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To determine Dysphoric Milk Ejection Reflex (DMER) incidence. Secondary objectives were to describe the symptom profiles and patient characteristics of DMER and assess DMER familiarity.A prospective observational study of people who initiated breastfeeding after delivery between December 2022 and May 2023 at two hospitals in New York. Participants filled out an Initial Survey, assessing prior DMER familiarity, and recurring DMER Symptoms Surveys, assessing symptom presence, severity, and transiency. Medical records were reviewed for patient demographics and clinical history. Descriptive and basic inferential statistics were performed. A p<0.05 was considered statistically significant.Based on the DMER definition utilized, incidence was 26.9 % (n=21), and symptom severity was mostly very mild to moderate. Those with DMER had similar baseline characteristics to those without, apart from a significantly higher rate of having delivered via cesarean section (71.4.0 vs. 33.3 %, p<0.01). Among the 55 patients who completed the initial survey, 61.8 % were unfamiliar with the condition.DMER is described as brief, abrupt, negative emotions experienced by breastfeeding individuals prior to milk letdown. We found that more than 1 in 4 participants screened positive. Future research could better define, quantify, qualify, and publicize this condition to inform clinical practices and facilitate successful breastfeeding relationships. [ABSTRACT FROM AUTHOR]

Purpose: Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest. Methods: For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians’ knowledge, and Mann‒Whitney U tests were performed. Results: Two-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1–6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops. Conclusion: Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines. Trial registration: , identifier: NCT04921644. Registered in June 2021. [ABSTRACT FROM AUTHOR]

Background: Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcin- oma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC). Methods: An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed. Results: Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p < 0.001). If treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups. The most reported reason for treating patients in both groups with TCS was symptoms, followed by clinical aspects of the lesion and prevention of progression to dVIN and VSCC. Conclusion: The majority of GOs who participated in our study endorse the utilisation of long-term ultra-potent TCS therapy in both patients with LSnoVSCC and LSVSCC. Nevertheless, Dutch GOs are currently prescribing TCS more frequently to patients with LSnoVSCC than to patients with LSVSCC. [ABSTRACT FROM AUTHOR]

Background : With over 2 million grafts performed annually, bone ranks second only to blood in the frequency of transplants. This high demand is primarily driven by the persistent challenges posed by bone defects, particularly following trauma or surgical interventions such as tumour excision. The demand for effective and efficient treatments has increased exponentially in the twenty-first century. Limitations associated with autologous bone grafts drive exploration into replacements, including allografts, synthetic substitutes, and 3D-printed scaffolds. This research aimed to unravel disparities in the knowledge and evaluation of current and future bone defect treatments between surgeons and biomaterial scientists. Methods: A prospective cross-sectional survey, pre-registered with the OSF (https://osf.io/y837m/?view%5fonly=fab29e24df4f4adf897353ac70aa3361) and conducted online from October 2022 to March 2023, collected data on surgeons' views (n = 337) and scientists (n = 99) on bone defect treatments. Results: Scientists were significantly more optimistic than surgeons regarding the future replacement of autologous bone grafts with synthetic or tissue-engineered substitutes (p < 0.001). Accordingly, scientists foresee a paradigm shift from autologous bone grafts to biomaterial and tissue-engineered solutions, reflecting their confidence in the ongoing advancements within this field. Furthermore, regulatory trepidations for 3D-printed bone scaffolds were acknowledged, with scientists emphasizing the need for a more significant focus on clinical relevance in preclinical studies and regulatory clarity. In a ranked categorical assessment, witnessing the technology in action was deemed most influential in adopting new bone regeneration methods by both scientists and surgeons. Conclusions: To conclude, this study was conducted through a web-based survey, highlighting a substantial translational gap. It underscores the immediate need ("call to action") for meaningful interdisciplinary collaboration between surgeons and scientists, often referred to as the need to "walk the talk". The findings underscore the critical importance of aligning clinical needs, research outcomes, and regulatory frameworks to improve the development and implementation of biomaterial-based bone graft substitutes that demonstrate efficacy and efficiency in bone defect treatment. [ABSTRACT FROM AUTHOR]

Individuals with long COVID report diverse symptoms lasting weeks or months after initial infection, causing significant psychosocial distress. Navigating health care interactions are often difficult for these individuals due to the diffuse nature of their symptoms, a lack of effective treatment options, and skepticism from some providers. To better understand these challenges, this study sought to further describe the lived experience of individuals with long COVID. A survey was conducted with individuals evaluated for long COVID at a specialty clinic (n = 200), which included questions about prior conditions, symptoms, use of medical and support services, and information and resource needs. Participants reported a mean of 10.75 persistent symptoms, the most common being fatigue and difficulty concentrating, with broad effects on daily functioning. Participants saw a mean of 5.92 providers for treatment of their symptoms, and 88.5% identified health care providers as a trusted source of information. Interest in research findings (60.5%) and opportunities for participation (47.5%) were moderate and varied by COVID vaccination status. Unvaccinated individuals (n = 27) also reported less trust in government sources of information, less college education, lower household income, and greater likelihood of having public insurance. Our findings suggest that individuals with long COVID experience many ongoing and complex symptoms with diverse effects on daily living; that health care providers are an important source for public health messaging about long COVID; and that unvaccinated individuals are likely to have differing needs and receptiveness to information than vaccinated individuals with long COVID. [ABSTRACT FROM AUTHOR]

Little is known about knowledge and perceptions of the public and farmers on livestock feed. However, it is important to know their perspectives to find widely accepted and sustainable solutions in agriculture, which account for animal welfare, societal expectations, economy and the environment alike. Therefore, the objective of the present study was to assess knowledge, perceptions and informational needs regarding livestock feed among the general population and farmers. A German-wide online survey was conducted with n = 1000 participants from the general population (representative for age and gender) and n = 251 farmers. Differences in answers were compared between the general population and farmers as well as between subgroups of the general population. Results indicate that the public is correctly informed about some livestock feeds, although knowledge gaps and misconceptions became evident. The general population rated potatoes, fodder beets, kitchen waste and bread as common feedstuffs for pigs, which was rather a common practice in smallholder "backyard" pig husbandry several decades ago. Ratings of relevant aspects of feed differ between the two groups and partially depend on sociodemographic variables (i.e. gender, rural/urban upbringing, age) in the general population. Farmers were more likely to have heard and know the meaning of the term feed additives and are better informed about the functions that are fulfilled by feed additives. Farmers also expressed higher agreement for use of most alternative feeds than participants from the general population, although no differences of acceptance levels were found for algae, insects, animal by-products and fungi. In the group of the general population, 56% agree with the use of cereals and only 17% with the use of soy as livestock feed. When asked for the level of knowledge on livestock feed, 42% of participants from the general population indicate low or very low knowledge, whereas 97% of farmers judged the knowledge among the public to be low or very low. Both groups rate the need for information on controls of feed highest. Providing more information on livestock feed to the public seems necessary to improve knowledge, increase acceptance of alternative feeds and of sustainable solutions in agriculture. [ABSTRACT FROM AUTHOR]

