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BACKGROUND: A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. OBJECTIVE: We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. METHODS: This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. RESULTS: A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI -2.0 to 3.8), with was no significant effect of group (P=.91). App users engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. CONCLUSIONS: In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. TRIAL REGISTRATION: ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483.

Few national studies have examined the community prevalence of ICD-11 posttraumatic stress disorder (PTSD) and Complex PTSD (cPTSD) symptoms, and their relationship with functioning. A nationally representative Danish sample (n = 689) provided data on trauma exposure. Participants who had experienced at least one traumatic event (n = 470) further provided self-reported data on ICD-11 PTSD and cPTSD, personality, and psychosocial functioning. Mediation analyses and linear regression models investigated the impact of impaired personality functioning, and the severity of PTSD/cPTSD on psychosocial functioning. Despite two-thirds reporting trauma exposure, PTSD and cPTSD prevalence was low (4.7% and 1.9%). Higher severity correlated with lower psychosocial functioning. The influence of impaired personality functioning post-trauma was limited. Replication of findings in clinical samples is warranted. [ABSTRACT FROM AUTHOR]

Introduction: The mental health of populations is usually affected after a disaster event. However, it is not known what the level of mental health of Chinese population 1 year after COVID-19, nor what factors influence it. Aim: This study aimed to examine the mental health status of general population in Chengdu 1 year after COVID-19, and then analyse influencing factors. Method: This study is a cross-sectional survey based on the SCL-90 questionnaire. Continuous data were described as M and SD, and counting data were described as frequencies(n) and percentages (%). Chi-square test or Fisher's exact test were used for statistical inference, and significance variables were included in the binary logistic regression equation for multivariate analysis. Results: There were 172 participants with positive screening results. Age, marital status, number of kids, self-perceived health and the presence of chronic disease had an effect on screening results. Logistic regression analysis showed that age and self-perceived health were the main influencing factors. Discussion: Young people aged 18–19 and those who consider themselves not very healthy were at higher risk of poor mental health 1 year after the COVID-19 outbreak. Impact statement: Community institutions and community workers should focus on the mental health status of people 1 year after COVID-19, with a focus on people with poor self-perceived health and younger age groups, and take early preventive measures. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and sociodemographic profiles of mental morbidity and multimorbidity. Methods: A descriptive analysis was performed with data from 25,269 women and 8,389 men from the French NutriNet-Santé general-population cohort. Participants were split into 8 groups: 1. No mental morbidity; 2. Pure anxiety; 3. Pure insomnia; 4. Pure eating disorders (ED); 5. Comorbid anxiety and insomnia; 6. Comorbid anxiety and ED; 7. Comorbid insomnia and ED; 8. Multimorbid anxiety, insomnia, and ED. Data were weighted using the 2016 French Census and analyzed with Chi2 tests. Results: 40.6% of the participants had ≥1 mental disorder; 2.3% had all 3 disorders. Most pure and comorbid disorders were more common in women than in men. The multimorbidity group had the largest proportions of men who were overweight (52.1%) and current smokers (23.2%). Men with insomnia and ED were the most likely to have obesity (45.8%) and low physical activity (44.3%). Women with ≥2 disorders were the most likely to be current smokers. Conclusion: The findings could inform research, prevention, and public health guidelines for multimorbidity. [ABSTRACT FROM AUTHOR]

Introduction: Genetic counseling and testing in psychiatry warrant attention, but research results on attitude, knowledge, personal experience and interest are limited. There are only a few studies that have compared the opinions of the general population and experts regarding genetic counseling and genetic testing in mental illness. Methods: This study aimed to investigate these gaps through a cross-sectional survey conducted in Austria, involving a sample of the web-active population, representative according to gender, age and geographical location (n=1,000, 24.5% of them had a psychiatric diagnosis), and experts (n=145, 83.4% of them psychiatrists). Two questionnaires were developed. Pearson chi-square statistics were used to compare responses, and regression analyses were employed to measure the strength of psycho-sociodemographic influences on answers. Results: The findings revealed that public considered genetic counseling to be more important than experts did (68.8% versus 54.2%; Pearson chi-square 12.183; df=1; p<0.001). The general population believed that genetic testing is useful for diagnosing mental disorders, which contrasted with experts' opinions (67.9% versus 17.2%; Pearson chi-square 137.236; df=1; p<0.001). Both groups agreed on the potential benefits of pharmacogenetic testing (79% versus 80%). A small number of individuals from the public had sought genetic counseling (8%), and only a minority of experts had specific training and experience in this field (28%). Discussion: This is the first survey study on the topic conducted in Austria, with limited international studies available. Austrian experts place less value on genetic counseling compared to their counterparts in other countries. Despite recognized importance placed on genetic counseling and testing, utilization rates remain low. The value of pharmacogenetics is predicted to increase in the future. Consequently, it is crucial for medical training programs to emphasize the significance of genetic counseling and enhance the understanding of genetic aspects related to mental illnesses to enable experts to provide adequate psychoeducation and personalized care to the extent possible to patients and their families. [ABSTRACT FROM AUTHOR]

Background and Aims: Dehydration is a prevalent and costly healthcare concern, linked to heightened risks of acute kidney injury and in-hospital mortality. Despite its significance, limited evidence exists regarding its prevalence and correlation with renal function decline in apparently healthy individuals. This retrospective cohort study aimed to investigate the prevalence and association of dehydration with renal function decline and the development or progression of chronic kidney disease (CKD) in the general population. Methods: The medical records of subjects undergoing annual health check-ups from 2016 to 2019 at a single center in Taiwan were analyzed, and those with CKD stage V, insufficient data, or an increased estimated glomerular filtration rate (eGFR) were excluded. Serum osmolality, eGFR, and relevant parameters were measured. Logistic regression and Kaplan–Meier analyses were used to assess associations between osmolality and CKD-related outcomes. Results: Among the 4449 eligible subjects, those in the higher osmolality quartiles had an elevated risk of CKD or CKD progression. Multivariate analyses identified age, systolic blood pressure, serum osmolality, uric acid, proteinuria, and a history of diabetes as independent risk factors, with high-density lipoprotein being protective. Cumulative incidence curves demonstrated a significant increase in the risk of CKD with increasing osmolality levels. Restricted cubic spline analyses confirmed a nonlinear relationship between osmolality and CKD risk. Conclusions: Elevated serum osmolality independently predicted renal function decline and CKD development in apparently healthy individuals, and this effect persisted after adjusting for established risk factors. Our findings underscore the importance of addressing dehydration as a modifiable risk factor for CKD. [ABSTRACT FROM AUTHOR]

Purpose: Sleep problems are frequently observed in cancer patients. Multiple questionnaires for assessing sleep quality have been developed. The aim of this study was to present transfer rules that allow the conversion of the patients' scores from one questionnaire to another. In addition, we anchored this common metric to the general population. Methods: A sample of 1,733 cancer patients completed the following questionnaires: Pittsburgh Sleep Quality Index, Insomnia Sleep Index, Jenkins Sleep Scale, EORTC QLQ-C30, and the sleep scale of the EORTC QLQ-SURV100. The methods for establishing a common metric were based on Item Response Theory. Results: The main result of the study is a figure that allows the conversion from one of the above-mentioned sleep scales into another. Furthermore, the scores of the questionnaires can be transferred to theta scores that indicate the position within the group of cancer patients and also to T scores that indicate the position in relation to the general population. The correlations between the sleep scales ranged between 0.70 and 0.85. Conclusions: The conversion rules presented in the study enable researchers and clinicians to directly compare single scores or mean scores across studies using different sleep scales, to assess the degree of sleep problems with regard to the general population, and to relate cutoff scores from one questionnaire to another. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has tremendous impact on public mental health and on psychological resources such as optimism. In this context, positive psychological interventions like the best possible self (BPS) intervention may be useful tools for resource activation. Therefore, a randomized controlled trial, conducted between January and December 2021, compared BPS (n = 87), C-BPS (n = 85), and daily activity writing groups (DA; n = 82) on psychological outcomes. Each group completed a writing task over four consecutive weeks. Data were analysed using repeated measures ANCOVA, controlling for age, gender, educational attainment, relationship status, current work status, dyslexia (perceived or diagnosed), and perceived social support. The BPS led to short-term increases in positive affect and mood, and decreases in negative affect. However, this effect was limited to the first week, but the trajectories suggest temporal trends that warrant further investigation. In addition, the approach holds promise for specific groups (e.g. people with depression). [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association of glycated haemoglobin (HbA1c) and serum glucose with intraocular pressure (IOP) in a large UK general population. Materials and Methods: Participants were selected from the UK Biobank, excluding those with eye conditions that may affect IOP. IOP was measured using an ocular response analyser. Goldmann‐correlated IOP (IOPg) and corneal‐compensated IOP (IOPcc) were outcomes of interest, and ocular hypertension was defined as left‐eye IOPg or IOPcc > 21 mmHg. HbA1c and random (non‐fasting) serum glucose were the exposures of interest. Multivariate restricted cubic spline models, as well as linear regression, were applied to explore the associations of interest. Results: Among 68 806 participants (46.5% male), the mean age was 56.7 years. The mean (standard deviation) for IOPg was 15.7 (3.6) mmHg and 15.9 (3.6) mmHg for IOPcc. Occular hypertension was prevalent in 8055 participants (11.7%) and 4178 participants (6.1%) had diabetes. Those with diabetes had higher IOP and a higher prevalence of ocular hypertension. After adjustment for demographic and clinical variables, HbA1c was positively associated with IOP in participants with diabetes, but not in those without diabetes. For every 10‐mmol/mol increase in HbA1c, IOPg increased by 0.20 mmHg (95% confidence interval [CI] 0.12, 0.28) and IOPcc by 0.15 mmHg (95% CI 0.07, 0.23); the odds of ocular hypertension was increased by 6% (95% CI 1.00, 1.13) in participants with diabetes. A borderline positive association between serum glucose and IOP was found only in participants without diabetes. Conclusions: Impaired glycaemic control was associated with elevated IOP and a possible risk of ocular hypertension among participants with diabetes but of normal ocular health. [ABSTRACT FROM AUTHOR]

