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No campo terapêutico, as feridas podem ser tratadas com os mais diversos produtos, sejam fármacos ou os de origem natural. Diante da diversidade de produtos existentes no mercado para tratamento de feridas, as plantas medicinais, em geral, apresentam baixo custo e são facilmente encontradas, ganhando espaço no mercado e aumentando as opções terapêuticas. Neste contexto, o gênero Caesalpinia (Fabaceae), com ocorrência em diversas regiões tropicais ao redor do mundo, possui espécies com ação cicatrizante reconhecida. A presente revisão de literatura objetivou analisar e discutir o uso de plantas medicinais do gênero Caesalpinia no processo de cicatrização de feridas. Foram analisados 21 artigos obtidos das plataformas SciELO, PubMed, Google Acadêmico, publicados entre os anos de 2010 e 2020. No total, cinco espécies de Caesalpinia foram descritas na literatura como possuidoras de atividade cicatrizante. É importante destacar o potencial do gênero Caesalpinia não só para a cicatrização, mas também para o tratamento de outras doenças, aplicação popular ou para a produção de drogas, juntamente com futuras investigações científicas, visando os benefícios e a seguridade para uso adequado.

The society enjoys a lot of medicinal plants due to their easy access and also due to the effectiveness of their use, currently, the popular use of these plants has been awakening the pharmaco-chemical study of their properties. Brazil with its great biodiversity worldwide, has an endemic biome, the Caatinga has a great diversity of plants with medicinal properties. The present work aimed to unite plants of the Caesalpinia genus with medicinal properties, through a literature review. The research was carried out on the electronic databases Google Scholar, Pubmed and Scielo using the following descriptors: “Plantas Medicinais”, medicinal plants, gênero Caesalpinia, Caesalpinia genus , fitoterápicos, herbal medicines, Caatinga. In total, 142 articles were found, of which 44 were included, with the characteristics of being plants with medicinal properties of the Caesalpinia genus in the Caatinga biome. After surveying the works found, it was possible to identify the following species, Caesalpinia pyramidalis Tul, Caesalpinia Ferrea Mart. Caesalpinia bracteosa Tul, found in the Caatinga biome. Each studied species had particular characteristics, having in common some anti-inflammatory properties, are studied by some researchers and are effective in their popular use.

Introduction: Distal tibial and fibular fractures are typically the result of high-energy trauma. Open reduction and internal fixation (ORIF) are often used to reconstruct and reduce displaced fractures, especially intra-articular ones. These fractures can be addressed either by a dual-incision approach (medial approach for the distal tibia and lateral approach for the fibula) or by a single-incision direct lateral approach to fix both the tibia and fibula. The direct lateral approach avoids injury to the medial soft tissues. This study was conducted to compare the postoperative clinico-radiological and functional outcomes of the single-incision direct lateral approach and the dual-incision approach for distal tibial and fibular fractures., Materials and Methods: A prospective comparative cohort study of 40 patients was conducted. The patients were classified into two cohorts of 20 each based on the surgical approach: those who underwent a single-incision direct lateral approach and those who underwent a dual-incision approach for distal tibial and fibular fractures (procedure: ORIF with plating). The study was conducted from September 2022 to March 2024. A follow-up period of at least 12 months was carried out, comparing operative time, discharge time, and postoperative outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, ankle range of motion (ROM), Southampton wound score for wound healing, visual analog scale (VAS) pain score, and periodic radiographs at each follow-up. Complications were also studied., Results: The mean operative time was 95.06 ± 7.04 minutes for the single-incision approach and 109.89 ± 7.88 minutes for the dual-incision approach. The average blood loss was 202.41 ± 32.76 mL for the single-incision approach and 248.39 ± 28.18 mL for the dual-incision approach. The hospital stay was shorter in the direct lateral approach group, and the AOFAS score at 12 months was better in the direct lateral approach group (91.47 ± 2.55 for the single-incision approach vs. 83.33 ± 8.71 for the dual-incision approach). Postoperative wound healing was observed, and the Southampton wound score was compared. Overall, soft tissue complications were fewer in the direct lateral approach group. The postoperative VAS pain score was consistently lower in the single-incision direct lateral approach group, which also demonstrated better ankle ROM. The p-value was significant (<0.05) for these parameters. At the six-month follow-up, all patients exhibited clinical and radiographic healing and bone union, except for one case in the dual-incision group. A medial compound wound, treated by plastic surgery with flap cover intervention, was identified as one of the definitive indications for single-incision plating., Conclusion: The single-incision approach was associated with better soft tissue healing, fewer wound complications, and superior ankle functional outcomes compared to the dual-incision approach., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of the Institute of Medical Sciences and SUM Hospital issued approval IEC/IMS.SH/SOA/2023/699. This is to certify that the Institutional Ethics Committee, after due ethical consideration, has approved the aforementioned documents submitted by you. The Institutional Ethics Committee of IMS and SUM Hospitals, Bhubaneswar, reviewed and discussed the documents submitted by you on September 9, 2023, related to the conduct of the abovementioned study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mishra et al.)