Problem: Investigations regarding perceptions of the institutional research integrity climate in the Arab Middle East remain underexplored. Subjects: We surveyed faculty from three Egyptian universities. Method: We utilized the Survey of Organizational Research Climate (SOuRCe) tool, which incorporates seven subscales that measure different aspects of the research integrity climate. Responses were obtained from a 5-point Likert scale. Findings: Of the 228 participants, the subscales 'Regulatory Quality' and '[Lack of] Integrity Inhibitors' received the highest mean scores, whereas the lowest scores pertained to 'Departmental Expectations,' 'Integrity Socialization,' and 'Responsible Conduct of Research´ indicating areas in need of improvement. Conclusions: Academic leaders should set fairer expectations for research and funding for their researchers, ensure junior researchers are socialized into research integrity practices, and promote effective RCR training and availability of RCR policies. We identify specific targeted interventions to enhance the research integrity climate within these institutions. [ABSTRACT FROM AUTHOR]

Objective: Oxygen therapy (OT) is the administration of oxygen (O2) at a concentration greater than that found in the atmosphere to prevent the symptoms of hypoxemia. The necessary knowledge, skills and attitudes of the staff while OT may affect the treatment outcomes. In our study, we aimed to determine the training and knowledge status of doctors and nurses working in our university hospital on OT. Methods: The cross-sectional study was completed with 231 participants after ethics committee approval. Data were obtained by hand-completion of questionnaires consisting of 23 questions to volunteer. According to the correct answers given to the questions investigating the level of knowledge, scores >80% were classified as good knowledge level and <60% as poor knowledge level. p<0.05 was considered significant. Results: The number of employees reached by the survey was 422 and 85% of nurses and 62% of doctors stated that they had knowledge of OT application. Twenty seven percent of nurses and 42% of doctors were using guidelines for OT. Eighty six percent of doctors and 90% of nurses felt that training for OT was necessary and the most common sources of information were school education. The rate of good knowledge was 9.7% among nurses and 14.3% among doctors (p=0.418). Regarding the expected clinical outcomes of OT, 71% of physicians and 49% of nurses had a good level of knowledge (p<0.001). Sixty four percent of physicians and 86% of nurses (p<0.001) had a poor level of knowledge about low-flow OT and 49% of physicians and 69% of nurses had a poor level of knowledge (p=0.004) about indications for short-term OT. Most of the participants (87.7%) had poor knowledge about O2 toxicity. Conclusion: It was concluded that the majority of healthcare professionals have insufficient knowledge in OT and comprehensive training programs are needed at regular intervals. [ABSTRACT FROM AUTHOR]

Background: The incidence of Legionnaires' disease (LD) is increasing steadily in Europe. Its early diagnosis by general practitioners (GPs) is crucial for better patient outcomes. Study objectives: This study assessed Belgian GPs' knowledge about LD and the accessibility of diagnostic tests in their practices. Methods: A specifically designed questionnaire was distributed to actively practicing GPs, including primary care trainees, between 31 January 2022 and 13 March 2022. This survey targeted approximately 4200 GPs with an estimated population catchment of 30% of the actively working Belgian GPs. Results: The response rate was estimated at 3%. Over 70% of the GPs correctly identified the LD occurrence peak, major risk factors, and clinical manifestations. While 62% of participants preferred the Legionella pneumophila urinary antigen test (UAT) as a primary diagnostic method, 75% were unsure about its availability within their laboratories and 82% had not prescribed it in the last year. Finally, 76% expressed a desire for additional information on this topic. Conclusions: Belgian GPs should evaluate the possibility of conducting UAT testing in their laboratories to enhance LD case management and improve their preparedness. Furthermore, initiatives should be implemented to improve communication between specialists and GPs and develop educational programs directed at Belgian GPs. [ABSTRACT FROM AUTHOR]

Background and Objectives: Regular whole blood donations are associated with an increased risk of iron deficiency. Iron supplementation is an effective strategy to prevent donation‐induced iron deficiency. However, research on donor perceptions towards such a policy is limited. Therefore, we aim to evaluate donors' knowledge on donation‐induced iron depletion and their perceptions regarding iron supplementation as a blood service policy. Materials and Methods: Three thousand Dutch whole blood donors were invited to complete a survey assessing their knowledge of donation‐induced iron depletion and attitudes and perceptions towards iron supplementation as a policy. Linear regression modelling was used to evaluate associations between explanatory variables and perceptions. Results: In total, 1093 (77.1%) donors were included in the analysis. Donors had poor knowledge of current iron management policies, but a better understanding of iron metabolism and supplementation. Iron supplementation as a policy was perceived mainly positive by donors, and the majority were willing to use iron supplements if provided. Iron supplementation was not perceived as invasive or negatively affecting donors' motivation to continue donating. Additional iron monitoring, information and donor physician involvement were regarded as important conditions for implementation. Male sex, trust in the blood service, prior experience with iron supplements and openness towards dietary supplements were strongly positively associated with willingness to use iron supplementation. Conclusion: Donors' knowledge regarding donation‐induced iron depletion is limited, but not associated with their perceptions regarding iron supplementation. Donors do not consider iron supplementation as invasive, deterring or demotivating, and a majority are willing to take supplements if offered. [ABSTRACT FROM AUTHOR]