Suicide, as an avoidable cause of death in public health systems, currently lacks effective global strategies to prevent it. However, several epidemiological studies found a correlation between the concentration of lithium (Li) in drinking water and lower suicide rates in the general population. Our ecological study investigated this hypothesis in the Rafsanjan district of Iran. Samples from the public water supply in 16 areas in the district were analyzed using the graphite furnace atomic absorption. The resulting data were examined in relation to the suicide attempt from March 2019 to March 2020 obtained from Iran's Ministry of Health's registration system. During that period, 239 suicide attempts were recorded, resulting in an average of 69 individuals (85 women and 54 men) per 100,000 residents of the area. The average Li concentration in the drinking water was 47.30 µg/L (ranging from 9.4 to 141 µg/L). A negative significant correlation (r = -0.551, p = 0.027) between Li concentration in water and the rate of suicide attempt were observed in the studied population. Notably, these findings indicate an inverse significant relationship between Li levels and suicide attempt rate in women (r = -0.725, p = 0.001). This is the first study in Iran that examines the relationship between Li levels in drinking water and suicide attempt rate. The findings of this study support an inverse relationship between the level of Li in public drinking water and the rate of women suicide attempt. [ABSTRACT FROM AUTHOR]

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Rationale: Knowledge regarding the prevalence and shared and unique characteristics of the restrictive spirometric pattern (RSP) and preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs. Objectives: To investigate shared and unique features for RSP and PRISm. Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50–64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score. Odds ratios with 95% confidence intervals (CIs) were calculated using adjusted logistic regression. RSP was defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ≥0.70 and FVC <80%. PRISm was defined as FEV1/FVC ≥0.70 and FEV1 <80%. A local reference equation was applied. Results: The prevalence of RSP and PRISm were 5.1% (95% CI, 4.9–5.4) and 5.1% (95% CI, 4.8–5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease, bronchial wall thickening, interstitial lung abnormalities, and bronchiectasis. Emphysema was uniquely linked to PRISm (odds ratio, 1.69; 95% CI, 1.36–2.10) versus 1.10 (95% CI, 0.84–1.43) for RSP. Coronary artery calcification score ≥300 was related to PRISm, but not among never-smokers. Conclusions: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The global prevalence of overweight/obesity has been rising, and this trend is apparent in US and European incident end‐stage kidney disease (ESKD) populations. We aimed to examine temporal trends in the prevalence of overweight/obesity and underweight among adult incident ESKD patients in Japan by year of dialysis initiation between 2006 and 2019 in comparison with those observed in the Japanese adult population during the same period.Using data from the Japanese Society of Dialysis Therapy Renal Data Registry and the National Health and Nutrition Survey, the sex‐specific prevalence of overweight/obesity and that of underweight (BMI ≥ 25 kg/m2 and <18.5 kg/m2, respectively) were calculated, adjusted for age according to the 2019 Population Census via the direct method. Average annual percentage changes (AAPCs) and corresponding 95% confidence intervals (CIs) were calculated to examine trends.From 2006 to 2019, the age‐adjusted prevalence of overweight/obesity in the incident ESKD population increased for males (AAPC 3.36 [95% CI, 2.70 to 4.09]) and females (AAPC 2.86 [95% CI, 1.65 to 4.19]). The age‐adjusted prevalence of overweight/obesity in the general population increased for males (AAPC 0.87 [95% CI, 0.26 to 1.42]) but not for females (AAPC 0.01 [95% CI, −0.55 to 0.57]). The age‐adjusted prevalence of underweight in the incident ESKD population significantly decreased but was higher than that in the general population for both sexes.An increasing trend of overweight/obesity was observed in the incident ESKD population in Japan. There is a pressing need to address both underweight and overweight/obesity in the incident ESKD population. [ABSTRACT FROM AUTHOR]

Background: While physicians are considered to be more susceptible to developing depressive symptoms, empirical data are lacking. The study aims to compare the risk of depressive symptoms between emergency physicians and the general population in China based on national data. Methods: This was a national cross-sectional study. 10 457 emergency physicians and 101 120 participants from the general population were investigated from July 2018 to August 2018 and January 2019 to February 2019, respectively. PHQ-9 was used to measure depressive symptoms, and a score ≥ 10 indicates major depression. Propensity score matching was adopted to balance the characteristics between emergency physicians and the general population. Multinomial logistic regression model was used to examine the association between occupational groups and the severity of depressive symptoms. Binary logistic regression model was performed to explore the risk factors of major depression among emergency physicians. Results: The prevalence of major depression among emergency physicians was 35.7%, whereas among the general population was 13.9%. Emergency physicians had a 3.65 times higher risk of major depression than the general population. And emergency physician was significantly associated with mild (OR: 3.12, 95% CI 2.95–3.30), moderate (OR: 4.94, 95% CI 4.60–5.30), moderately severe (OR: 9.48, 95% CI 8.61–10.44), and severe depressive symptoms (OR: 14.18, 95% CI 12.47–16.13) compared with none depressive symptoms. Even after matching, the results remained consistent. Factors associated with major depression among emergency physicians included bachelor degree or above (OR: 1.22, 95% CI 1.06–1.40), worked long years (OR: 1.26, 95% CI 1.08–1.46 for 1–5 years; OR: 1.56, 95% CI 1.32–1.84 for ≥ 6 years), experienced workplace violence (OR: 2.51, 95% CI 2.16–2.94), worked more night shifts per month (OR: 1.33, 95% CI 1.16–1.51 for 6–10 times; OR: 1.83, 95% CI 1.58–2.11 for ≥ 11 times), smoked (OR: 1.64, 95% CI 1.47–1.84), and effort-reward imbalance (OR: 4.18, 95% CI 3.62–4.85). Conclusions: Emergency physicians had a higher risk of depressive symptoms than the general population. There is a need for greater awareness of the mental health issues faced by emergency physicians. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The COVID‐19 pandemic has had negative physical and psychological impacts worldwide. However, there has been a lack of real‐world evidence concerning the predictors of severe psychological distress (SPD) among the general population in Japan during the COVID‐19 pandemic. The aim of this study was to examine predictors of SPD during the COVID‐19 pandemic.We investigated the predictors of new‐onset SPD in the general Japanese population using data from a large‐scale internet‐based cohort study.We included 16 489 study participants (age range = 16–81, mean age = 52.7, percentage of male = 50%) in the analysis. Over the course of 1 year from baseline, the estimated proportion of participants who experienced SPD was 5.2% with inverse probability weighting. The predictors of SPD included younger age, being never married, being unemployed, having a higher education background, scoring higher on the Fear of Coronavirus‐19 Scale, experiencing more adverse childhood experiences, reporting poorer subjective health status, and COVID‐19 with oxygen therapy. Our internet‐based survey of the Japanese population may have selection bias, limiting the generalizability to other countries and cultures.This study revealed that being afflicted with COVID‐19 requiring oxygen therapy is the most significant predictor of SPD. In addition, we found that vulnerability to social isolation, such as never being unmarried, anxiety toward COVID‐19, and susceptibility to stress, are predictors of the emergence of SPD. Therefore, the implementation of online support systems and ensuring access to accurate information may protect against SPD during the COVID‐19 pandemic in Japan. [ABSTRACT FROM AUTHOR]