Background Anterior cruciate ligament (ACL) avulsion fractures often necessitate surgical intervention, with various fixation techniques available. Among these, the arthroscopic suture pull-out technique has gained attention as a promising approach. However, the influence of surgical timing on patient outcomes remains insufficiently studied. This study aims to evaluate the efficacy of the arthroscopic suture pull-out technique for ACL tibial avulsion fractures and assess how the timing of surgical intervention affects functional outcomes. Methodology This study was conducted at our hospital from November 2020 to October 2022. A total of 17 patients aged 21 to 41 years with isolated ACL avulsion fractures and no additional injuries or osteoarthritis were included. Participants were divided into three groups based on the interval from injury to surgery (one, two, or three weeks). The surgical procedure involved the suture pull-out technique. Postoperative management included immobilization, isometric exercises, and gradual weight-bearing. Functional outcomes were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lachman test at 6, 10, and 14 months, along with radiological evaluations. Results Significant functional improvements were observed in all groups, with postoperative Lysholm, IKDC, and Tegner scores showing notable enhancements compared to preoperative values. No significant differences were found among the groups regarding the timing of surgery, indicating that delays within the first three weeks did not adversely impact outcomes. Most patients achieved a full range of motion. Two minor postoperative complications were reported, namely, one case of arthrofibrosis and one case of persistent laxity. Conclusions The arthroscopic suture pull-out technique is effective and reliable for ACL tibial avulsion fixation. The timing of surgery within the first three weeks does not significantly affect functional outcomes. Future research with larger sample sizes and longer follow-ups is recommended to further validate these findings and optimize surgical strategies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee Institute of Medical Sciences (IMS) and Sum Hospital issued approval Ref.no/IEC/IMS.SH/SOA/2022/335. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar Das et al.)

The study aimed to investigate nutrition-related health behaviors among nursing and medical students compared to healthcare workers (HCWs), including nurses and physicians. A cross-sectional survey was conducted between May and November 2022, using the I-MEDAS and lifestyle-related behavior questionnaires. The participants included nursing and medical students, nurses, and physicians, with a total of 384 participants: 16.9% physicians, 23.17% nurses, and 59.9% students, 93% of whom were nursing students. The average I-MEDAS score (out of 17) was 7 for physicians, 8 for nurses, and 8 for students, with no significant differences in lifestyle behavior scores between the groups (p = 0.11), although nurses tended to score lower. Nurses also had a significantly higher BMI compared to physicians and students (p < 0.001). Physicians and nurses reported lower engagement in leisure activities and household chores, fewer sleep hours, and poorer sleep quality. The findings highlight a decline in healthy lifestyle behaviors and poor adherence to the Mediterranean diet among HCWs and students, particularly nurses, emphasizing the need for interventions to promote healthier habits in these groups., (© 2024 The Author(s). Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.)