Abstract Background With over 2 million grafts performed annually, bone ranks second only to blood in the frequency of transplants. This high demand is primarily driven by the persistent challenges posed by bone defects, particularly following trauma or surgical interventions such as tumour excision. The demand for effective and efficient treatments has increased exponentially in the twenty-first century. Limitations associated with autologous bone grafts drive exploration into replacements, including allografts, synthetic substitutes, and 3D-printed scaffolds. This research aimed to unravel disparities in the knowledge and evaluation of current and future bone defect treatments between surgeons and biomaterial scientists. Methods A prospective cross-sectional survey, pre-registered with the OSF ( https://osf.io/y837m/?view_only=fab29e24df4f4adf897353ac70aa3361 ) and conducted online from October 2022 to March 2023, collected data on surgeons’ views (n = 337) and scientists (n = 99) on bone defect treatments. Results Scientists were significantly more optimistic than surgeons regarding the future replacement of autologous bone grafts with synthetic or tissue-engineered substitutes (p

Background: The role of social determinants of health (SDH) in patient outcomes, quality of life, and overall well-being has been well documented. However, the inclusion of these variables in randomized control trials (RCTs) remains limited; thus, the extent of generalizability from such trials is brought into question. The purpose of this study is to explore the rates of reporting SDH variables in RCTs focused on shoulder surgery from the past decade. Methods: The PubMed database was searched for RCTs with a focus on shoulder surgery from 2013 to 2023. Duplicates, responses to the editor, biomechanical studies, and nonshoulder studies were excluded. Each article was reviewed and data pertaining to patient demographics and socioeconomic covariates. Journal of publication was recorded, and studies from the 5 most common journals were analyzed. These journals were the Journal of Shoulder and Elbow Surgery, the Journal of Bone and Joint Surgery, the American Journal of Sports Medicine (AJSM), the Bone and Joint Journal, and the Journal of the American Medical Association. Multivariate logistic regression was performed to determine the independent effect of study characteristics on the reporting rates of SDH. Results: A total of 255 articles were reviewed. Of these, 93.3% and 90.2% of articles reviewed reported age and sex, respectively. Employment status was reported in 11.8% of articles. Less than 10% reported race, ethnicity, income, insurance, and housing, with even less performing formal analyses on these variables. Studies that were conducted in the United States, multicenter, had a sample size of 251+, and had a combination of public and private funding which were significantly more likely to report on race and ethnicity. Reporting employment status was significantly associated with being European-based, multicenter, sample size 251+, double-blinded, and published in AJSM. Newer studies were significantly less likely to report education. Only publication in AJSM was significant for reporting income. Study intervention and topic were not significant for any SDH reporting. Discussion: These data reflect how small of a proportion of RCTs report and analyze on SDH variables. These findings reflect a need for future RCTs to accurately report SDH variables that influence outcomes, such as race, ethnicity, education, employment, income, housing status, and insurance. SDH are infrequently reported and analyzed in RCTs pertaining to shoulder surgery. Academic medical journals should incorporate guidelines to encourage studies to include such variables and enable the assessment of outcomes to apply to a broader population.

Background: The incidence of Legionnaires’ disease (LD) is increasing steadily in Europe. Its early diagnosis by general practitioners (GPs) is crucial for better patient outcomes. Study objectives: This study assessed Belgian GPs’ knowledge about LD and the accessibility of diagnostic tests in their practices. Methods: A specifically designed questionnaire was distributed to actively practicing GPs, including primary care trainees, between 31 January 2022 and 13 March 2022. This survey targeted approximately 4200 GPs with an estimated population catchment of 30% of the actively working Belgian GPs. Results: The response rate was estimated at 3%. Over 70% of the GPs correctly identified the LD occurrence peak, major risk factors, and clinical manifestations. While 62% of participants preferred the Legionella pneumophila urinary antigen test (UAT) as a primary diagnostic method, 75% were unsure about its availability within their laboratories and 82% had not prescribed it in the last year. Finally, 76% expressed a desire for additional information on this topic. Conclusions: Belgian GPs should evaluate the possibility of conducting UAT testing in their laboratories to enhance LD case management and improve their preparedness. Furthermore, initiatives should be implemented to improve communication between specialists and GPs and develop educational programs directed at Belgian GPs.

Background: Police officers are an occupational group with a high risk of developing musculoskeletal, cardiovascular, and mental diseases because of the nature of their work. This study aimed to gain an understanding of job-related health risks by comparing overall health awareness, presence of physical and mental disabilities and their causes, medical use patterns, and quality of life of the general public through a survey. Methods: In this comparative study, police officer data were collected through a survey conducted from October 1, 2022, to November 15, 2022, and general public data from the 8th National Health and Nutrition Examination Survey of Korea were used for comparison. Results: Police officers’ health perception of physical or mental disabilities was significantly more negative than that of the general public because of their work characteristics, patterns, and functions. In addition, police officers with disabilities had severe work and daily living limitations, and their awareness of their overall quality of life was low enough to warrant alarm. Despite their high rates of seeking treatment in medical institutions, continuous medical use was limited. Conclusion: More research on major diseases to which police officers are at risk of exposure is necessary to analyze risk factors and accumulate related data to systematize health management. In addition, Korean medicine treatment techniques with excellent disease prevention are recommended for the health management of police officers.

Abstract Background The undergraduate tutorial system (UTS) is a crucial measure in China for adhering to the principle of prioritizing foundational education, innovating the undergraduate talent training mode, and building a powerful country of higher education. This study investigated undergraduate students’ satisfaction with UTS and the influencing factors, aiming to promote the healthy and sustainable development of UTS and provide practical implications and suggestions for universities. Methods Based on relevant theories, we conducted a survey study and leveraged structural equation modeling to assess students’ satisfaction with UTS and explore the influencing factors. Results Our Pearson correlation analysis showed that students’ satisfaction with mentors was positively correlated with dimensions such as humanistic care (r = 0.844, P