Introduction: The mental health of populations is usually affected after a disaster event. However, it is not known what the level of mental health of Chinese population 1 year after COVID-19, nor what factors influence it. Aim: This study aimed to examine the mental health status of general population in Chengdu 1 year after COVID-19, and then analyse influencing factors. Method: This study is a cross-sectional survey based on the SCL-90 questionnaire. Continuous data were described as M and SD, and counting data were described as frequencies(n) and percentages (%). Chi-square test or Fisher's exact test were used for statistical inference, and significance variables were included in the binary logistic regression equation for multivariate analysis. Results: There were 172 participants with positive screening results. Age, marital status, number of kids, self-perceived health and the presence of chronic disease had an effect on screening results. Logistic regression analysis showed that age and self-perceived health were the main influencing factors. Discussion: Young people aged 18-19 and those who consider themselves not very healthy were at higher risk of poor mental health 1 year after the COVID-19 outbreak. Impact statement: Community institutions and community workers should focus on the mental health status of people 1 year after COVID-19, with a focus on people with poor self-perceived health and younger age groups, and take early preventive measures. [ABSTRACT FROM AUTHOR]

Background: Over the last five decades, a fair number of echocardiographic studies have evaluated the prevalence of mitral valve prolapse (MVP) in various cohorts of individuals, including heterogeneous study populations. The present systematic review has been primarily designed to summarize the main findings of these studies and to estimate the overall MVP prevalence in the general community. Methods: All echocardiographic studies assessing the MVP prevalence in various cohorts of individuals, selected from PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The full texts of 21 studies with 1354 MVP individuals out of 63,723 participants were analyzed. The overall pooled prevalence of MVP was 4.9% (range of 0.6–21%). When dividing the studies in two groups according to the echocardiographic criteria used for MVP diagnosis (less specific old criteria or more specific new criteria, respectively), the estimated pooled prevalence of MVP was 7.8% (range of 2–21%) for the older studies (performed between 1976 and 1998) and 2.2% (range of 0.6–4.2%) for the more recent ones (conducted between 1999 and 2021). Potential selection bias, hospital- or referral-based series, and the use of less specific echocardiographic criteria for MVP diagnosis have been indicated as the main reasons for the higher MVP prevalence detected by the older studies. MVP was commonly associated with a narrow antero-posterior thoracic diameter, isolated ventricular premature beats and nonspecific ST-T-wave abnormalities on a resting electrocardiogram, mild-to-moderate mitral regurgitation (MR), the reduced probability of obstructive coronary artery disease, and a low frequency of serious complications, such as severe MR, infective endocarditis, heart failure, stroke, and atrial fibrillation. Conclusions: MVP has a low prevalence in the general population, regardless of age, gender, and ethnicity, and is associated with a good outcome. [ABSTRACT FROM AUTHOR]

With increasing prevalence rate of depression by years, more attention has been paid to the influence of environmental pollutants on depression, but relationship between exposure to volatile organic compounds (VOCs) and depression is rarely studied. Therefore, this cross-sectional study use the National Center for Health Statistics (NHANES) database (2013–2016 years) to explore association between exposure to multiple VOCs and depression in general population. Multiple linear and logistic regression models were used to analyze the association between urinary VOC metabolism (mVOCs) and depression. To further analyze effect of multiple mVOCs mixed exposure, Bayesian kernel machine regression (BKMR) models were performed. A total of 3240 participants and 16 mVOCs were included in the analysis. Results showed that 10 mVOCs exposure were positively correlated with depression by multiple linear and logistic regression models, especially CYMA and MHBMA3, which also showed significant positive association with depression in BKMR model. Mixed exposure of multiple mVOCs was significantly positively correlated with depression. Gender differences were existed in effects of some VOCs concentrations on depression. AAMA, CYMA and MA had significant positive correlations with depression by women, and DHBMA had significant positive correlations with depression by men. Hence, this study showed that exposing to VOCs might have negative impacts on depression, and impact of CYMA and MHBMA3 on depression may be more evident, which provide new ideas for prevention and control of depression. But further research and exploration are needed to clarify the mechanism and influence factors of this relationship, to demonstrate the reliability of these relationship. • 10 mVOCs severally had significantly positively correlated with depression, especially CYMA and MHBMA3. • 16 mVOCs mixed exposure had a positive exposure-response relationship with depression at high concentrations. • Positive associations between DHBMA and depression were more significant in the male group. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) contributes to decreased life expectancy. We examined the association between leisure-time physical activity (LTPA), non-leisure-time physical activity (non-LTPA) and kidney function. Methods: This was a cross-sectional study including 32 162 community-dwelling adults aged ≥ 20 years from the Tohoku Medical MegaBank community-based cohort study. Kidney function was evaluated using cystatin C-based estimated glomerular filtration rate (eGFR) as well as self-reported LTPA and non-LTPA. CKD was defined as either eGFR decline (≤ 60 mL/min/1.73 m2) or presence of albuminuria (albumin-creatinine ≥ 30 mg/g). The association between domain-specific physical activity and kidney function, and CKD prevalence was examined using multivariable-adjusted ordinary least squares and modified Poisson models. Results: The mean eGFR was 98.1 (± 13.2) mL/min/1.73 m2. 3 185 (9.9%) participants were classified as having CKD. The mean LTPA and non-LTPA levels were 2.9 (± 4.2) and 16.6 (± 14.2) METs-hour/day, respectively. For LTPA, in the adjusted model, the quartile groups with higher levels had a higher kidney function (β, 0.36; 95% confidence intervals [CI], [0.06, 0.66]; p = 0.019 for the 2nd quartile, β, 0.82; 95% CI, [0.51, 1.14]; p < 0.001 for the 3rd quartile, and β, 1.16; 95% CI, [0.83, 1.49]; p < 0.001 for the 4th quartile), whereas there were no apparent associations for prevalence of CKD. For non-LTPA, 4th quartile was associated with decreased eGFR (β, -0.42; 95% CI, [-0.72, -0.11]; p = 0.007) and higher prevalence of CKD prevalence (Prevalence ratio, 1.12; 95% CI, [1.02, 1.24]; p = 0.022). These associations with kidney function remained consistent in the subgroup analyses divided by demographic and biological variables. Conclusions: We observed a positive association between higher LTPA levels and better kidney function, but not association with CKD prevalence. In contrast, higher non-LTPA was negatively associated with both kidney function and CKD prevalence. These findings suggest that promoting LTPA is beneficial for kidney function. [ABSTRACT FROM AUTHOR]

Background: The association between arterial stiffness and alcohol consumption is still controversial. We investigated this relationship by performing continuous analysis in men drinking only beer/cider, and women drinking only red wine. Methods: This cross‐sectional study involved participants aged 40–69 years consisting of 9029 men who drank only beer/cider, and 6989 women drinking only red wine. Alcohol consumption was captured by self‐reported questionnaire and reported as units per week, where one unit is equal 10 mL pure ethanol. Arterial stiffness index (ASI) was estimated using photoplethysmography. Results: In men consuming a mean 17.8 (5th and 95th percentiles, 2.6–76.7) units/week, ASI increased by heptiles (sevenths) of alcohol captured from beer/cider consumption and after adjusting for age (9.14, 9.40, 9.51, 9.53, 9.80, 9.80, 10.00 m/s; p‐trend < 0.001) and after full adjustment (9.29, 9.46. 9.55, 9.55, 9.73, 9.73, 9.75 m/s; p‐trend = 0.013). Similarly, in women consuming a mean 8.1 (1.6–29.3) units/week, ASI increased by heptiles of alcohol captured from red wine consumption and after adjusting for age (8.05, 8.05, 8.05, 8.11, 8.17, 8.30, 8.45 m/s; p‐trend = 0.012) and borderline significant after full adjustment (8.05, 8.07, 8.05, 8.07, 8.11, 8.22, 8.43 m/s; p‐trend = 0.055). These associations were confirmed in multivariable‐adjusted regression analysis in all men, men younger and older than 50 years, and when consuming more than 14 units per week. Similarly, these associations were confirmed in all women, women older than 50 years, and in those consuming more than 14 units per week. Conclusions: Positive linear relationships exist between arterial stiffness and alcohol, irrespective of whether captured from beer/cider consumption in men or red wine consumption in women. No evidence existed to support the notion that our arteries benefit from any level of alcohol consumption. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Hair dyes are widely used in daily life. However, data on self‐reported adverse skin reactions are scarce.To estimate the proportion of lifetime hair dye use and self‐reported adverse skin reactions in the Dutch general population, and to investigate the association between (adverse skin reactions to) hair dye use and contact allergy‐related factors.This cross‐sectional study collected questionnaire‐derived data from the Lifelines cohort. Logistic regression analyses were conducted between (adverse skin reactions to) hair dye use and black henna tattoo use, reactions to henna tattoos, patch testing, hand eczema and an occupation as hairdresser or beautician.The proportion of hair dye use was 63.1% of 70 987 participants, of which 6.8% experienced adverse skin reactions, mostly mild (77.7%). Hair dye users and those with skin reactions were both positively associated (p < 0.05) with female sex, middle‐age, (positive) patch test results and hairdresser or beautician occupations. Hair dye users were more likely to have had henna tattoos, and those with reactions to hair dye were more likely to have had reactions to henna tattoos.Hair dye use is prevalent among the Dutch general population and frequently causes adverse skin reactions, especially in females who had black henna tattoos. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy has been suggested to increase the risk of urinary incontinence (UI), although evidence is controversial. In our population‐based cohort study, we aimed to assess the independent effect of hysterectomy on the risk of de novo UI. Material and Methods: This is a population‐based cohort study on the women of the Northern Finland Birth Cohort 1966 (n = 5889). We identified all hysterectomies among the cohort (n = 461) using the national Care Register for Health Care and classified them according to surgical approach into laparoscopic (n = 247), vaginal (n = 107), and abdominal hysterectomies (n = 107). Women without hysterectomy formed the reference group (n = 3495). All women with UI diagnoses and operations were identified in the register, and women with preoperative UI diagnosis (n = 36) were excluded from the analysis to assess de novo UI. Data on potential confounding factors were collected from registers and the cohort questionnaire. Incidences of different UI subtypes and UI operations were compared between the hysterectomy and the reference groups, and further disaggregated by different hysterectomy approaches. Logistic regression models were used to analyze the association between hysterectomy and UI, with adjustments for several UI‐related covariates. Results: We found no significant difference in the incidence of UI diagnoses or the rate of subsequent UI operations between the hysterectomy and the reference groups (24 [5.6%] vs. 166 [4.7%], p = 0.416 and 14 [3.3%] vs. 87 [2.5%], p = 0.323). Hysterectomy was not significantly associated with the risk of any subtype of UI (overall UI: OR 1.20, 95% CI 0.77–1.86; stress UI (SUI): OR 1.51, 95% CI 0.89–2.55; other UI: OR 0.80, 95% CI 0.36–1.74). After adjusting for preoperative pelvic organ prolapse (POP) diagnoses, the risk was decreased (overall UI: OR 0.54, 95% CI 0.32–0.90; other than SUI: OR 0.40, 95% CI 0.17–0.95). Regarding different hysterectomy approaches, the risks of overall UI and SUI were significantly increased in vaginal, but not in laparoscopic or abdominal hysterectomy. However, adjusting for preoperative POP diagnosis abolished these risks. Conclusions: Hysterectomy is not an independent risk factor for de novo UI. Instead, underlying POP appears to be a significant risk factor for the incidence of UI after hysterectomy. [ABSTRACT FROM AUTHOR]