Introduction: First carpometacarpal (CMC) joint arthritis is a common debilitating condition affecting thumb function. Surgical management often involves trapeziectomy to alleviate pain and restore functionality. The suspensionplasty techniques maintain the trapezial height after trapeziectomy. The older techniques used the help of ligamentoplasty by taking the flexor carpi radialis or the abductor pollicis longus. A new technique of suspensionplasty where the first metacarpal is suspended to the second by means of a strong suture material (fiberwire) and tied with help of a suture button (Mini TightRope; Arthrex, Naples, FL, USA). This technique is less invasive than the previous ligamentoplasties, because there is no need to harvest another nearby tendon. The addition of Mini TightRope suspensioplasty aims to stabilize the joint, potentially improving outcomes., Methods: A retrospective analysis was conducted on 20 patients undergoing trapeziectomy and Mini TightRope suspensioplasty between January 2022 and December 2023. Preoperative and postoperative assessments included pain scores, grip strength measurements, range of movement evaluations, and patient-reported outcomes using standardized questionnaires., Results: Significant improvements were observed postoperatively in pain relief, with Visual Analog Scale scores decreasing from 7.8 preoperatively to 1.2 at six months follow-up. Grip strength increased by an average of 35%, and 85% of patients achieved near-normal range of movement. Patient-reported outcomes indicated high satisfaction rates, with enhanced ability to perform daily activities., Conclusion: Trapeziectomy combined with Mini TightRope suspensionplasty demonstrates favorable outcomes in managing first CMC joint arthritis. This approach effectively reduces pain, improves grip strength, and enhances functional capabilities, underscoring its role as a promising surgical option for patients seeking relief from thumb arthritis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Ethics Committee, Institute of Medical Sciences and SUM Hospital issued approval IEC/IMS.SH/SOA/2022/247A. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Das et al.)

Background: In today's world, essential health care services are expected round the clock, leading to distinct shift work requirements. A notable aspect is the "quick return," where the rest interval between nursing shifts is <11 h. Preliminary research suggests a potential association between quick return schedules, diminished sleep quality, and possible nurse burnout. Yet, the motivation of nurses could potentially moderate this relationship., Objective: To examine a moderated-mediation model, whereby sleep duration and nurse's motivation act together to mediate the link between quick return schedules and nurse's burnout., Design: A prospective repeated measures (4-5 nursing shifts per nurse) multi-source (self-report and objective measures) study., Setting: Internal and surgical departments across one large and one medium scale teaching hospitals in Israel., Participants: Registered nurses who provide direct patient care (n = 79) across 369 shifts., Methods: Nurses completed a questionnaire containing personal information and information regarding their shifts during the study week. They wore an accelerometer (a wrist worn device that monitors and records an individual's activity level) during a work-week to objectively determine their sleep duration, completed a motivation questionnaire at the beginning of each shift, and completed a burnout questionnaire at the end of the week. Mixed-model regression analysis was used to test a moderated-mediation model following Hayes' recommendations, whereby the joint effect of sleep duration and motivation mediates the link between quick return schedules and burnout., Results: The moderated-mediation model was supported. Quick return schedules were negatively statistically significantly associated with sleep duration (b = -126.54, SE = 20.85, p < 0.001); so that more frequent quick return schedules were related to shorter sleep duration. However, no direct correlation was observed between sleep duration and burnout (p = 0.171). A statistically significant interaction was observed between sleep duration and motivation (b = 0.00, SE = 0.00, p < 0.001) concerning burnout. Thus, nurses with lower motivation were prone to experiencing higher levels of burnout with shorter sleep duration compared to nurses with higher motivation., Conclusions: The mediating role of sleep duration, moderated by motivation, plays a role in the connection between quick return schedules and burnout. This indicates that nurses can sustain their work motivation even within the demands of quick return schedules, consequently mitigating burnout levels. To prioritize employees' well-being, organizations should adopt shift work structures that minimize quick return schedules and extend nurses' sleep duration. Consequently, managers must employ strategies to enhance nurses' motivation when addressing scenarios that necessitate quick return schedules., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was funded by the Israel National Institute for Health Policy Research (NIHP) (23/2020). The grant provided funding for research assistant salaries but did not cover the author's salary., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Fe-N-C catalysts are currently the leading candidates to replace Pt-based catalysts for the oxygen reduction reaction in proton exchange membrane fuel cells. To maximize their activity, it is necessary to optimize their structure to allow high active site density on one hand, and hierarchical porous structure that will allow good mass transport of reactants and products to and from the active sites on the other hand. Hence, the hierarchical structure of the catalyst plays an important role in the balance between the electrochemical active site density and the mass transport resistance. Aerogels were synthesized in this work to study the interplay between these two parameters. Aerogels are covalent organic frameworks with ultra-low density, high porosity, and large surface area. The relative ease of tuning the composition and pore structure of aerogels make them prominent candidates for catalysis. Herein, we report on a tunable Fe-N-C catalyst based on an Fe porphyrin aerogel, which shows high electrocatalytic oxygen reduction reaction activity with tunable hierarchical pore structure and studied the influence of the porous structure on the overall performance in proton exchange membrane fuel cells.