Introduction: This survey investigates brain MRI practices for isolated GHD among Pediatric Endocrine Society (PES) members, focusing on gadolinium-based contrast agents (GBCAs) versus non-contrast MRI. Methods: A 15-question survey was distributed to 1,553 PES members, capturing data on GBCA usage, non-contrast imaging access, and awareness of gadolinium retention. Results: A total of 85% of respondents routinely order brain MRIs for isolated GHD, with 60% using GBCAs. Most respondents have access to high-resolution non-contrast imaging, though 54% are unaware of gadolinium retention risks. Conclusion: High-resolution non-contrast MRI demonstrates diagnostic efficacy, suggesting a shift away from GBCAs in clinic practice for isolated GHD. The survey forms the basis to update PES guidelines in the evaluation of isolated GHD. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim(s) Design Methods Data Sources Results Conclusion Implications for the Profession and/or Patient Care Patient or Public Contribution To explore whether nurses' use of different approaches to manage patient mistreatment can exert distinctive effects on their emotional exhaustion and life satisfaction, and to examine whether supervisor support can mitigate the negative effects of emotional exhaustion on nurses' life satisfaction.A time‐lagged three‐wave survey study with a 2‐week time interval was conducted in 2022.A total of 257 nurses from a Joint Commission International (JCI) accredited general hospital located in eastern China in 2022 completed three‐wave surveys. Descriptive analyses, confirmatory factor analyses and mediation and moderated mediation analyses were performed.Data were collected by using three‐wave self‐reported questionnaires from 257 nurses from a Joint Commission International (JCI) accredited general hospital located in eastern China in 2022.Nurses who managed patient mistreatment more cooperatively experienced lower levels of emotional exhaustion, whereas those who managed patient mistreatment more competitively experienced higher levels of emotional exhaustion. Emotional exhaustion was negatively related to life satisfaction. Moreover, emotional exhaustion mediated the positive and negative relationships between cooperative and competitive conflict management approaches and overall life satisfaction. Additionally, supervisor support mitigated the negative impact of emotional exhaustion on life satisfaction and the indirect effects of conflict management approaches on life satisfaction.To effectively manage the negative impact of patient mistreatment on nurses, both nurses themselves and their supervisors play an important role. Nurses who adopt a cooperative conflict management approach experience lower levels of emotional exhaustion and higher levels of life satisfaction. Supervisor support can alleviate the negative effect of emotional exhaustion on life satisfaction.The findings provide a better understanding for nurses on how to mitigate the detrimental effects of patient mistreatment on nurses and highlight the role of both nurses themselves and their supervisors in protecting nurses' well‐being.No patient or public contributed to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Healthcare facilities are among the stressful interiors that are likely to negatively affect patients and visitors. When designing hospitals, design techniques that reduce stress and create a positive environment for users should be taken into account. Studies show that the use of green elements and the inclusion of natural factors in indoor spaces reduces people's stress levels and positively increases their psychological state, creativity, productivity, mood and well-being. Biophilic design, which includes the use of both green elements and natural factors which has been frequently used in many public buildings in recent years and has been included in many studies, appears to have positive effects on the environment and people. Incorporating natural design elements into healthcare environments with biophilic design principles positively affects the atmosphere of the place and the indoor comfort of the users. The purpose of this study is to examine the effects of the existing interior garden on the users of Medicana International hospital in Izmir and to reveal which biophilic design strategies they prefer in the hospital interior. In line with the purpose of the study, a survey consisting of open-ended and Likert scale questions was applied to 55 people in line with the interviews held with the upper management at the selected location. According to the findings, it is seen that users generally prefer indoor gardens in hospitals and that a green space has a positive impact on their healing processes and mental health. Lastly, the results were generally consistent among users, when the obtained quantitative data were analyzed, it was seen that the reliability coefficients (correlation analysis) were in the range of .48 - .57. [ABSTRACT FROM AUTHOR]

Purpose: To assess the knowledge and confidence level regarding the basic first-aid for treating epistaxis among medical staff, including nurses and physicians across various medical disciplines. The study focused three aspects of first aid management: location of digital pressure, head position and duration of pressure. Methods: The study involved 597 participants, categorized into five groups according to their specialties: emergency medicine, internal medicine, surgery, pediatrics, and community-based healthcare. A paper-based multiple-choice questionnaire assessed knowledge of managing epistaxis. Correct answers were determined from literature review and expert consensus. Results: Most medical staff showed poor knowledge regarding the preferred site for applying digital pressure in epistaxis management. For head position, pediatricians and internal medicine physicians were most accurate (79.4% and 64.8%, respectively, p < 0.01), and nurses from the emergency department outperformed nurses from other disciplines; internal medicine, surgery, pediatrics, and community-based healthcare (61.1%, 41.5%, 43.5%, 60%, 45.6%, respectively, p < 0.05). While most medical staff were unfamiliar with the recommended duration for applying pressure on the nose, pediatricians and community clinic physicians were most accurate (47.1% and 46.0%, respectively, p < 0.01), while ER physicians were least accurate (14.9%, p < 0.01). Interestingly, a negative correlation was found between years of work experience and reported confidence level in managing epistaxis. Conclusions: Our findings indicate a significant lack of knowledge concerning epistaxis first-aid among medical staff, particularly physicians in emergency departments. This finding highlights the pressing need for education and training to enhance healthcare workers' knowledge in managing epistaxis. [ABSTRACT FROM AUTHOR]

• Endometriosis has been associated with sleep disorders. • Hyperarousal is involved in pathogenesis of sleep disorder. • Hyperarousal is involved in pathogenesis of endometriosis. • Investigating hyperarousal in Endometriosis patients is useful. • CBT is effective in improving hyperarousal and sleep disorders. Endometriosis has been associated with sleep disorders, and hyperarousal appears to be involved in their pathogenesis; however, the presence of hyperarousal in the endometriosis population was never investigated. We conducted a case-control survey study by sending a questionnaire to all endometriosis patients followed up at our Centers. Controls were recruited among the general population. The questionnaire included demographic information, symptoms and history of endometriosis, the Hyperarousal Scale (H-Scale), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). A total of 847 women completed the questionnaires: 430 (50.8 %) had endometriosis, and 417 (49.2 %) were controls. Endometriosis was associated with higher H-scale score (OR 2.9, 95 % CI 2.4–3.8, p = 0.000), higher PSQI score (OR 4.3, 95 % CI 3.2–5.7, p = 0.000), and higher ISI score (OR 4.6, 95 % CI 3.5–6.1, p = 0.000) in multivariable ordinal logistic regressions analysis. With path analysis, hyperarousal (H-Scale) reported a partial mediating role in the association between endometriosis and sleep disorders. The mediation effect represented 22.3–27.8 % of the entire association between endometriosis and sleep disturbances. Endometriosis patients complaining sleep disorders may benefit by investigating the presence of hyperarousal given cognitive behavioral therapy was reported effective in improving hyperarousal and associated sleep disorders. [ABSTRACT FROM AUTHOR]