Demoralization comprises multiple dimensions. Among them, Subjective Incompetence (SI) is the perception of being incapable of appropriate action in demanding circumstances. SI may be an early sign of demoralization preceding hopelessness, thus we aimed at integrating items related to Subjective Incompetence into the clinical assessment of demoralization. We assessed 414 subjects from the general population with the Demoralization Scale, 24 items (DS24) and the Subjective Incompetence Scale, 12 items (SIS12). We used multiple approaches to detect the optimal number of factors and their item structure, then conducted Bayesian Item Response Theory analyses to study item psychometric properties. Item Response Theory models were used to extrapolate latent severity ratings of clinical dimensions. We modelled the DS24 with five factors (Disheartenment, Sense of Failure, Helplessness, Irritability, Loss of Purpose) and the SIS12 with three (Subjective Incompetence, Inability to plan, Inability to Deal). The more complex IRT model had the best predictive value and helped to identify the items with better discrimination properties across the different dimensions. Twenty items were retained and used to develop the combined Demoralization and Subjective Incompetence Scale (DSIS20), which maintained high correlation with raw and latent trait scores of the longer versions. We combined selected items of the DS24 and the SIS12 to develop the DSIS20, a shorter assessment instrument that includes Subjective Incompetence as well as other clinical dimensions of demoralization. Further study may clarify if DSIS20 may be helpful for the early detection of demoralization. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of poor sleep quality (PSQ) in the general population leads to negative health outcomes. Since estimates of PSQ prevalence in the Chinese general population vary widely, this meta-analysis aimed to refine these estimates and to identify moderating factors. Methods: A comprehensive literature search was undertaken in both international (PubMed, PsycINFO, Web of Science, and EMBASE) and Chinese (Wanfang, and the China National Knowledge Infrastructure databases) databases from inception to 23 November 2023. Studies were required to have used standard scales such as the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). The pooled prevalence of PSQ and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify sources of heterogeneity. Results: In 32 studies with a combined 376,824 participants, the pooled prevalence of PSQ was 19.0% (95% CI 15.8–22.8%; range 6.6–43.6%). Across 22 studies that reported PSQI data, the pooled mean score was 4.32 (95%CI 3.82–4.81; SD = 0.502). The pooled mean sleep duration across 8 studies was 7.62 (95% CI 7.23–8.00; SD = 0.194) hours. Subgroup analyses showed that lower education (Q = 4.12, P = 0.042), living in less developed regions (Q = 60.28, P < 0.001), and lower PSQI cutoff values (Q = 9.80, P = 0.007) were significantly associated with PSQ. Meta-regression analyses showed that study quality was inversely associated with estimated PSQ prevalence (β = − 0.442, P = 0.004). Limitations: Although measures such as subgroup and meta-regression analyses were performed, substantial heterogeneity remained. Information related to sleep quality, such as comorbid physical diseases or psychiatric disorders, substance use, occupational types, and employment status, were not reported in most studies. Conclusion: One in five people in the general population of China may have PSQ and people with lower education or living in western regions may be more susceptible. [ABSTRACT FROM AUTHOR]

The Patient Health Questionnaire (PHQ-15) has been widely used to assess somatic symptoms. This study aimed to analyze the psychometric properties of the Spanish version of the PHQ-15, its structure and score distribution across demographic variables in a Spanish sample. In addition, we examined variations in somatic symptoms among different demographic subgroups. 1495 individuals from the Spanish population answered a series of self-reported measures, including PHQ-15. To examine the factorial structure of the PHQ-15, Confirmatory Factor Analysis (CFA) was performed. Additionally, a bifactor CFA model was examined using the Exploratory Structural Equation Modeling (ESEM) framework. Women showed more somatic symptoms than men, and younger individuals showed more somatic symptoms than the older ones. It was also revealed positive associations between somatic symptoms and levels of depression, anxiety, and suspiciousness, while negative associations were found between somatic symptoms and perceived resilience and happiness. Regarding the factorial structure of the PHQ-15, although the one-factor and bifactor models were suitable, the bifactor model underscores the presence of a robust general factor. It is a cross-sectional study, not including non-institutionalized individuals. Somatic symptoms are more frequent in women and younger individuals. Furthermore, the presence of physical symptoms is associated to other psychological aspects, such as depression or anxiety. Finally, bifactor model was the most appropriate to explain the factorial structure of the PHQ-15. • Women present more somatic symptoms than men. • Younger individuals have more somatic symptoms than older ones. • Somatic symptoms are positively associated with depression and anxiety. • The structure of the PHQ-15 fits well with a bifactor model. [ABSTRACT FROM AUTHOR]

Background: On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel's southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation. Methods: Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14–21, 2024 (N = 1,360), and the evacuees' data from March 1–9, 2024 (N = 372; 133 from the north, 239 from the south). Results: Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples. Conclusions: The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges. [ABSTRACT FROM AUTHOR]

Negligence is defined as doing something which reasonably competent people not suppose to do or not doing something which reasonably competent persons suppose to do. Present cross sectional study was undertaken with aim to assess knowledge and awareness of general population visiting Out Patient Departments (OPD) of Civil Hospital associated B. J. Medical College, Ahmedabad towards medical negligence and legal proceeding regarding medical negligence. Total 350 people from general population were subjected to pre-tested and pre-validated questionnaire related to medical negligence after obtaining their informed written consent. Questionnaire contain 16 questions related to medical negligence and legal proceeding regarding medical negligence with responses based on Likert's scale varied from strongly disagree to strongly agree. Responses obtained were tabulated in MS Excel sheet and analyzed via SPSS software. Out of 350 participants, 32.8% were between 31-40 years age group, 64% were male. Total 54% were agreed upon that failure to maintain a medical record by hospital is negligence. 65% were agreed that doctor can be liable for negligence. 67% were agreed upon that performing operation without informed written consent is negligence. 30% were agreed upon that treating a patient without his consent is negligence. 81% were strongly agreed upon that carelessly leaving an instrument in patient's body after operation is negligence. 49% were strongly agreed upon that refusing to attend patient in emergency is negligence. 57% were strongly agreed upon that death due to negligence is punishable by court. 44% were agreed upon that compensation for negligence can be claimed in consumer court. 53% were agreed about that wrong diagnosis followed by wrong treatment is considered as negligence. 50.5% of participants were agreed upon that postmortem is necessary in case of death due to medical negligence, while 34.8% were disagreed. All participants believed and agreed upon that threaten or attack on a doctor is punishable in court even if doctor is truly negligent. Present study reflected that general population has quite a good knowledge regarding medical negligence which may increase gradually over a period of time due to news papers, internet and other resources but less knowledge about legal proceedings regarding medical negligence. Training programs should be conducted for them to bring true knowledge and awareness regarding medical negligence which indeed helps to them as well as medical professionals. [ABSTRACT FROM AUTHOR]

