intrauterine or neonatal demise and those missing BF data were excluded. Bivariate statistics were used to compare characteristics and Poisson regression was used to estimate relative risks (RR). Results Of 255 patients with early-onset sPREX, 228 (89.4%) had BF initiation at maternal hospital discharge. Initiation of BF occurred less frequently among patients with tobacco use in pregnancy (7.5 vs. 37.0%, χ2 , p < 0.001, RR: 0.69 [95% confidence interval, CI: 0.52–0.92]). At 6 weeks' PP, 159 of 199 (79.9%) patients had BF continuation. Maternal age under 20 years (1.9 vs. 17.5%, χ2 , p = 0.01, RR: 0.36 [95% CI: 0.14–0.91]) and experiencing maternal morbidity (25.2 vs. 45.0%, χ2 , p = 0.01, RR: 0.80 [95% CI: 0.66–0.96]) were associated with BF cessation at the PP visit. Conclusion Among patients with early sPREX, tobacco use in pregnancy was associated with noninitiation of BF at discharge, whereas young maternal age and maternal morbidity were associated with cessation of BF by routine PP visit. Further research is needed on how to support BF in this population, especially among patients with these associated factors. Key Points Tobacco use was associated with BF noninitiation in patients with early preeclampsia. Maternal age < 20 and maternal morbidity were associated with BF cessation by PP visit. BF support for patients with risk factors is important for BF success PP. [ABSTRACT FROM AUTHOR]

Background: Mindfulness practices enhance executive function skills and academic achievement, spurring interest in integrating mindfulness interventions into education. Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and boost game‐based learning, yet this approach remains unexplored. Objectives: We investigated the learning benefits of integrating mindfulness exercises in a digital math learning game and examined how students' trait mindfulness might moderate the outcomes. Methods: Two classroom studies were conducted with 404 5th and 6th grade students from six public schools in the U.S. (nStudy 1 = 227, nStudy 2 = 177). The two randomized controlled experiments assigned students to one of the three conditions: passive control (playing the digital learning game Decimal Point), story‐enriched active control, or mindfulness‐enriched condition. Trait mindfulness, learning gains, and in‐game problem‐solving (including problem‐solving duration, error count and correctness after reminder) were assessed. Study 2 included a manipulation check to better understand the effects of the mindfulness intervention. Results: Findings showed no significant differences in learning gains, problem‐solving duration or error count among the conditions. Students' trait mindfulness did not moderate these outcomes. Mindfulness reminders in the mindfulness‐enriched game led to more correct answers after errors than jokes in the story‐enriched game. Study 2 revealed that we failed to induce higher state mindfulness through the mindfulness inductions. Conclusions: Mindfulness prompts could be especially beneficial for students experiencing frustration during gameplay, warranting more exploration for digital game‐based instruction. We highlight barriers and future directions for fostering mindfulness through computer‐based instruction in classrooms. Lay Description: What is currently known about this topic?: Researchers focus on digital games as productive learning environments for math, with potential for higher learning gains compared with traditional methods. However, results are mixed, and not all games lead to improved math outcomes.Executive function (EF) skills are crucial for math learning, and mindfulness‐based interventions show promise in enhancing EF skills in school‐aged students.Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and, in turn, boost EF skills and game‐based learning, yet this approach remains unexplored What does this paper add?: This paper presents the results of two randomized control trials investigating the feasibility and benefits of incorporating mindfulness exercises into a digital math game designed for middle school students. Benefits are compared to those of a story‐enriched and regular version of the same digital math learning game.The paper also explores variations in the effects of the mindfulness‐enriched game based on students' initial trait mindfulness levels.We observe that listening to mindfulness inductions at the beginning of game sessions do not induce mindfulness, and therefore does not benefit math learning.We find that mindfulness prompts received after recurrent errors can be beneficial for students' problem solving. Implications of study findings for practitioners: Our study provides important information on how digital learning game designers should attempt to induce mindfulness in a digital game to promote learning.Digital learning game designers should consider incorporating mindfulness exercises into their games strategically. Presenting mindfulness inductions in audio format at the beginning of game sessions may not induce mindfulness or benefit math learning. Instead, designers should focus on integrating mindfulness prompts at moments when students encounter frustration within the learning game.Beyond embedding audio mindfulness exercises in the game, learning designers should also consider alternative technological and game features to induce mindfulness within a learning game. [ABSTRACT FROM AUTHOR]