Aerogels are a very interesting group of materials owing to their unique physical and chemical properties. In the context of electrocatalysis, the focus has been on their physical properties, and they have been used primarily as catalyst supports so far. In this work, we synthesized porphyrin aerogels containing Ni and NiFe mixed metal materials and studied them as catalysts for the oxygen evolution reaction (OER). Different Ni : Fe ratios were synthesized and studied in electrochemical cells, and DFT calculations were conducted in order to gain insight into their behavior. The activity trends were dependent on the metal ratios and differ from known NiFeOOH materials due to the change in the oxidation states of the metals to higher numbers. Herein, we show that Ni and Fe have a synergistic effect on the OER, despite being structurally separated. They are connected electronically, though, through a large organic aromatic system that facilitates electron sharing between them. Among the mixed metal porphyrin aerogels, the best ratio was found to be Ni : Fe = 35 : 65, in contrast to oxide/oxyhydroxide materials in which a ratio of 80 : 20 was found to be ideal.

Introduction: Pelvic bone fracture is often observed in high-speed road traffic accidents, and forms a medical emergency as it is often complicated with associated internal exsanguination, shock, and mortality. Managing such cases cost-effectively in a developing country with limited assets, without compromising on patient outcomes still remains an obstacle., Objective: To compare and contrast the clinical aftermath of urgent non-surgical and surgical treatment of closed pelvic ring fracture patients and to analyze the types and severity of complications and final functional outcome., Material and Methods: Twenty-five patients with pelvic fractures received at the casualty of IMS and SUM Hospital, Bhubaneswar, between January 2017 and January 2018 were included in the study. Marvin Tile classification was used to classify the fractures. Analysis and assessment of patients were done preoperatively and at six-month follow-up after management, with radiology and functional score using D'Aubinge-Postel Scale. The mode of injury, various management protocols for each type of fracture pattern, and associated complications were also noted. And finally, an outcome comparison was drawn between surgical and non-surgical options for various fractures. A Chi-square test was used to compare the outcomes., Results: The functional outcome as per the D'Aubigne-Postel Scale, on average six months, was excellent in nine patients (36%), good in seven (28%), fair in four (16%), and poor in four (16%). The outcome comparison was insignificant statistically in both radiological assessment (p 0.614) and functional scores (p 0.26) between the conservative and surgical outcomes. The average duration of hospital stay, duration to ambulation, duration to full recovery, and complications were significantly more in patients managed conservatively. While the cost of treatment was more in the surgical group. One death was observed in the study group due to septicemia which might have been directly related to the severity of pelvic injury and choice of treatment., Conclusion: Tile's Type B and C fractures, managed surgically allow faster mobilization of the patient and a shorter recovery period while the cost of treatment is significantly more. Tiles type A is best managed conservatively., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mishra et al.)