The survey entitled "Field Survey of Alabama Department of Transportation (ALDOT) Transportation Maintenance Technicians (TMTs) Perception of Worker Safety" investigates the safety perceptions and concerns of maintenance workers within ALDOT through a multifaceted analysis approach. The findings reveal critical insights that can significantly enhance ALDOT's safety practices, training programs, and overall safety culture. Disparities in safety perceptions across different ALDOT's areas were found, emphasizing the need for ALDOT to tailor its strategies to meet the unique needs of each area, ensuring that safety measures are both relevant and effective. The study emphasizes the importance of implementing targeted interventions focused on high-risk activities and prevalent safety concerns, allowing ALDOT to prioritize resources effectively. Additionally, the research highlights the necessity for continuous improvement by regularly evaluating safety initiatives based on feedback and best practices. This ongoing evaluation ensures that safety measures remain relevant and effective in addressing the evolving needs of TMTs. By integrating these insights into its safety management practices, ALDOT can cultivate a more proactive and resilient work environment that not only addresses immediate safety concerns but also establishes a sustainable culture of safety prioritizing employee well-being. The study provides a roadmap for future improvements in workplace safety and initiates discussions on the implications and recommendations for enhancing ALDOT's and other transportation agencies' safety management practices. [ABSTRACT FROM AUTHOR]

Background: The acquisition of healthy lifestyle habits by adolescents is largely influenced by close interpersonal relationships including their parents and teachers. Methods: A cross-sectional survey regarding tobacco use was conducted among 304 parents and 41 teachers of secondary school adolescents (12–17 years of age) enrolled in the first, second, and third grades of compulsory secondary education at the largest high school in Sueca, Valencia, Spain. Results: The prevalence of smoking was 36.2% among parents (occasional smokers 75.4%) and 19.5% among teachers (occasional smokers 62.5%). Most parents (89.8%) did not believe that their child smoked and 95.7% viewed it negatively if they did. Also, 75.2% of parents agreed that tobacco consumption encourages adolescents to use cannabis or other drugs. Friends who smoke and additives added to cigarettes were considered very influential factors for starting smoking. Most teachers (90.2%) reported having given a recommendation to their students to quit smoking. Cannabis and cigarette smoking were rated as harmful to health. Most respondents believed that cigarette smoking may favor the consumption of cannabis. Conclusions: The use of e-cigarettes was also considered a risk factor for starting smoking. It would be advantageous incorporating parents and teachers as role models in multidisciplinary interventions addressing smoking behavior in secondary school students. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI) is a common condition that can significantly impact a patient's quality of life. Although multiple diagnostic and treatment options exist, significant variability in SUI management exists between countries. Since women's SUI prevalence in Jordan is high, and Jordan is a lower-middle-income country, this study aimed to investigate how obstetricians and gynecologists (OBGYNs) across Jordan manage and treat women with SUI. Method: A Google Forms survey was prepared and sent out to Jordanian OBGYNs via WhatsApp. The results were collected and arranged in Microsoft Excel and then transferred to SPSS for statistical analysis. Results: Out of the 804 Jordanian registered OBGYNs, 497 could be reached, 240 conduct gynecological surgeries, and 94 completed the survey, providing a response rate of 39.2%. Most of the respondents were females between 41 and 55 years old. More than 70% of the OBGYNs worked in the private sector, and 88.3% operated in the capital of Jordan. Most of the respondents favored lifestyle and behavior therapy (43.6%) or pelvic floor physiotherapy (40.4%) as the first-line management for SUI. The transobturator mid-urethral sling (MUS) was the most common initial surgical treatment option. The physicians preferred two-staged procedures for the repair of pelvic organ prolapse alongside concomitant SUI. In the case of recurrent SUI following surgery, 77% of the respondents chose to refer to a urologist or urogynecologist. Conclusions: The Jordanian OBGYNs preferred using lifestyle/behavioral therapy and pelvic floor muscle physiotherapy as the first-line treatment to manage SUI. Secondly, the MUS would be the most frequently preferred surgical choice. To effectively manage SUI, adequate training in urogynecology and referral resources are essential in lower-middle-income countries. [ABSTRACT FROM AUTHOR]

Introduction: X-linked retinitis pigmentosa (XLRP) is a rare, incurable, vision-threatening, genetic disease. In this study, we aimed to reveal the real-world burden of this disease from the viewpoint of retina specialists and geneticists involved directly in XLRP care and to identify unique insights that may not otherwise be available through typical clinical studies or health economic research. Methods: In this exploratory, cross-sectional study (EXPLORE XLRP-1), retina specialists (n = 20) and geneticists (n = 5) in France, Germany, Italy, Spain, and the UK provided anonymized insights on their experiences managing patients with XLRP (n = 80) via an online survey and 60-min telephone interview. Results: Survey respondents reported that patient independence decreased over time, where 37% of patients were considered "completely autonomous" at diagnosis versus 23% at the last consultation. At their last visit, 45% of patients were active in the workforce; 67% (12/18) of "completely autonomous" patients had active working status compared with 13% (1/8) of "completely dependent" patients. The average time from onset of symptoms to diagnosis was 4 years and varied among countries. In 78% of patients, XLRP was confirmed by genetic testing, the rate of which varied among countries (range, 50–94%), taking up to 6 months to receive results. Specialists identified unmet needs in XLRP management including more standardized assessments of quality of life (QoL) as well as easier and earlier access to specialists, genetic testing, patient support programs, and effective treatment options. Conclusions: The diagnosis, genetic testing, and management pathways among patients with XLRP can vary considerably. There is a need for more standardized diagnosis and management pathways, and QoL assessments, due to the major impact that XLRP has on patients' lives. [ABSTRACT FROM AUTHOR]

Background Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcinoma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC).Methods An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed.Results Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p

Little is known about knowledge and perceptions of the public and farmers on livestock feed. However, it is important to know their perspectives to find widely accepted and sustainable solutions in agriculture, which account for animal welfare, societal expectations, economy and the environment alike. Therefore, the objective of the present study was to assess knowledge, perceptions and informational needs regarding livestock feed among the general population and farmers. A German-wide online survey was conducted with n = 1000 participants from the general population (representative for age and gender) and n = 251 farmers. Differences in answers were compared between the general population and farmers as well as between subgroups of the general population. Results indicate that the public is correctly informed about some livestock feeds, although knowledge gaps and misconceptions became evident. The general population rated potatoes, fodder beets, kitchen waste and bread as common feedstuffs for pigs, which was rather a common practice in smallholder “backyard” pig husbandry several decades ago. Ratings of relevant aspects of feed differ between the two groups and partially depend on sociodemographic variables (i.e. gender, rural/urban upbringing, age) in the general population. Farmers were more likely to have heard and know the meaning of the term feed additives and are better informed about the functions that are fulfilled by feed additives. Farmers also expressed higher agreement for use of most alternative feeds than participants from the general population, although no differences of acceptance levels were found for algae, insects, animal by-products and fungi. In the group of the general population, 56% agree with the use of cereals and only 17% with the use of soy as livestock feed. When asked for the level of knowledge on livestock feed, 42% of participants from the general population indicate low or very low knowledge, whereas 97% of farmers judged the knowledge among the public to be low or very low. Both groups rate the need for information on controls of feed highest. Providing more information on livestock feed to the public seems necessary to improve knowledge, increase acceptance of alternative feeds and of sustainable solutions in agriculture.