Background: Ventricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long‐term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation. Methods: We searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all‐cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow‐conducting anatomical isthmus (SCAI)‐based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre‐ablation history of VT. Results: Fifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non‐inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI‐based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. p < 0.001; I2 = 0%) with no recurrence in patients with preventive ablation (mean follow‐up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all‐cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant. Conclusions: SCAI‐based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation. [ABSTRACT FROM AUTHOR]

Aims Mitral regurgitation (MR) causes left atrial (LA) enlargement and impaired reservoir function. We assessed whether changes in LA size, strain, and stiffness in significant (moderate or greater) primary MR are sex-specific. Methods and results In the 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation study, 111 patients with primary MR were prospectively investigated with 2D and 3D echocardiography. MR was severe if the 3D regurgitant fraction was ≥50%. LA size was assessed by maximum, minimum, and pre-A 3D volume (LAV), mechanics by peak reservoir (LASr) and contractile strain, and stiffness by the ratio: mitral peak E-wave divided by the annular e′ velocity (E/e′)/LASr. Women were older, had higher heart rate, and lower body mass index and MR regurgitant volumes (P < 0.05). 3D LAV indexed for body surface area and LA contractile strain did not differ by sex, while LASr was lower (22.2 vs. 25.0%) and LA stiffness higher in women (0.56 vs. 0.44) (P < 0.05). In linear regression analysis, female sex was associated with higher LA stiffness independent of age, minimum LAV, left ventricular global longitudinal strain, diabetes, and coronary artery disease (R 2 = 0.56, all P < 0.05). In logistic regression analysis, women had a four-fold (95% CI 1.2–13.1, P = 0.02) higher adjusted risk of increased LA stiffness than men. Conclusion Women with significant primary MR have more impaired LA reservoir mechanics and increased LA stiffness compared with men despite lower MR regurgitant volumes and similar indexed LA size. The findings reveal sex-specific features of LA remodeling in MR. Trial Registration ClinicalTrials.gov Identifier: NCT04442828 [ABSTRACT FROM AUTHOR]

While life expectancy of people living with HIV is increasing, their burden of non-communicable diseases, including mental health disorders, is growing as well. The aim of this study is to investigate the prevalence and identify the risk factors associated with mental health disorders among this population in Rwanda. This cross-sectional study enrolled people living with HIV from 12 HIV clinics across Rwanda using random sampling. Trained HIV nurses conducted the Mini International Neuropsychiatric Interview to estimate the prevalence of major depressive episode, post-traumatic stress disorder, and generalized anxiety disorder. Sociodemographic, psychosocial, and HIV-related data were also collected. Associated risk factors for being diagnosed with one of the mental health disorders were assessed using modified Poisson regression with robust error variance. Of 428 participants, 70 (16.4%) had at least one mental health disorder with major depressive episode being most prevalent (n = 60, 14.0%). Almost all participants were adherent to antiretroviral therapy (n = 424, 99.1%) and virally suppressed (n = 412, 96.9%). Of those diagnosed with a mental health disorder, only few were aware of (n = 4, 5.7%) or under treatment for this mental health disorder (n = 5, 7.2%). Mental health disorders were associated with experiences of HIV-related stigma and discrimination (aRR = 2.14, 95%CI 1.30–3.53, p = 0.003). The results demonstrate underdiagnosis and undertreatment of mental health disorders among Rwandan People Living with HIV. Using HIV nurses to diagnose mental health disorders could serve as a low-cost strategy for integrating mental health care with existing HIV services and could inspire the implementation in other low-resource settings. [ABSTRACT FROM AUTHOR]