With improved life expectancy and ever-increasing geriatric population with concomitant osteoporosis, there is increase in osteoporotic intertrochanteric hip fractures. Even the best surgical advances fail to provide satisfactory and early results. As a result, researchers' focus has lately shifted to developing a more integrated approach that combines the pharmacotherapeutic capabilities of teriparatide, a recombinant version of human parathyroid hormone (1-34), a new anabolic drug that enhances bone mass and strength by promoting osteoblastic activity and hastens fracture union in both human and animals. We attempted to evaluate the therapeutic efficiency of teriparatide therapy on outcomes of surgically managed Intertrochanteric hip fractures in osteoporotic patients. A total of 31 patients with established osteoporosis and Intertrochanteric fractures were selected and divided into two groups, managed surgically with proximal femur nailing, and then prospectively compared with one group receiving teriparatide therapy in addition to standard treatment after taking necessary consent and allocation into two groups based on the preference of patients to take additional teriparatide or not after understanding the benefits and risks involved. We aimed to assess the functional and radiological effects of teriparatide on bone mineral density, the time taken for fracture union, and other fracture-related postoperative complications such as weight bearing and residual bone pain. All patients were followed up at 6, 12, and 24 weeks. Time to fracture union was significantly shortened, with considerable improvement in bone density and functional outcome in the teriparatide group. Varus collapse, the rate of migration of the helical blade, and shortening of the femoral neck were also significantly less in the study group. From the assembled data, we can safely assume that with early union rates with better functional improvement with additional advantage of increased bone mass, we favor supplemental teriparatide therapy in the management of osteoporotic patients with femoral intertrochanteric fractures to augment healing. Further studies with a larger sample size are required to support our observation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mishra et al.)

The development of precious group metal-free (PGM-free) catalysts for the oxygen reduction reaction is considered as the main thrust for the cost reduction of fuel cell technologies and their mass production. Within the PGM-free category, molecular catalysts offer an advantage over other heat-treated PGM-free catalysts owing to their well-defined structure, which enables further design of more active, selective, and durable catalysts. Even though non-heat-treated molecular catalysts with exceptional performance have been reported in the past, they were rarely tested in a fuel cell. Herein, we report on a molecular catalyst under alkaline conditions: fluorinated iron phthalocyanine (FeFPc) supported on cheap and commercially available high-surface area carbon─BP2000 (FeFPc@BP2000). It exhibits the highest activity ever reported for molecular catalysts under alkaline conditions in half-cells and fuel cells.

In order to solely rely on renewable and efficient energy sources, reliable energy storage and production systems are required. Hydrogen is considered an ideal solution as it can be produced electrochemically by water electrolysis and renewably while no pollutants are released when consumed. The most common catalysts in electrolyzers are composed of rare and expensive precious group metals. Replacing these materials with Earth-abundant materials is important to make these devices economically viable. Metal organic frameworks are one possible solution. Herein we demonstrate the synthesis and characterization studies of metal benzene-tri-carboxylic acid-based metal-organic frameworks embedded in activated carbon. The conductive composite material was found to be electrocatalytically active for both the oxygen evolution reaction and the hydrogen evolution reaction. Furthermore, several metal organic frameworks sharing the same ligand but with different first-row transition metals (M = Co, Cu, Fe, Mn) were compared, and the trend of their activity is discussed. Cobalt was found to have the highest activity among the studied metal centers, and therefore has the best potential to serve as a bifunctional catalyst for alkaline electrolyzers.

Molecular oxygen reduction reaction catalysts based on metallo-corrole with the smallest meso-substituent reported to-date, Co(iii)CF 3 -corrole, was synthesized and compared to the well-studied Co(iii)tpfcorrole when adsorbed on a high surface area carbon support. This study shows the improved electrocatalytic performance with the new corrole, attributed to its unique compact structure, which enables surface interactions in favor of lowering the reaction overpotential by 70 mV.