Background: Alcohol use is one of the leading public health concerns in the Czech Republic. Drinking motives play a vital role in both initiation and subsequent alcohol use. A revised version of the self-report Drinking Motives Questionnaire (DMQ-R) has been proposed to assess these motives. The present study aims to validate the DMQ-R in the Czech general population. Methods: A total sample of 1,784 Czech participants completed a national survey. For the analysis, only a sub-sample of the past 12 months alcohol users was used: N = 1,123; 52.8% male; mean (SD) age = 40.2 (13.3). Drinking motives were assessed by the adopted Czech version of the DMQ-R. Both confirmatory (CFA) and exploratory factor analysis (EFA) were conducted to examine the factorial structure of the instrument. The age of the participant was additionally considered in the analysis (15–24 years as opposed to 25–64 years). Results: The CFA supported the four-factor model in the 25–64 age group. The analysis supported the construct validity of the Social, Conformity, and Coping factors. The Enhancement factor retained only two items and was found to refer more to a domain of 'Pleasant Feeling'. For the 15–24 age group, the hypothesised four-factor structure was not corroborated. Conclusions: The Czech version of the DMQ-R was found to be a reliable measurement tool of the Social, Conformity, and Coping motives. Future research should investigate the dimensionality of the instrument items presumed to correspond to the Enhancement motives. This should be conducted particularly among adolescents and young adults aged 15–24 years, where administering the DMQ-R with a large enough sample is also needed. [ABSTRACT FROM AUTHOR]

Background: Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artificial UV radiation. Since the incidence of skin cancer is increasing worldwide, it is necessary to monitor UV-related risk behaviors such as intentional indoor and outdoor tanning, as well as sun protection behavior in the general population and specific subgroups and settings. This is the aim of the National Cancer Aid Monitoring online (NCAM-online), a continuation and further development of the NCAM. Methods: The NCAM-online is a longitudinal trend study consisting of four annual survey waves. Each year, 4,000 individuals aged 16–65 years living in Germany will be surveyed using online questionnaires. Each year, intentional indoor and outdoor tanning will be assessed. In addition, varying specific topics regarding skin cancer prevention, such as the utilization of skin cancer screening, will be addressed in the questionnaires. Discussion: The findings of the NCAM-online will provide an important basis for the German Cancer Aid and Working Group on Dermatologic Prevention (Arbeitsgemeinschaft Dermatologische Prävention, ADP) to develop targeted prevention campaigns and projects aimed at preventing skin cancer. The explorative nature of the NCAM-online allows for the identification of new potential starting points for prevention and education. In addition, the longitudinal design allows for a description of the trend in the prevalence of intentional tanning. For tanning bed use, representative trend data from 2012 are available for Germany, to which NCAM-online will add annual data until 2027. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Studies on wet work and hand eczema (HE) frequently rely solely on self‐reports regarding wet work.To assess the association between wet work and moderate‐to‐very‐severe HE, within the Dutch general population, by using a (sex‐specific) job exposure matrix (JEM).Within the Lifelines Cohort Study, participants with self‐reported moderate‐to‐very‐severe HE at worst in the past year were linked to data from the Danish (sex‐specific) wet work JEM, a tool that links occupations with wet work indices (including duration and probability of glove use, wet hands and total wet work for at least 2 and 4 h/working day).In total, 56 978 (41.9%) participants were included. The multivariate binary logistic regression analyses showed significant associations between all facets of wet work and moderate‐to‐very‐severe HE. When using the sex‐specific JEM, significant associations were found in females, but not in males.This study is the first to use a wet work‐specific JEM in a general population sample, and found positive associations between wet work and HE. The sex‐specific findings should be interpreted with caution, due to limitations inherent in using a JEM, and should be further explored with observational studies, with a focus on duration, frequency, and exposure type. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia has been associated with reduced bone mineral density and osteoporotic fractures, but the relation between lipid and bone metabolism remains poorly understood. Analysing the effects of lipoprotein subclasses on bone turnover may provide valuable insights into this association. We therefore examined whether lipoprotein subclasses, measured by proton nuclear magnetic resonance (1H-NMR) spectroscopy, are associated with bone turnover markers (BTMs) and with the ultrasound-based bone stiffness index. Methods: Data from 1.349 men and 1.123 women, who participated in the population-based Study of Health in Pomerania-TREND were analysed. Serum intact amino-terminal propeptide of type I procollagen (P1NP, bone formation) and carboxy-terminal telopeptide of type I collagen (CTX, bone resorption) concentrations were measured. Associations between the lipoprotein data and the BTMs or the stiffness index were investigated using linear regression models. Results: The triglyceride or cholesterol content in very-low-density lipoprotein and intermediate-density lipoprotein particles was inversely associated with both BTMs, with effect estimates being slightly higher for CTX than for P1NP. The triglyceride content in low-density lipoprotein and high-density lipoprotein particles and the Apo-A2 content in high-density lipoprotein particles was further inversely associated with the BTMs. Associations with the ultrasound-based bone stiffness index were absent. Conclusions: Consistent inverse associations of triglycerides with bone turnover were observed, which argue for a protective effect on bone health, at least in the normal range. Yet, the presented associations did not translate into effects on the ultrasound-based bone stiffness. Further, there was no relevant gain of information by assessing the lipoprotein subclasses. Nevertheless, our study highlights the close relations between lipid and bone metabolism in the general population. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusions Although the evidence is uncertain, existing estimates for hepatitis C virus (HCV) in sub‐Saharan Africa (SSA) indicate a high burden. We estimated HCV seroprevalence and viraemic prevalence among the general population in SSA.We searched Medline, Embase, Web of Science, APA PsycINFO, and World Health Organization Africa Index Medicus for community‐based studies. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool, and heterogeneity using the index of heterogeneity (I2). Two approaches were deployed. First, we used random‐effects meta‐analysis to pool prevalence. Second, to derive representative estimates, we weighted each country's HCV seroprevalence using 2021 United Nations country population sizes.We synthesized 130 studies. Overall, SSA HCV seroprevalence from the random‐effects model was 4.17% (95% confidence interval [CI]: 3.71–4.66, I2 = 99.30%). There were no differences between males (4.31%) and females (4.03%). Seroprevalence was 2.25%, 3.31%, and 16.23% for ages ≤20, 21–64, and ≥65 years, respectively, and was higher in rural (6.63%) versus urban (2.93%). There was indication of decrement overtime from 5.74% to 4.35% to 3.03% in the years 1984–2000, 2001–2014, and 2015–2023, respectively. The weighted overall SSA HCV seroprevalence was estimated to be 2.30% (95% CI: 1.59–3.00) with regional variation: Africa‐Southern (.79%), Africa‐Central (1.47%), Africa‐Eastern (2.71%), and Africa‐Western (2.88%). HCV viremia among HCV seropositives was 54.77% (95% CI: 47.80–61.66).HCV seroprevalence in SSA remains high. Populations aged ≥65 years, rural communities, Africa‐Western, and some countries in Africa‐Central and Africa‐Eastern appear disproportionately affected. These results underline the need for governmental commitment to achieve the 2030 global HCV elimination targets. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether metabolic dysfunction-associated fatty liver disease (MAFLD) defined by the fatty liver index (FLI) affects the decline in kidney function and whether this relationship is still observed in MAFLD defined by ultrasonography (USG). A retrospective cohort study was conducted using de-identified data from participants who received health checkups at Samsung Changwon Hospital between 2002 and 2018. The primary and secondary exposures were the presence of FLI- and USG-defined MAFLD, respectively. The primary outcome was 5-years slope of eGFR. The secondary outcome was a rapid decline in kidney function, defined as a 5-years slope of estimated glomerular filtration rate (eGFR) of less than − 3 mL/min/1.73 m2 per year. A total of 37,500 participants were included in the analysis. Participants with FLI-defined MAFLD had a larger decline in 5-year eGFR slope than those without FLI-defined MAFLD (beta coefficients − 0.11; 95% CI − 0.14 to − 0.08). Participants with FLI-defined MAFLD had a higher risk of rapid kidney function decline than those without FLI-defined MAFLD (odds ratio 1.33; 95% confidence intervals (CIs) 1.05–1.69). However, USG-defined MAFLD was less related to kidney function decline. In conclusion, the presence of FLI-defined MAFLD was associated with larger and faster kidney function decline. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of unruptured intracranial aneurysms (UIAs) in the general population is 3%. Aneurysmal subarachnoid hemorrhage can be prevented by screening for UIAs followed by monitoring and, if needed, preventive neurosurgical or endovascular treatment of identified UIAs. Therefore, we developed a diagnostic model for the presence of UIAs in the general population to help identify persons at high risk of having UIAs. Methods: Between 2005 and 2015, participants from the population-based Rotterdam Study underwent brain magnetic resonance imaging at 1.5 T, on which the presence of incidental UIAs was evaluated. We developed a multivariable logistic regression model using candidate diagnostic markers that were selected based on the literature, including sex, age, hypertension, smoking, hypercholesterolemia, diabetes, alcohol, and their interactions. We corrected for overfitting using bootstrapping. Model performance was assessed with discrimination, calibration, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: 5,835 persons were included (55.0% women, mean age 64.9 ± 10.9 years) with a 2.2% UIA prevalence. Sex, age, hypertension, smoking, diabetes, and interactions of sex with age, hypertension, and smoking were independent diagnostic markers. The resulting model had a c-statistic of 0.65 (95% confidence interval [CI]: 0.60–0.68) and 56% sensitivity, 52% specificity, 98% PPV, and 3% NPV for UIA presence at a cutoff value of 4%. Because of interactions with sex, additional models for men and women separately were developed. The model for men had a c-statistic of 0.70 (95% CI: 0.62–0.78) with age, hypertension, and smoking as diagnostic markers and comparable additional performance values as for the full model. The model for women had a c-statistic of 0.58 (95% CI: 0.52–0.63) with smoking as the only diagnostic marker. Conclusion: Our diagnostic model had insufficient performance to help identify persons at high risk of having UIAs in the general population. Rather, it provides insight in risk factors contributing to UIA risk and shows that these may be in part sex-specific. Plain Language Summary: A burst of a blood vessel in the brain, also known as a ruptured intracranial aneurysm, causes a severe and often fatal type of stroke (aneurysmal subarachnoid hemorrhage). When such an aneurysm has not ruptured yet, it is called an unruptured intracranial aneurysm (UIA). Approximately 3% of persons in the general population have a UIA. We developed models to help identify persons in the general population at high risk of having a UIA. These models show which person characteristics predict the risk of having a UIA. We developed a model for the whole general population and for men and women separately. We found that in the whole general population, female sex, higher age, high blood pressure, and smoking increased the risk of having a UIA, while diabetes decreased this risk. For men separately, only higher age, high blood pressure, and smoking increased the risk of having a UIA. For women separately, only smoking increased the risk of having a UIA. However, the models had insufficient performance to help identify persons at high risk of having a UIA from other persons in the general population. Rather, they provide insight into risk factors contributing to UIA risk and show that these may be in part sex-specific. [ABSTRACT FROM AUTHOR]