There is high burden of long bone fractures in low- and middle-income countries (LMICs). Given a limited availability of fluoroscopy in LMICs, the Surgical Implant Generation Network (SIGN) developed two types of intramedullary nails: the SIGN standard nail and the SIGN Fin Nail. A limited number of studies have analyzed healing outcomes with the SIGN Fin Nail and the current study is the largest one to date. The purpose of this study is to compare outcomes between the SIGN standard nail and SIGN Fin Nails in adult femoral shaft fractures treated with a retrograde approach. A retrospective cohort study of adults with femoral shaft fractures was performed using the Sign Online Surgical Database (SOSD). The primary outcome was achieving full painless weight bearing and the secondary outcomes assessed were radiographic healing and infection. A propensity-score adjustment was performed for potential confounders and effect modification due to fracture location was tested using a Mantel-Haenszel test for heterogeneity. Of 19,928 adults with femoral shaft fractures, 2,912 (14.7%) had the required 6-month follow-up to be included. The overall propensity score weighted relative risk between the Fin and Standard Nail for achieving painless weight-bearing was 0.99, 95% CI [0.96–1.03] and for radiographical healing was 0.99, 95%CI [0.97–1.02]. The propensity score weighted relative risk for infection was 1.30, 95% [0.85–1.97]. Use of the Fin nail was also significantly associated with shorter surgery times (p < 0.005, effect size = 24 min). Sub-group analysis based on fracture location and injury cause demonstrated no change in relative risk. The Fin nail showed no change in relative risk in terms of achieving full painless weightbearing or radiographic healing compared to the standard nail for retrograde nailing of femoral shaft fractures in adults. The heterogeneous nature of the cohort and large sample size allow for generalizability and add to a growing base of literature supporting use of the Fin Nail for retrograde femoral nailing. However, there are limitations as we could not correct for comminution at the fracture site or measure radiographic alignment or shortening. [ABSTRACT FROM AUTHOR]

Introduction: Current physical activity guidelines recommend 150 min of moderate-to-vigorous physical activity (MVPA) for health benefits, regardless of the pattern of MVPA. However, MVPA that occurs in sessions (MVPA-S) may have different health implications compared to MVPA that is not accumulated in sessions (MVPA-nonS). This study aimed to investigate the associations of MVPA-S and MVPA-nonS with mortality. Methods: We conducted a cohort study of the National Health and Nutrition Examination Survey 2003–2006 (n = 5,658) with accelerometer-measured physical activity at baseline and mortality followed through December 31, 2019. A session was defined as a time window of 30 min or longer where the average intensity was at or above 2020 counts/minute. MVPA accumulated within such sessions was quantified as MVPA-S, while MVPA accumulated outside the sessions was quantified as MVPA-nonS. We examined the joint association of MVPA-S and MVPA-nonS by classifying the participants into four groups (both < 75 min/week [referent], MVPA-S ≥ 75 and MVPA-nonS < 75, MVPA-S < 75 and MVPA-nonS ≥ 75, and both ≥ 75). We used 75 min as the cut-point because it is half of the guideline-recommended MVPA volume where a strong MVPA-mortality association has been observed in previous studies, and because it was close to the median of MVPA-nonS (75 min/week was the 54th percentile), allowing a sufficient sample size in each group for testing statistical significance. The hazard ratios and 95% confidence intervals were estimated with adjustment for important confounders. Results: During 13.9 years of follow-up (74,988 person-years), there were 1,424 deaths, out of which 472 were related to cardiovascular diseases (CVD). Compared to the referent combination (both < 75), the hazard ratios in the other three combinations were 0.48 (0.33–0.69), 0.85 (0.71–1.01), and 0.45 (0.30–0.67) for all-cause mortality; and were 0.34 (0.17–0.70), 0.96 (0.69–1.33), and 0.40 (0.17–0.90) for CVD mortality, respectively. Results were largely consistent in the spline-based models, age- and sex-stratified analyses, complete-case analysis, competing risk analysis, and the analysis excluding deaths within two years of follow-up. Conclusion: In conclusion, MVPA accumulated in sessions that lasted at least 30 min was associated with significant reductions in all-cause and CVD-specific mortality risks. The health implications of MVPA that were not accumulated in such sessions warrant further investigation. [ABSTRACT FROM AUTHOR]