In spaces with considerable volumes that are sporadically used and typically not operating at full capacity, existing thermal comfort models face limitations. This research aims to reveal disparities between these models and survey-based comfort assessments. Comfort calculations were conducted using conventional thermal comfort models based on measured parameters and compared with survey data. Notable differences prompted the formulation of a more robust correlation, accounting for 83.4 % of the variations in Predicted Mean Votes (PMV). A regression model derived from survey data shows a high coefficient of determination (R2 = 0.84), supporting its applicability for large intermittently used spaces like mosques. Addressing limitations of existing models, this research introduces a practical and simplified approach to predicting thermal comfort, enhancing assessments in these distinctive spaces. The study also examines mosque indoor air quality dynamics. Despite sporadic ventilation, CO2 levels rose from 1500 ppm to 2500 ppm during Friday prayers, posing potential health risks. Before prayers, indoor CO2 and humidity met ASHRAE Standard 62, ISO 7730, and EN15231 values. To mitigate health concerns from elevated CO2 levels, improved ventilation systems are necessary. Comfort temperatures were only achieved during prayer periods.

Background: Interest in the oligometastatic prostate cancer (OMPC) is increasing, and various clinical studies have reported the benefits of metastasis-directed radiation therapy (MDRT) in OMPC. However, the recognition regarding the adopted definitions, methodologies of assessment, and therapeutic approaches is diverse among radiation oncologists. This study aims to evaluate the level of agreement for issues in OMPC among radiation oncologists. Methods: We generated 15 key questions (KQs) for OMPC relevant to definition, diagnosis, local therapies, and endpoints. Additionally, three clinical scenarios representing synchronous metastatic prostate cancer (mPC) (case 1), metachronous mPC with visceral metastasis (case 2), and metachronous mPC with castration-resistance and history of polymetastasis (case 3) were developed. The 15 KQs were adapted according to each scenario and transformed into 23 questions with 6–9 per scenario. The survey was distributed to 80 radiation oncologists throughout the Republic of Korea. Answer options with 0.0–29.9%, 30–49.9%, 50–69.9%, 70–79.9%, 80–89.9%, and 90–100% agreements were considered as no, minimal, weak, moderate, strong, and near perfect agreement, respectively. Results: Forty-five candidates voluntarily participated in this study. Among 23 questions, near perfect (n = 4), strong (n = 3), or moderate (n = 2) agreements were shown in nine. For the case recognized as OMPC with agreements of 93% (case 1), near perfect agreements on the application of definitive radiation therapy (RT) for whole metastatic lesions were achieved. While ≥70% agreements regarding optimal dose-fractionation for metastasis-directed RT (MDRT) has not been achieved, stereotactic body RT (SBRT) is favored by clinicians with higher clinical volume. Conclusion: For the case recognized as OMPC, near perfect agreement for the application of definitive RT for whole metastatic lesions was reached. SBRT was more favored as a MDRT by clinicians with a higher clinical volume.

Prior research on Automated Vehicle (AV) transportation services has largely concentrated on specific cases, leading to a narrow comprehension of wider public mobility requirements in AV deployment. Additionally, the impacts of socio-demographics on AV transportation preferences remain underexplored, hindered by limitations in current modeling methodologies. Moreover, mediating roles of safety between socio-demographics and AV transportation preferences lack quantitative validation. This study aims to uncover the reasons behind public preference for AV-based services and investigate safety’s mediating effects on these preferences. In a survey conducted in Kentucky, USA, with 673 responses, the most preferred uses for AV services were post-alcohol rides, airport shuttles, and long-distance travel. Urban areas showed a higher preference for AV services. Age, gender, urbanization, affordability, travel needs, and exposure to AV technology significantly influenced these preferences. The study underscores a high demand for AV services while validating safety concerns as a major barrier to their widespread adoption. [ABSTRACT FROM AUTHOR]

Background: Interest in the oligometastatic prostate cancer (OMPC) is increasing, and various clinical studies have reported the benefits of metastasis-directed radiation therapy (MDRT) in OMPC. However, the recognition regarding the adopted definitions, methodologies of assessment, and therapeutic approaches is diverse among radiation oncologists. This study aims to evaluate the level of agreement for issues in OMPC among radiation oncologists. Methods: We generated 15 key questions (KQs) for OMPC relevant to definition, diagnosis, local therapies, and endpoints. Additionally, three clinical scenarios representing synchronous metastatic prostate cancer (mPC) (case 1), metachronous mPC with visceral metastasis (case 2), and metachronous mPC with castration-resistance and history of polymetastasis (case 3) were developed. The 15 KQs were adapted according to each scenario and transformed into 23 questions with 6–9 per scenario. The survey was distributed to 80 radiation oncologists throughout the Republic of Korea. Answer options with 0.0–29.9%, 30–49.9%, 50–69.9%, 70–79.9%, 80–89.9%, and 90–100% agreements were considered as no, minimal, weak, moderate, strong, and near perfect agreement, respectively. Results: Forty-five candidates voluntarily participated in this study. Among 23 questions, near perfect (n = 4), strong (n = 3), or moderate (n = 2) agreements were shown in nine. For the case recognized as OMPC with agreements of 93% (case 1), near perfect agreements on the application of definitive radiation therapy (RT) for whole metastatic lesions were achieved. While ≥70% agreements regarding optimal dose-fractionation for metastasis-directed RT (MDRT) has not been achieved, stereotactic body RT (SBRT) is favored by clinicians with higher clinical volume. Conclusion: For the case recognized as OMPC, near perfect agreement for the application of definitive RT for whole metastatic lesions was reached. SBRT was more favored as a MDRT by clinicians with a higher clinical volume. [ABSTRACT FROM AUTHOR]