Aerogels are fascinating materials that can be used for a wide range of applications, one of which is electrocatalysis of the important oxygen reduction reaction. In their inorganic form, aerogels can have ultrahigh catalytic site density, high surface area, and tunable physical properties and chemical structures-important features in heterogeneous catalysis. Herein, we report on the synthesis and electrocatalytic properties of an iron-porphyrin aerogel. 5,10,15,20-(Tetra-4-aminophenyl)porphyrin (H 2 TAPP) and Fe II were used as building blocks of the aerogel, which was later heat-treated at 600 °C to enhance electronic conductivity and catalytic activity, while preserving its macrostructure. The resulting material has a very high concentration of atomically dispersed catalytic sites (9.7×10 20  sites g -1 ) capable of catalyzing the oxygen reduction reaction in alkaline solution (E onset =0.92 V vs. RHE, TOF=0.25 e -  site -1  s -1 at 0.80 V vs. RHE)., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Aims: The aim of this study was to examine the effectiveness of a scheduled 30-min nap and its interaction with individual factors on sleepiness and cognition during an 8-hr night shift., Design: This prospective, within-subjects study conducted between 2011-2014 compared sleepiness and cognition with/without a nap during the night shift, in 109 female nurses, tested on two nights with and two nights without a nap in counterbalanced order., Methods: Nurses completed the Munich ChronoType Questionnaire for Shiftwork, Pittsburgh Sleep Quality Index and Pre-Sleep Arousal Scale at study onset. They reported sleepiness hourly and performed the Digit Symbol Substitution and the Letter Cancellation Tasks at 3:00 and 7:00 a.m. They took a nap at 4:00 a.m. on nap nights and worked as usual on no-nap nights. Sleep-wake patterns were monitored using actigraphs 24 hr before and during the shift. Caffeine consumption, workload and adverse events were reported. To assess the effectiveness of a scheduled nap, mixed-models and repeated measures analyses of variance were used., Results: Lower levels of sleepiness were found at 5:00, 6:00 and 7:00 a.m. on nap versus no-nap nights. Increments in performance between 3:00-7:00 a.m. were significantly greater on nap versus no-nap nights for Digit Symbol Substitution Task correct responses and Letter Cancellation Task capacity. No interactions between the nap and any of the individual factors emerged., Conclusion: A scheduled nap provides an effective countermeasure against the negative consequences of night-time shift work in female nurses above and beyond interpersonal differences., Impact: Changes in attitude and policy are required to implement this beneficial and cost-effective strategy., Trial Registration Number: ACTRN12618001857291., (© 2019 John Wiley & Sons Ltd.)