(1) Background: Adolescence is a critical period when dietary choices are a major concern. It is therefore important to understand the psychological factors that explain these choices. The objective of this study was to assess the predictive role of perceived self-efficacy for healthy eating and weight regulation on healthy and unhealthy eating behavior through the mediation of autonomous motivation, controlled motivation, amotivation, and perceived barriers to daily mechanisms affecting healthy consumption. (2) Methods: A total of 994 adolescents between 15 and 19 years old from Mexico and Spain participated in the study. The Spanish versions of the healthy eating and weight self-efficacy questionnaire, the behavioral regulation in exercise questionnaire, the barriers to healthy eating scale, and the weight-related behaviors scale questionnaire were used to measure the variables of interest. (3) Results: Mediated serial regression analysis showed that barriers to healthy eating (the daily mechanism of food consumption) reduced healthy eating choices. Healthy eating and weight self-efficacy also showed a positive significant relationship with autonomous motivation and a negative relationship with controlled motivation and amotivation. All the types of motivation showed a positive relationship with barriers to healthy eating. (4) Conclusions: The results point out the need to enhance self-efficacy, promote autonomous motivation, and reduce perceived barriers in young people with respect to healthy eating. [ABSTRACT FROM AUTHOR]

Objective: To evaluate knowledge about HPV and its vaccine, additionally, to examine the effect of knowledge about HPV and its vaccine on perceived benefits and barriers to HPV vaccination among individuals in the western region of Saudi Arabia. Methods: A cross-sectional design was employed in the western region of Saudi Arabia through a self-administered web-based survey. The survey assessed knowledge, perceived benefits, and perceived barriers to HPV vaccination. Results: A total of 1149 eligible participants completed the survey. Participants exhibited limited knowledge of HPV and its vaccine, with an average total score of 4.76 out of 15. Over 80% of participants were unaware that HPV may not show symptoms, cannot lead to HIV, and is not treatable with antibiotics. Over half were unaware that HPV can cause cervical cancer, oral cancer, or genital warts. Unmarried and graduate-educated participants demonstrated greater knowledge. Perceived benefits were positively associated with knowledge levels, while perceived barriers were negatively associated with knowledge levels after controlling for other variables. Conclusions: This study highlights the need for education and healthcare efforts to raise knowledge about HPV and its vaccine in the western region of Saudi Arabia. Also, this study indicated that enhanced knowledge boosts positive attitudes towards HPV vaccination, while reducing perceived barriers, thereby increasing vaccination rates. [ABSTRACT FROM AUTHOR]

The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18–<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose–response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period. [ABSTRACT FROM AUTHOR]

This study presents a systematic review with meta-analysis to evaluate the success rates of endodontic retreatments in teeth where separated instruments are located within the roots. The search and selection of studies were conducted across two databases, SCOPUS and PubMed, as well as the Cochrane Library registry, yielding a total of 1620 records. Following the selection process, 11 studies were included in the systematic review. Overall, out of 1133 retreated teeth, there were 172 failures in instrument removal and 55 perforations. The meta-analysis results indicate that failures are more frequent when instruments are located in the apical third, with a failure rate of 21%, compared to an 8.8% failure rate in the middle/coronal third. The anatomy of the root canals, particularly the location of the separated instruments, significantly influences the success rates. [ABSTRACT FROM AUTHOR]