A survey was conducted to analyze the discrepancies of the functional requirements of the façade system in residential units among 605 of the real-life public and 73 experts. Personal and housing information, resident life patterns, public façade usage behavior, and functional requirements were collected from the respondents. Both the public and experts recognized insulation as the main function of façade opening systems. More than 85% of the public and experts opened windows for ventilation, but ventilation was ranked 3rd amongst the public and 4th amongst experts in the main functions list of façade systems. The public cited the inflow of fine dust as the main reason for dissatisfaction with opening windows. In contrast, the experts cited a decrease in thermal comfort due to the inflow of external moisture as the reason for dissatisfaction with opening windows. The results showed that discrepancies exist between the public and experts' perceptions of the main function of housing façade systems. Analyzing the common points and differences between the public and experts' perception can help in developing façade system design and control technology. [ABSTRACT FROM AUTHOR]

Despite their use in life-saving treatment, blood and blood products can cause life-threatening complications. To administer blood transfusion safely, national guidelines and protocols should be consulted in healthcare organizations. In Türkiye, there are guides and regulations published by the Ministry of Health. With the definition of hemovigilance in the regulations; training in clinical use of blood and transfusion practice fields is now mandatory. This study presents data from a survey designed to assess transfusion knowledge levels of clinical departments for the purpose of planning our training programs. A two-part survey was conducted on 110 nurses from various departments. Questions included sociodemographic attributes, department they worked in, employment duration, knowledge level on transfusion practices. Statistical analysis was performed. Of the nurses that participated; 52.7% were above 40 years old, 15.5% were 31–40 years old and 31.8% were below 30 years old. For education; 84.5% of the nurses were graduates or postgraduates. For work experience; 64.5% were working in internal medicine departments, 58.2% had been working as a nurse for 10 or more years while 85.5% worked in the same department for less than 5 years. It was determined that the nurses should know more about transfusion. Beginner nurses in the intense care unit were found to have lower levels of transfusion practice knowledge, from this it was deduced additional training should be scheduled for beginner nurses with low transfusion knowledge. In addition to theoretical instructions, one-on-one training on operation controls and "observation and guidance" style practical training should be implemented. Theoretical and practical topics with inadequate knowledge should be instructed in finer detail to increase the knowledge level in these subjects. [ABSTRACT FROM AUTHOR]

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With a possible decline in public pension benefits, private savings will become critical for maintaining desired living standards, yet most people undersave. We focus on one of the possible explanations for this: trust in the state. Using data from a dedicated survey and applying structural equation modeling, this study demonstrates that Polish citizens cherish the unconditional, albeit subconscious, belief in the state as a potential rescuer of last resort in life-threatening situations. This trust plays an essential role in people's propensity to save for the future. We discuss potential explanations of this phenomenon and its consequences for social policymaking. [ABSTRACT FROM AUTHOR]

Though we spend a significant amount of time in indoor and built environments as general occupants of residential or commercial spaces, we do not necessarily know how the heating, cooling, and ventilation services work in our occupied spaces. As the mechanical systems of buildings become more complex for energy saving and better indoor air quality, it is beneficial for occupants to learn more their built environment so that they can cooperate effectively for the building's performance. In this context, the purpose of this research is to develop and evaluate how virtual reality (VR) technology can support occupants in understanding their built environment. An educational building on campus was selected for the development as it provides familiar spaces for potential participants in this research. This research was carried out in two stages. In Stage One, we, as researchers in mechanical engineering, explored the workflow for VR development and developed VR tours for four spaces: a classroom, an auditorium, a conference room, and a mechanical room. In Stage Two, we conducted a survey study to examine the VR experience from the perspective of users. In this survey study, we recruited 34 participants from engineering students/graduates, industry participants, and a sustainability group. The participants generally indicated a positive experience with the VR tours, although the quiz scores on the VR content were weak. From our reflection, we consider that positive and effective VR experiences for the education of the built environment require collaboration from three domains: (1) mechanical systems of buildings, (2) VR technology, and (3) pedagogy. [ABSTRACT FROM AUTHOR]

Technical debt (TD) is a metaphor used to refer to the added software system costs acquired from taking shortcuts. Unfortunately, large amounts of TD can lead to serious consequences, and, thus, the management of TD is essential. Due to TD being a relatively new subject of study, many aspects of TD remain ambiguous. Fortunately, Twitter has been proven to hold a wealth of information on many subjects. As such, this survey study aims to gain a better understanding on how interest in TD has evolved over time and how TD is addressed on Twitter. A total of 128,897 TD‐related tweets were scrapped from Twitter and analyzed using a number of proxy measures and Latent Dirichlet Allocation (LDA). The results revealed that interest in TD on Twitter has been generally increasing since the platform's early stages. Furthermore, TD‐related tweets were found to revolve around 11 distinct categories. The TD in games category was discovered to be the most popular category, followed by TD communication and TD repayment. The results highlight that TD is a diverse and overarching topic that contains many potential avenues for further exploration. Software engineering researchers, practitioners, and educators can utilize this study to help steer their TD‐related future efforts. [ABSTRACT FROM AUTHOR]

This research aims to examine international migration movements and their effects on agricultural sustainability and the socio-economic structure in Turkey's Çukurova Region. The primary goal of the study is to provide strategic recommendations for the development of agricultural policies in the region by conducting a detailed analysis of the impacts of migration movements on agricultural sustainability. The first phase of the research was to investigate the general structure of international migration movements to the Çukurova Region and their socio-economic effects. In the second phase, data collected through surveys conducted with 14 family heads selected from the three most migration-receiving districts that represent the region in January and March 2024 was used. These surveys covered topics such as the migrants' countries of origin, family structures, capital transfers, sectors they work in, socioeconomic statuses, and education levels. The collected data was evaluated using statistical and thematic analysis techniques, and these analyses provided a deep understanding of the dynamics of migration and their impacts on the agricultural sector. Findings reveal significant demographic shifts, with economic motivations driving migration decisions. The study points out the importance of understanding migrants' economic circumstances and cultural dynamics in shaping integration policies. Recommendations are proposed to facilitate economic integration and foster cultural harmony, contributing to a deeper understanding of migration's impact on agricultural sustainability. [ABSTRACT FROM AUTHOR]