Understanding the frequency of abuse suffered by older individuals proves challenging when attempting to link it to everyday social issues due to variations in the interpretation and comprehension of this form of mistreatment. This cross-sectional study conducted in May and June of 2023 aimed to investigate the perceptions and attitudes of the general population in the Republic of Croatia regarding the abuse of older individuals. The research included 822 volunteers aged from 18 to 64 who actively engaged in social media. A self-developed, structured questionnaire (based on an exhaustive review of the relevant literature) that underwent a thorough pilot testing phase to confirm clarity, coherence, and respondent comprehension was used to collect the study data. The data analysis included descriptive statistics, chi-square tests for associations between variables, and Mann–Whitney U and Kruskal–Wallis tests to assess the relationships between correct answers and observed indicators, with a significance level set at p < 0.05 (two-tailed). It can be concluded that there was a statistically significant difference in knowledge of possible causes of abuse depending on the age groups of the respondents (p = 0.001) and their present employment within the health or social system (p < 0.001). A prevailing neutral stance was observed among the majority of the surveyed population regarding the attribution of responsibility to older individuals themselves for any mistreatment they face. When confronted with scenarios illustrating abusive behaviour towards older individuals, the participants exhibited nuanced recognition across different forms of abuse, with the exception of financial abuse, where most participants indicated that there was no abuse or possible abuse. These findings underscore the need for enhanced public education initiatives concerning the diverse manifestations of abuse and neglect within the community of older individuals in the Republic of Croatia. Additionally, there is a pressing need for counselling services aimed at fostering a deeper understanding of the unique needs of older individuals and the underlying factors contributing to abusive behaviour. Through such measures, societal awareness and support mechanisms can be fortified, fostering a culture of respect, empathy, and protection for older adults. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection is among the leading causes of cirrhosis and hepatocellular carcinoma. Knowledge of its prevalence and risk factors can help to effectively fight the virus. This study was the first to investigate the seroprevalence of HCV, its genotypes, and factors associated with it among the general adult population of Armenia selected countrywide via cluster sampling. Anti-HCV antibodies were detected using third-generation immunoassay. Polymerase chain reaction and genotyping was performed among anti-HCV-positive individuals. Shortly after testing, the participants underwent a telephone survey. Logistic regression models were fitted to identify factors associated with anti-HCV antibody positivity and chronic HCV infection. The prevalence of anti-HCV antibodies among 3831 tested individuals was 2% (99% CI 1.4, 2.5), and chronic HCV infection was 0.7% (99% CI 0.4, 1.0), with genotypes 3 and 2 being the most common. The risk factors for chronic HCV infection included self-reported chronic liver disease (95% CI 1.47, 15.28), having tattoos (95% CI 1.34, 10.94), ever smoking (95% CI 1.16, 9.18), and testing positive for hepatitis B virus core antibody (95% CI 1.02, 7.17). These risk factors demonstrate that there could be room for strengthening infection control measures to prevent the transmission of HCV in Armenia. [ABSTRACT FROM AUTHOR]

Objectives: The Mental Health Inventory (MHI‐5) is frequently used as a screener for mood and anxiety disorders. However, few population‐based studies have validated it against a diagnostic instrument assessing disorders following current diagnostic criteria. Methods: Within the third Netherlands Mental Health Survey and Incidence Study (NEMESIS‐3), a representative population‐based study of adults (N = 6194; age: 18–75 years), the MHI‐5 was used to measure general mental ill‐health in the past month. Presence of mood (major depressive disorder, persistent depressive disorder, or bipolar disorder) and anxiety disorders (panic disorder, agoraphobia, social phobia, or generalized anxiety disorder) in the past month was assessed with a slightly modified version of the Composite International Diagnostic Interview 3.0 per the Diagnostic and Statistical Manual of Mental disorders‐5. Results: The MHI‐5 was good to excellent at distinguishing people with and without a mood disorder, an anxiety disorder, and any mood or anxiety disorder. The cut‐off value associated with the highest sensitivity and highest specificity for mood disorder was ≤68, and ≤76 for an anxiety disorder or any mood or anxiety disorder. Conclusions: The MHI‐5 can identify individuals at high risk of a current mood or anxiety disorder in the general population when diagnostic interviews are too time consuming. [ABSTRACT FROM AUTHOR]

With remarkable progress in the field of respiratory syncytial virus (RSV) prophylaxis, it is critical to understand population immunity against RSV. We aim to describe the RSV pre-F IgG antibodies across all age groups in Southern China and to evaluate the risk factors associated with lower antibody levels. We performed a community-based cross-sectional sero-epidemiological study in Anhua County, Hunan Province, Southern China, from July 15, 2021, to November 5, 2021. Serum samples were tested for IgG antibodies against the RSV prefusion F (pre-F) protein using an enzyme-linked immunosorbent assay. We estimated the geometric mean titres (GMTs) and seropositivity rates across all age groups. The generalized linear models were built to identify factors associated with antibody levels. A total of 890 participants aged 4 months to older than 89 years were enrolled. The lowest RSV pre-F IgG GMTs were observed in infants and toddlers aged 4 months to younger than 2 years (3.0; 95% CI, 2.6–3.5). With increasing age, the RSV pre-F IgG GMT increased to 4.3 (95% CI, 4.1–4.4) between the ages of 2 and younger than 5 years and then stabilized at high levels throughout life. All the children had serological evidence of RSV infection by the age of 5 years. Age was associated with RSV pre-F antibody levels in children, with an estimated 1.9-fold (95% CI, 0.8–3.6) increase in titre per year before 5 years of age, although it was not significantly associated with antibody levels in adults aged older than 60 years. Our findings could provide a comprehensive understanding of the gaps in RSV immunity at the population level and inform the prioritization of immunization platforms. [ABSTRACT FROM AUTHOR]