One of the most important chemical reactions for renewable energy technologies such as fuel cells and metal-air batteries today is oxygen reduction. Due to the relatively sluggish reaction kinetics, catalysts are necessary to generate high power output. The most common catalyst for this reaction is platinum, but its scarcity and derived high price have raised the search for abundant nonprecious metal catalysts. Inspired from enzymatic processes which are known to catalyze oxygen reduction reaction efficiently, employing transition metal complexes as their catalytic centers, many are working on the development of bioinspired and biomimetic catalysts of this class. This research news article gives a glimpse of the recent progress on the development of bioinspired molecular catalyst for oxygen reduction, highlighting the importance of the molecular structure of the catalysts, from advancements in porphyrins and phthalocyanines to the most recent work on corroles, and 3D networks such as metal-organic frameworks and polymeric networks, all with nonpyrolyzed, well-defined molecular catalysts for oxygen reduction reaction., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Decline in cognitive functioning in the workplace is a major concern for health care systems. Understanding factors associated with nighttime functioning is imperative for instituting organizational risk management policies and developing personalized countermeasures. The present study aims to identify individual factors associated with cognitive functioning during the night shift of hospital nurses working on irregular rotating-shift schedules. Ninety-two female nurses were recruited from 17 wards in two general hospitals, using convenience sampling by clusters. Inclusion criteria were working at least 28 h a week (75% of full time) and one night shift per week. Exclusion criteria were pregnancy, diagnosed sleep disorders or medical conditions that may affect sleep and/or function. Cognitive performance was measured during the middle (03:00 h) and at the end (07:00 h) of the night shift using the Digit Symbol Substitution Task (DSST) and the Letter Cancellation Task (LCT) over two night shifts. Subjective sleepiness was assessed by the Karolinska Sleepiness Scale (KSS) at the same time points. All participants completed a sociodemographic questionnaire, the Munich ChronoType Questionnaire for Shift-Workers (MCTQShift) and the Pittsburgh Sleep Quality Index (PSQI). Sleep duration 24 h before the night shift and time awake since last sleep opportunity were monitored by actigraphy. Univariate repeated measures ANOVA found main effects for clock time (p<0.001), age (p<0.05), time awake (p<0.05) and sleepiness (p<0.01) for DSST correct responses; main effects for clock time (p<0.001) and sleepiness (p<0.001) for LCT capacity; and main effects for clock time (p<0.001) and age (p<0.01) for LCT omission errors. All factors remained significant in a mixed-model analysis for DSST. Cognitive performance among hospital nurses is low during the middle of the night shift and increases at the end of the shift; decreased functioning is associated with increased subjective sleepiness, older age and prolonged time awake. Identifying factors contributing to performance during the night shift may provide a basis for the development of risk management policies and preventative interventions.

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift. Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.

Aim: To study current treatment options for pediatric hepatitis C infection and their associated success rates., Methods: We retrospectively reviewed charts of thirty children who had been treated with combination therapy of pegylated interferon alfa plus ribavirin for chronic hepatitis C infection. Patients had been treated with ribavirin (15 mg/kg per day) and either pegylated interferon alfa 2a (180 mg/m(2) once weekly) or pegylated interferon alfa 2b (1.5 mg/kg once weekly). Patients' follow-up included subjective assessment of complaints, physical examination including weight and height, as well as laboratory evaluations for viral load [before treatment, at 12 wk, and 6 mo following treatment completion, as determined by sustained viral response (SVR)], complete blood count, liver enzymes, alkaline phosphatase, bilirubin, renal function tests, and thyroid function tests. For patients not achieving a two log decrease in viral load at treatment week 12, treatment was discontinued and the patient was considered a treatment non-responder., Results: Thirty children aged 3-18 years were included in the study. Twenty patients (11 males, 9 females) received pegylated interferon alfa 2b and ten patients (6 males, 4 females) received pegylated interferon alfa 2a. Twenty-three patients were infected with genotype 1, six patients were infected with genotype 3, and one patient was infected with genotype 2. Twenty patients (67%) achieved SVR. Treatment success rates were 90% with pegylated interferon alfa 2a vs 55% with pegylated interferon alfa 2b. Although a trend was noted for improved outcomes in the group receiving pegylated interferon alfa 2a, there were no statistically significant outcome differences between the two treatment groups (P = 0.1). Treatment success was 56.5% for patients infected with genotype 1 virus, compared to 100% for patients infected with other genotypes (P = 0.064). There was no difference in treatment response between males and females. A cut-off age of twelve years was used to dichotomize younger vs older participants; however, no difference in treatment response was observed between these groups. Using multivariate regression analysis, we could not determine predictors for achieving SVR from among the variables we examined (age, sex, and viral genotype). Although we noted a trend toward SVR with peginterferon alfa-2a, there was no statistical difference between the two peginterferons. A high incidence of adverse reactions to treatment was noted. Twenty-five patients (83%) suffered from at least one adverse reaction, but most experienced more than one adverse reaction. All patients except one became leukopenic (white blood cell count less than 5500 leukocytes/μL), six (20%) became anemic (hemoglobin less than 110 g/L), and one (3.3%) became thrombocytopenic (platelets less than 100 000/μL)., Conclusion: Combination therapy to treat hepatitis C in children is as effective as in adults. There may be a benefit for treatment with pegylated interferon alfa 2a.