Background: Globally, HCC presents a significant health burden, characterized by high incidence and mortality rates. Epidemiological studies have increasingly suggested a link between dietary patterns and the risk of hepatocellular carcinoma (HCC), yet consensus on this relationship remains elusive. Objective: This study aims to synthesize existing literature and provide a comprehensive analysis of the association between dietary patterns and HCC risk through meta-analytical methods. Methods: A systematic search of PubMed, Embase, and the Cochrane Library databases was conducted to identify studies examining common dietary patterns in relation to HCC, published up to August 2023. Study quality was rigorously evaluated using the Newcastle–Ottawa Scale. We employed a random effects model to synthesize effect sizes, calculating hazard ratios (HRs) and 95% confidence intervals (CIs). Results: We identified 13 papers, of these 10 investigating a priori dietary patterns(index-based dietary patterns) and 3 focusing on a posterior dietary patterns (data-driven dietary patterns). Analysis of a priori dietary patterns revealed that higher scores in the Healthy Eating Index (HEI) & alternative HEI (HR = 0.67, 95% CI: 0.54–0.85), Dietary Approaches to Stop Hypertension (DASH) (HR = 0.77, 95% CI: 0.66–0.91), and the Mediterranean diet (HR = 0.65, 95% CI: 0.56–0.75) were associated with a reduced risk of HCC. Conversely, pro-inflammatory dietary patterns were linked with an increased risk (HR = 2.21, 95% CI: 1.58–3.09). In a posterior dietary patterns, a vegetable-based diet was negatively correlated with HCC risk (HR = 0.63, 95% CI: 0.49–0.81). Conclusion: This meta-analysis underscores a significant association between dietary patterns and the risk of HCC. Adherence to healthy dietary patterns characterized by high in vegetables, whole grains, legumes, nuts, and low in red and processed meats may confer a protective effect against HCC, whereas inflammatory diets appear to elevate risk. [ABSTRACT FROM AUTHOR]

Background and Purpose: Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self‐reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID‐19 and pain intensity and sensitivity in patients with chronic non‐specific low back pain (LBP). Methods: This was a cross‐sectional secondary analysis with 83 participants with chronic non‐specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used. Results: The model for pain intensity explained 34% of its variance (Adjusted R2 = −0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05). Discussion: This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI. [ABSTRACT FROM AUTHOR]

Introduction: Severe trauma-induced blood loss can lead to metabolic acidosis, shock, and death. Identification of abnormalities in the bicarbonate and serum markers may be seen before frank changes in vital signs in the hemorrhaging trauma patient, allowing for earlier lifesaving interventions. In this study the author aimed to evaluate the usefulness of serum bicarbonate and other lab markers as predictors of mortality in trauma patients within 30 days after injury. Methods: This retrospective, propensity-matched cohort study used the TriNetX database, covering approximately 92 million patients from 55 healthcare organizations in the United States, including 3.8 million trauma patients in the last two decades. Trauma patients were included if they had lab measurements available the day of the event. The analysis focused on mortality within 30 days post-trauma in comparison to measured lab markers. Cohorts were formed based on ranges of bicarbonate, lactate, and base excess levels. Results: Before propensity score matching, a total of 1,275,363 trauma patients with same-day bicarbonate, lactate, or base excess labs were identified. A significant difference in mortality was found across various serum bicarbonate lab ranges compared to the standard range of 21-27 milliequivalents per liter (mEq/L), post-propensity score matching. The relative risk of death was 6.806 for bicarbonate ≤5 mEq/L; 8.651 for 6-10; 6.746 for 11-15; 2.822 for 16-20; and 1.015 for bicarbonate ≥28. Serum lactate also displayed significant mortality outcomes when compared to a normal level of ≤2 millimoles per liter. Base excess showed similar significant correlation at different values compared to a normal base excess of-2 to 2 mEq/L. Conclusion: This study, approximately 100 times larger than prior studies, associated lower bicarbonate levels with increased mortality in the trauma patient. While lactate and base excess offer prognostic value, lower bicarbonate values have a higher relative risk of death. The greater predictive value of bicarbonate and accessibility during resuscitations suggests that it may be the superior prognostic marker in trauma. [ABSTRACT FROM AUTHOR]

Background: The efficacy and safety of adjunctive low‐voltage area (LVA) ablation on outcomes of catheter ablation (CA) for atrial fibrillation (AF) remains uncertain. Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing CA with versus without LVA ablation for patients with AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random‐effects model. Our primary endpoint was recurrence of atrial tachyarrhythmia (ATA), including AF, atrial flutter, or atrial tachycardia. We used R version 4.3.1 for all statistical analyses. Results: Our meta‐analysis included 10 RCTs encompassing 1780 patients, of whom 890 (50%) were randomized to LVA ablation. Adjunctive LVA ablation significantly reduced recurrence of ATA (RR 0.76; 95% CI 0.67−0.88; p <.01) and reduced the number of redo ablation procedures (RR 0.54; 95% CI 0.35−0.85; p <.01), as compared with conventional ablation. Among 691 (43%) patients with documented LVAs on baseline substrate mapping, adjunctive LVA ablation substantially reduced ATA recurrences (RR 0.57; 95% CI 0.38−0.86; p <.01). There was no significant difference between groups in terms of periprocedural adverse events (RR 0.78; 95% CI 0.39−1.56; p =.49). Conclusions: Adjunctive LVA ablation is an effective and safe strategy for reducing recurrences of ATA among patients who undergo CA for AF. [ABSTRACT FROM AUTHOR]