Objectives: Prior analyses of the Occupational Disease Surveillance System (ODSS) have compared cancer rates using internal referent groups. As an exploratory analysis, we sought to estimate cancer risk using general population reference rates to evaluate the impact that the comparison population has on findings from our surveillance program. Methods: A cohort of approximately 2.3 million workers in Ontario, Canada with an accepted lost‐time workers' compensation claim were followed for all cancer diagnoses between 1983 and 2018. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for workers in specific occupational groups using (1) all other workers in the ODSS cohort, and (2) the general population of Ontario. Results: SIRs using the general population reference group were generally equal to or modestly lower compared to SIRs using the internal reference group. Within occupation groups, SIRs had a discordant direction of association (increased rate in the internal comparison and decreased in the external comparison) for some cancer sites including urinary, prostate, and colorectal. Conclusions: Findings emphasize the importance of the choice of reference group when evaluating cancer risks in large occupational surveillance cohorts. Importantly, the magnitude of confounding and the healthy worker hire bias may depend on the occupation group and cancer site of interest. [ABSTRACT FROM AUTHOR]

Abstract Background Mental health apps (MHA) have gained popularity in recent years. Most freely available apps are of low quality and lack evidence for effectiveness. Yet, download rates indicate high usage. MHA are potentially beneficial for individuals with no/low symptom severity as prevention, or as an option to reach underserviced populations. However, currently very little is known about the characteristics of MHA users in the general population, about the kind of MHA used, or the motivation behind MHA usage. Methods We collected survey-data from N = 1,247 individuals from the general population to investigate MHA usage. Results Descriptive statistics revealed that 41% had used MHA in the past 12 months; prescription app-use however was low (1.5% of MHA users). Mindfulness, moodtracking, and relaxation were the most popular categories of MHA. Perceived helpfulness, fun, and availability were the top reasons for MHA usage. Non-users reported distrust, lack of perceived need, and data security concerns as usage barriers. MHA users and non-users did not differ regarding sociodemographic variables. Multiple regression analyses revealed that sub-threshold symptoms of psychological disorders as well as higher levels of anxiety and stress were linked to higher probability of MHA usage. Higher levels of depression were associated with lower likelihood of MHA usage in general, but increased likelihood of usage of self-help apps specifically for depression. Conclusions It follows that MHA use is common in the general population independent of sociodemographic characteristics. MHA can reach people who might benefit, but more awareness and better structure of the market is needed to reduce distrust, increase usage of high-quality MHA, and improve the fit between app and user.

Abstract Background While physicians are considered to be more susceptible to developing depressive symptoms, empirical data are lacking. The study aims to compare the risk of depressive symptoms between emergency physicians and the general population in China based on national data. Methods This was a national cross-sectional study. 10 457 emergency physicians and 101 120 participants from the general population were investigated from July 2018 to August 2018 and January 2019 to February 2019, respectively. PHQ-9 was used to measure depressive symptoms, and a score ≥ 10 indicates major depression. Propensity score matching was adopted to balance the characteristics between emergency physicians and the general population. Multinomial logistic regression model was used to examine the association between occupational groups and the severity of depressive symptoms. Binary logistic regression model was performed to explore the risk factors of major depression among emergency physicians. Results The prevalence of major depression among emergency physicians was 35.7%, whereas among the general population was 13.9%. Emergency physicians had a 3.65 times higher risk of major depression than the general population. And emergency physician was significantly associated with mild (OR: 3.12, 95% CI 2.95–3.30), moderate (OR: 4.94, 95% CI 4.60–5.30), moderately severe (OR: 9.48, 95% CI 8.61–10.44), and severe depressive symptoms (OR: 14.18, 95% CI 12.47–16.13) compared with none depressive symptoms. Even after matching, the results remained consistent. Factors associated with major depression among emergency physicians included bachelor degree or above (OR: 1.22, 95% CI 1.06–1.40), worked long years (OR: 1.26, 95% CI 1.08–1.46 for 1–5 years; OR: 1.56, 95% CI 1.32–1.84 for ≥ 6 years), experienced workplace violence (OR: 2.51, 95% CI 2.16–2.94), worked more night shifts per month (OR: 1.33, 95% CI 1.16–1.51 for 6–10 times; OR: 1.83, 95% CI 1.58–2.11 for ≥ 11 times), smoked (OR: 1.64, 95% CI 1.47–1.84), and effort-reward imbalance (OR: 4.18, 95% CI 3.62–4.85). Conclusions Emergency physicians had a higher risk of depressive symptoms than the general population. There is a need for greater awareness of the mental health issues faced by emergency physicians.

Abstract Background Chronic kidney disease (CKD) contributes to decreased life expectancy. We examined the association between leisure-time physical activity (LTPA), non-leisure-time physical activity (non-LTPA) and kidney function. Methods This was a cross-sectional study including 32 162 community-dwelling adults aged ≥ 20 years from the Tohoku Medical MegaBank community-based cohort study. Kidney function was evaluated using cystatin C-based estimated glomerular filtration rate (eGFR) as well as self-reported LTPA and non-LTPA. CKD was defined as either eGFR decline (≤ 60 mL/min/1.73 m2) or presence of albuminuria (albumin-creatinine ≥ 30 mg/g). The association between domain-specific physical activity and kidney function, and CKD prevalence was examined using multivariable-adjusted ordinary least squares and modified Poisson models. Results The mean eGFR was 98.1 (± 13.2) mL/min/1.73 m2. 3 185 (9.9%) participants were classified as having CKD. The mean LTPA and non-LTPA levels were 2.9 (± 4.2) and 16.6 (± 14.2) METs-hour/day, respectively. For LTPA, in the adjusted model, the quartile groups with higher levels had a higher kidney function (β, 0.36; 95% confidence intervals [CI], [0.06, 0.66]; p = 0.019 for the 2nd quartile, β, 0.82; 95% CI, [0.51, 1.14]; p

Introduction: Rabies, a deadly viral disease transmitted through animal bites, poses a significant public health challenge in many regions, including Puducherry. Effective prevention and control rely heavily on community awareness and perception. Understanding how the general population perceives rabies risk and prevention strategies is crucial for developing targeted public health interventions. Objectives: To describe the sociodemographic profile and to assess community perceptions of rabies prevention and control among the general population in Puducherry. Methods: A community-based cross-sectional study, conducted in the rural and urban Puducherry region from October 2023 to December 2023. A total of 200 individuals were chosen from rural and urban Puducherry regions using a systematic random sampling technique. Individuals over 18 years of age residing in both rural and urban areas of Puducherry were included in the study. Semi-structured questionnaire was used to collect the data and entered in MS Excel 2019. Chi-square test was applied to test the difference in knowledge between urban and rural. Results: The majority of the study participants belonged to the age group of 18-29 years (55%), 152 were males and 48 were females. Most of the participants (99%) heard about Rabies and their source of knowledge about Rabies was from Doctors (40.5%), Newspapers & Media (39.5%), and Friends (19.0%). Approximately 82.5% of participants were aware of how rabies is transmitted, while 78.5% understood the signs of the disease. Conclusion: Education plays a significant role in the awareness of rabies as most participants were educated at least up to the primary level in the current study. According to our findings, clear gaps exist in rural people's understanding and attitudes toward rabies prevention and control.

Abstract Background On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel’s southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation. Methods Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14–21, 2024 (N = 1,360), and the evacuees’ data from March 1–9, 2024 (N = 372; 133 from the north, 239 from the south). Results Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples. Conclusions The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges.

Abstract Background Dyslipidemia has been associated with reduced bone mineral density and osteoporotic fractures, but the relation between lipid and bone metabolism remains poorly understood. Analysing the effects of lipoprotein subclasses on bone turnover may provide valuable insights into this association. We therefore examined whether lipoprotein subclasses, measured by proton nuclear magnetic resonance (1H-NMR) spectroscopy, are associated with bone turnover markers (BTMs) and with the ultrasound-based bone stiffness index. Methods Data from 1.349 men and 1.123 women, who participated in the population-based Study of Health in Pomerania-TREND were analysed. Serum intact amino-terminal propeptide of type I procollagen (P1NP, bone formation) and carboxy-terminal telopeptide of type I collagen (CTX, bone resorption) concentrations were measured. Associations between the lipoprotein data and the BTMs or the stiffness index were investigated using linear regression models. Results The triglyceride or cholesterol content in very-low-density lipoprotein and intermediate-density lipoprotein particles was inversely associated with both BTMs, with effect estimates being slightly higher for CTX than for P1NP. The triglyceride content in low-density lipoprotein and high-density lipoprotein particles and the Apo-A2 content in high-density lipoprotein particles was further inversely associated with the BTMs. Associations with the ultrasound-based bone stiffness index were absent. Conclusions Consistent inverse associations of triglycerides with bone turnover were observed, which argue for a protective effect on bone health, at least in the normal range. Yet, the presented associations did not translate into effects on the ultrasound-based bone stiffness. Further, there was no relevant gain of information by assessing the lipoprotein subclasses. Nevertheless, our study highlights the close relations between lipid and bone metabolism in the general population.