ObjectiveCOVID-19 risk perceptions are discussed to be volatile and have been shown to be connected to the adoption of preventive public health behaviors. This study aimed to investigate changes in COVID-19 concerns and influencing factors as a function of season among the German public.MethodsSixty-three waves of cross-sectional telephone surveys with German participants aged 14 years and older conducted at least monthly between June 2020 and April 2023 provided the data basis (N = 63,471). After pooling participants of different waves by season (spring, summer, fall, winter), data were analyzed with regard to changes in physical health, mental health, economic, and social COVID-19 concerns. Individual characteristics (e.g., age), COVID-19 behavior (e.g., hygiene practices), and related perceptions (e.g., controllability of risk) were considered as predictors of composite concerns in different seasons.ResultsResults showed a higher between-seasons than within-seasons variability in concerns, with rises in physical and mental health and social concerns during fall. Multivariate regressions revealed being female, lower education, adopting protective measures, and higher perceived probability of infection in both public and private settings to be consistent predictors of higher COVID-19 concerns. Coefficients of these predictors remained comparatively stable over seasons and years.ConclusionResults indicate re-occurring changes in concerns during a prolonged crisis, with distinct characteristics being consistently associated with higher reported concerns. To ensure the application of protective measures, communicators should consider that risk perceptions are subject to fluctuations, but that certain groups of individuals tend to develop them and therefore deserve particular focus.

The role of stressors, insect bites, and infections on disease relapse of ANCA vasculitis has yet to be entirely explored, with limited retrospective studies focused on disease onset from small participant cohorts. Our study analyzes longitudinal survey data from 2011–2022 to evaluate this perspective from a large ANCA vasculitis cohort. We collected surveys every three to six months to obtain information on self-reported psychological stressors and significant life events, insect bites, and infections throughout clinical disease. We defined cohorts as those who relapsed (Relapse Cohort) and controls as those who did not relapse (Remission Cohort) during the study period. Survey responses were retrospectively reviewed during a 15-month timeframe prior to relapse or during 15 months of remission and categorized by type of stress event, insect bite, and infections at every available 3-month interval. There were no significant differences in stress and insect bites between the relapse and remission cohorts. Patients who relapsed reported more frequent upper respiratory infections and other infections, such as those affecting the skin and eyes, but there were no significant differences in the incidence of pulmonary or urinary infections compared to the remission cohort. There was a significant difference in reported upper respiratory infections 9 to 15 months prior to the relapse date, indicating a remote history of infections as a potentially significant physical stressor that may contribute to disease relapse. More frequent patient-reported infections, specifically upper respiratory infections, may contribute to patient vulnerability to relapse. Counseling and close monitoring of patients after infectious symptoms could aid in earlier detection of disease flares. Future studies are essential to further understand the importance of distal risk factors and how they impact relapse.

Abstract Background A considerable body of research has demonstrated that reducing sitting time benefits health. Therefore, the current study aimed to explore the prevalence of sedentary behavior (SB) and its patterns. Methods A total of 6975 university students (49.1% female) were chosen randomly to participate in a face-to-face interview. The original English version of the sedentary behavior questionnaire (SBQ) was previously translated into Arabic. Then, the validated Arabic version of the SBQ was used to assess SB. The Arabic SBQ included 9 types of SB (watching television, playing computer/video games, sitting while listening to music, sitting and talking on the phone, doing paperwork or office work, sitting and reading, playing a musical instrument, doing arts and crafts, and sitting and driving/riding in a car, bus or train) on weekdays and weekends. Results SBQ indicated that the total time of SB was considerably high (478.75 ± 256.60 and 535.86 ± 316.53 (min/day) during weekdays and weekends, respectively). On average, participants spent the most time during the day doing office/paperwork (item number 4) during weekdays (112.47 ± 111.11 min/day) and weekends (122.05 ± 113.49 min/day), followed by sitting time in transportation (item number 9) during weekdays (78.95 ± 83.25 min/day) and weekends (92.84 ± 100.19 min/day). The average total sitting time of the SBQ was 495.09 ± 247.38 (min/day) and 58.4% of the participants reported a high amount of sitting time (≥ 7 hours/day). Independent t-test showed significant differences (P ≤ 0.05) between males and females in all types of SB except with doing office/paperwork (item number 4). The results also showed that male students have a longer daily sitting time (521.73 ± 236.53 min/day) than females (467.38 ± 255.28 min/day). Finally, 64.1% of the males reported a high amount of sitting time (≥ 7 hours/day) compared to females (52.3%). Conclusion In conclusion, the total mean length of SB in minutes per day for male and female university students was considerably high. About 58% of the population appeared to spend ≥7 h/day sedentary. Male university students are likelier to sit longer than female students. Our findings also indicated that SB and physical activity interventions are needed to raise awareness of the importance of adopting an active lifestyle and reducing sitting time.

The current research aims to study the content of the social studies course book that was developed according to the Egypt Vision 2030 for the fourth grade of primary school and the extent to which sustainable development issues were included in the curriculum. A content analysis of the course book and an achievement test were conducted on 1000 pupils in schools in Port Said, Egypt. The results of the research showed that issues of sustainable development in the developed social studies curriculum were 34.8% although the curriculum explained the global issues of sustainable development except for the elimination of global famines. Additionally, the results of the achievement test medium for pupils are considered a medium for most issues, so it could be concluded that it is necessary to increase the time of social studies classes in schools and add ways of eliminating global famine issues to the curriculum.

Since March 11, 2020, the global community has faced the challenges of the COVID-19 pandemic. In response, numerous countries, including the Republic of Lithuania, mandated the wearing of face masks to curb the virus’s spread. Yet, a section of the Lithuanian populace resisted this move, voicing concerns about the inconvenience of mask-wearing and potential privacy infringements. These concerns endured, even amidst debates on the masks’ effectiveness. This article explores how the Lithuanian public responded to mask-wearing protocols during the pandemic. Survey analysis highlighted a troubling trend: many individuals dispose of face masks with their regular trash, often without proper packaging. Most masks are sourced from pharmacies or are provided by employers and are typically thrown away after just one day of use. The data underscores a significant knowledge gap in correct mask disposal, as a significant portion ends up mingled with general household waste, without proper containment. Moreover, many people keep used masks in pockets or bags. Notably, during the pandemic, an estimated 2 mln adult Lithuanians may have generated roughly 15.24 Mg of hazardous plastic waste through mask disposal.