Black girls are the only group of girls across the United States disproportionally suspended from school. Studies have documented that disproportionality cannot be explained solely by greater misbehavior among students of color. Instead, discipline disparities are also informed by punitive/inequitable discipline policies and practices, less discussed has been the relationship between childhood adversity and school discipline outcomes at the intersection of race and gender. Examining this phenomenon is important and timely as schools are increasingly providing trauma-informed practices to support socioemotional learning. Yet doing so without data-driven practices rooted in an understanding of disproportionate adversity may render these practices insufficient for Black girls. Thus, this study asks, what types of childhood adversities do Black girls have the greatest risk of experiencing? Using 2016–2019 data from the National Survey of Children's Health (N = 63,674), risk ratios and Pearson's chi-square test of independence were performed to determine across-race and within-gender group differences by the type of childhood adversity. Analyses demonstrated that Black girls had a greater risk for six out of nine adversities compared with other girls of color and seven out of nine compared with White girls. [ABSTRACT FROM AUTHOR]

The aim was to investigate methicillin‐resistant Staphylococcus aureus (MRSA) incidence, conversion and outcomes in diabetic foot infections (DFIs). This is a pooled patient‐level analysis of combined data sets from two randomised clinical trials including 219 patients admitted to the hospital with moderate or severe DFIs. Intraoperative bone and tissue cultures identified bacterial pathogens. We identified pathogens at index infections and subsequent re‐infections. We identified MRSA conversion (MSSA to MRSA) in re‐infections. MRSA incidence in index infections was 10.5%, with no difference between soft tissue infections (STIs) and osteomyelitis (OM). MRSA conversion occurred in 7.7% of the re‐infections in patients who initially had MSSA in their cultures. Patients with re‐infection were 2.2 times more likely to have MRSA compared to the first infection (10.5% vs. 25.8%, relative risk [RR] = 2.2, p = 0.001). Patients with MRSA had longer antibiotic treatment during the 1‐year follow‐up, compared to other pathogens (other 49.8 ± 34.7 days, MRSA 65.3 ± 41.5 days, p = 0.04). Furthermore, there were no differences in healing, time to heal, length of stay, re‐infection, amputation, re‐ulceration, re‐admission, surgery after discharge and amputation after discharge compared to other pathogens. The incidence of MRSA at the index was 10.5% with no difference in STI and OM. MRSA incidence was 25.8% in re‐infections. The RR of having MRSA was 2.2 times higher in re‐infections. Patients with MRSA used more antibiotics during the 1‐year follow‐up. Furthermore, there were no differences in clinical outcomes compared to other bacterial pathogens. [ABSTRACT FROM AUTHOR]

Problem-drinking among university students is common and poses serious health-related risks. Therefore, identifying and addressing associated factors is important. A large cross-sectional online-survey with 12,914 university students from Berlin was conducted from November 2016 to August 2017. Relative-risk- and correlation-analysis was used to identify factors associated with problem-drinking and regular heavy-drinking. Independent t-tests compared impulsivity and personality traits, chi-square-tests compared drinking motives between risk- and non-risk-drinkers. Male gender, tobacco-smoking, illegal substance use, impulsivity and various sociodemographic and psychosocial variables were significantly related to problem/heavy-drinking. Extraversion was a risk, conscientiousness and agreeableness were protective factors. Drinking-motives did not differ significantly between risk- and non-risk-drinkers. Generally, the main drinking-motives were to feel elated, relax and social purposes. The identified markers and related problem behaviors may serve as a tool to enhance the identification of student subgroups at risk for problem/heavy-drinking, and hence improve targeted health-intervention-programs. [ABSTRACT FROM AUTHOR]