Abstract Background Alcohol use is one of the leading public health concerns in the Czech Republic. Drinking motives play a vital role in both initiation and subsequent alcohol use. A revised version of the self-report Drinking Motives Questionnaire (DMQ-R) has been proposed to assess these motives. The present study aims to validate the DMQ-R in the Czech general population. Methods A total sample of 1,784 Czech participants completed a national survey. For the analysis, only a sub-sample of the past 12 months alcohol users was used: N = 1,123; 52.8% male; mean (SD) age = 40.2 (13.3). Drinking motives were assessed by the adopted Czech version of the DMQ-R. Both confirmatory (CFA) and exploratory factor analysis (EFA) were conducted to examine the factorial structure of the instrument. The age of the participant was additionally considered in the analysis (15–24 years as opposed to 25–64 years). Results The CFA supported the four-factor model in the 25–64 age group. The analysis supported the construct validity of the Social, Conformity, and Coping factors. The Enhancement factor retained only two items and was found to refer more to a domain of ‘Pleasant Feeling’. For the 15–24 age group, the hypothesised four-factor structure was not corroborated. Conclusions The Czech version of the DMQ-R was found to be a reliable measurement tool of the Social, Conformity, and Coping motives. Future research should investigate the dimensionality of the instrument items presumed to correspond to the Enhancement motives. This should be conducted particularly among adolescents and young adults aged 15–24 years, where administering the DMQ-R with a large enough sample is also needed.

Abstract This study aimed to investigate whether metabolic dysfunction-associated fatty liver disease (MAFLD) defined by the fatty liver index (FLI) affects the decline in kidney function and whether this relationship is still observed in MAFLD defined by ultrasonography (USG). A retrospective cohort study was conducted using de-identified data from participants who received health checkups at Samsung Changwon Hospital between 2002 and 2018. The primary and secondary exposures were the presence of FLI- and USG-defined MAFLD, respectively. The primary outcome was 5-years slope of eGFR. The secondary outcome was a rapid decline in kidney function, defined as a 5-years slope of estimated glomerular filtration rate (eGFR) of less than − 3 mL/min/1.73 m2 per year. A total of 37,500 participants were included in the analysis. Participants with FLI-defined MAFLD had a larger decline in 5-year eGFR slope than those without FLI-defined MAFLD (beta coefficients − 0.11; 95% CI − 0.14 to − 0.08). Participants with FLI-defined MAFLD had a higher risk of rapid kidney function decline than those without FLI-defined MAFLD (odds ratio 1.33; 95% confidence intervals (CIs) 1.05–1.69). However, USG-defined MAFLD was less related to kidney function decline. In conclusion, the presence of FLI-defined MAFLD was associated with larger and faster kidney function decline.

Junaid Amin,1 Ammar Ahmed Siddiqui,2 Muhammad Ilyas,3 Salman Amin,4 Mishal M Aldaihan,5 Hamayun Zafar5 1Department of Physical Therapy, College of Applied Medical Sciences, University of Ha’il, Ha’il, 2440, Saudi Arabia; 2Preventive Dental Sciences, College of Dentistry, University of Ha’il, Ha’il, 2440, Saudi Arabia; 3Department of Management & MIS, College of Business Administration, University of Hail, Ha’il, 2440, Saudi Arabia; 4Department of Oral and Maxillofacial Surgery, University College of Medicine and Dentistry,The University of Lahore, Lahore, Pakistan; 5Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi ArabiaCorrespondence: Junaid Amin, Department of Physical Therapy, College of Applied Medical Sciences, University of Ha’il, 2440, Ha’il, Saudi Arabia, Tel +966-580931017, Email Junaid768@hotmail.comBackground: Prior research has revealed substantial psychological impacts of COVID-19 among the general population. However, there is a noticeable gap in studies addressing the enduring anxiety levels before and during lockdown periods of the COVID-19 pandemic.Objective: The study assessed and compared the psychological impact of the COVID-19 pandemic before and during lockdown periods among the general population in Saudi Arabia.Methods: A validated and reliable General Anxiety Disorder (GAD)-7 instrument was used to quantify stress levels by measuring anxiety. Nonprobability snowball sampling was used to collect data from 516 participants residing in Saudi Arabia. The difference in scores for each of the seven related questions of GAD-7 was determined using a non-parametric Wilcoxon rank test.Results: A mild level of anxiety was consistently observed both before and during the lockdown, as indicated by GAD-7 scores of 6.17 (SD = 5.5) before the lockdown and 6.42 (SD = 5.7) during the lockdown. There were no differences in GAD-7 scores before 6.17 (SD = 5.5) and during 6.42 (SD = 5.7) the lockdown periods. However, levels of moderate anxiety increased by 5% during the lockdown period. Anxiety levels before and during lockdown were significantly associated with gender (χ 2 (3, n = 516) =11.23 p = 0.01) and employment status (χ 2 (3, n = 516) = 9.41 p = 0.024). Among the GAD-7 questionnaire items, item number 1 (“Feeling nervous, anxious, or on edge”) (p= 0.00) and item number 7 (“Feeling afraid as if something awful might happen”) (p= 0.025) showed a significant association with anxiety levels before and during the lockdown periods.Conclusion: The enduring prevalence of mild anxiety, persisting both before and during the lockdown periods, underscores the profound impact of COVID-19 on the mental health of the general population in Saudi Arabia.Plain Language Summary: This study aimed to understand how the COVID-19 pandemic affected the mental well-being of people in Saudi Arabia, specifically looking at anxiety levels before and during lockdown. We used a survey with 516 participants and found that, overall, people reported mild anxiety both before and during the lockdown. However, there was a 5% increase in moderate anxiety during the lockdown.Interestingly, we discovered that gender and employment status were linked to anxiety levels. Women and those with certain employment statuses reported different anxiety levels. Specific questions in the survey, such as feeling nervous or afraid, were mainly associated with anxiety during both periods.In conclusion, even though anxiety levels were generally mild, some groups and specific concerns showed differences. This information can help us understand how to better support people’s mental health during challenging times like a pandemic.Keywords: anxiety, COVID-19, GAD-7, general population, psychological impact, Saudi Arabia

Background: Low level of health literacy is a public health problem. By improving people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment. This study was conducted to assess the health literacy of the adult population in the Bishnupur district of Manipur and to determine its association with socio-demographic factors. Methods: A cross-sectional study was conducted among general adult population of Bishnupur district. Data were collected using a validated structured questionnaire-Health Literacy Survey-European Union Questionnaire (HLS-EU-Q16) using Google Form from 576 participants selected by stratified multistage cluster sampling with proportional allocation. Descriptive statistics, Chi-square test, and multivariate logistic regression were applied using SPSS vn. 26, and P < 0.05 was considered statistically significant. Results: Median age of the participants was 43 (32–53) years, and half of them were females. Among the participants, majority, 514 (89.2%) had inadequate health literacy. Being employed [aOR: 0.470 (0.227-0.973)], having no formal education [aOR: 0.097 (0.011–0.845)], educated up to primary school [aOR: 0.111 (0.013-0.933)] or secondary school [aOR: 0.258 (0.082-0.806)] had lesser odds of having adequate health literacy. Fair self-perception of health [aOR: 10.098 (1.176-86.736)] had higher odds of adequate health literacy. Conclusions: Nine out of ten participants had inadequate health literacy. Measures to improve health literacy should be taken as it is an important determinant of health.

Abstract Background Preventive treatment of tuberculosis infection (TBI) is considered a crucial strategy to prevent and control tuberculosis (TB). However, the acceptance and completion rates of preventive therapy for TBI are still far from optimistic. Evidence is mounting that TB knowledge and stigma may have a substantial effect on acceptance of TBI treatment. This study aimed to explore the effect of stigma on the relationship between the level of TB knowledge and acceptance of TBI treatment. Methods 7017 general population were included in the study. We adjusted for the covariates at the individual. Stepwise logistic regression was used to examine the moderating role of TB stigma and also explore the association between TB knowledge and acceptance of TBI treatment. Results The acceptance rate of TBI treatment among the respondents was 84.38% (n = 5921). Among respondents, a significant positive correlation between acceptance of TBI treatment and TB knowledge (OR = 1.096,95%CI = 1.073,1.118). Additionally, the association between TB knowledge and acceptance of TBI treatment was found to be moderated by TB stigma. In other words, TB stigma was found to weaken the impact of TB knowledge on acceptance of TBI treatment (OR = 0.994,95%CI = 0.991,0.996). Conclusion The findings of the study indicated that having a high level of awareness about TB can enhance the general population’s acceptability of TBI treatment. TB stigma moderated this association; it weakened the relationship between TB knowledge and individuals’ willingness to accept TBI treatment. To mitigate TB stigma and enhance the intention of individuals with TBI to accept preventive therapy, it is imperative to enhance TB-related health education.