Aim: We aimed to study the association between day care attendance and changes in the height, weight and weight/height ratio over a 6-month period., Methods: Data were retrieved from three maternal and child health care centres. Parents were asked to fill a short questionnaire regarding the infant/toddler life style, the day care facilities and the family demographic information., Results: One hundred and seventy infants participated in the study. The research group consisted of 85 infants that had placed in day care centre prior to the age of 18 months. The control group consisted of 85 infants who had placed in day care at a later age. The research group had significantly shorter stature 3 months after day care enrolment (mean height percentiles of 56.9 versus 66.3, respectively, p = 0.024,). This trend was more pronounced after 6 months (mean height percentiles of 52.3 versus 63.7, p = 0.022). We could not, however, demonstrate a concomitant significant deceleration in weight or weight/height percentiles., Conclusions: The explanation for this rather dramatic finding remains speculative. Possible mechanisms are stress-related growth hormone suppression. Our findings reinforce the importance of monitoring infant/toddler weight and height growth velocities, especially when he/she is introduced to day care., (© 2010 The Author(s)/Acta Paediatrica © 2010 Foundation Acta Paediatrica.)

Background and Aims: Over the last years we have noted an association between the endoscopic finding of a continuously patent gastroesophageal junction (GEJ) throughout the procedure and macroscopic or microscopic esophagitis. We could not find documentation for these endoscopic findings as a predictor of esophagitis in the literature. We aimed to find an association between these findings and microscopic and macroscopic esophagitis., Methods: During upper endoscopy, we routinely observe the GEJ for about 60 s and note the behavior of the GEJ and esophageal contractions. Patients with a persistently patent GEJ were recorded. A group of patients referred for upper endoscopy for reasons other than suspected reflux, whose esophagus was normal, and patients with reflux symptoms served as a control groups., Results: We found 21 patients (3.0%) in whom a patent GEJ had been noted. No significant age differences were noted between study and control groups. Eighteen out of 21 patients (86%) in the study group had varying degrees of microscopic esophagitis ranging from mild to severe (ten with mild esophagitis, three with moderate esophagitis, and five with severe esophagitis). Interestingly, ten out of 18 (55%) study patients with esophagitis on biopsies had no evidence of additional esophageal abnormality. Although all control patients had a normally appearing esophagus on upper endoscopy, 8/26 (31%) had mild esophagitis on biopsies. Differences were statistically significant (p < 0.001)., Conclusions: A continuously patent GEJ predicts quite accurately the presence of esophagitis in biopsies and may serve an additional endoscopic finding for the diagnosis of esophagitis especially non-erosive GER.

Background: Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease., Objective: To retrospectively review the experience with children and young adults presenting with halitosis to a pediatric gastroenterology clinic., Methods: A retrospective chart review of patients diagnosed with halitosis as a primary or secondary symptom was conducted. All endoscopies were performed by the same endoscopist., Results: A total of 94 patients had halitosis, and of the 56 patients (59.6%) who were recently examined by a dental surgeon, pathology (eg, cavities) was found in only one (1.8%). Pathology was found in only six of 27 patients (28.7%) who were assessed by an otolaryngology surgeon. Gastrointestinal pathology was found to be very common, with halitosis present in 54 of the 94 (57.4%) patients. The pathology was noted regardless of dental or otolaryngological findings. Most pathologies, both macroscopically and microscopically, were noted in the stomach (60% non-H pylori related), followed by the duodenum and the esophagus. Fifty-two of 90 patients (57.8%) were offered a treatment based on their endoscopic findings. Of the 74 patients for whom halitosis improvement data were available, some improvement was noted in 24 patients (32.4%) and complete improvement was noted in 41 patients (55.4%)., Conclusions: Gastrointestinal pathology was very common in patients with halitosis regardless of dental or otolaryngological findings, and most patients improved with treatment.