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Background: Drug repositioning has the potential to reduce costs and accelerate the rate of drug development, with highly promising applications. Currently, the development of artificial intelligence has provided the field with fast and efficient computing power. Nevertheless, the repositioning of traditional Chinese medicine (TCM) is still in its infancy, and the establishment of a reasonable and effective research method is a pressing issue that requires urgent attention. The use of graph neural network (GNN) to compute the similarity between TCM prescriptions to develop a method for finding their new indications is an innovative attempt. Methods: This paper focused on traditional Chinese medicine prescriptions containing ephedra, with 20 prescriptions for treating external cough and asthma taken as target prescriptions. The remaining 67 prescriptions containing ephedra were taken as to-be-matched prescriptions. Furthermore, a multitude of data pertaining to the prescriptions, including diseases, disease targets, symptoms, and various types of information on herbs, was gathered from a diverse array of literature sources, such as Chinese medicine databases. Then, cosine similarity and Jaccard coefficient were calculated to characterize the similarity between prescriptions using graph convolutional network (GCN) with a self-supervised learning method, such as deep graph infomax (DGI). Results: A total of 1340 values were obtained for each of the two calculation indicators. A total of 68 prescription pairs were identified after screening with 0.77 as the threshold for cosine similarity. Following the removal of false positive results, 12 prescription pairs were deemed to have further research value. A total of 5 prescription pairs were screened using a threshold of 0.50 for the Jaccard coefficient. However, the specific results did not exhibit significant value for further use, which may be attributed to the excessive variety of information in the dataset. Conclusions: The proposed method can provide reference for finding new indications of target prescriptions by quantifying the similarity between prescriptions. It is expected to offer new insights for developing a scientific and systematic research methodology for traditional Chinese medicine repositioning. [ABSTRACT FROM AUTHOR]

Background: The use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews. Methods: Children with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app. Results: We enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ''simple and intuitive" at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21–25) for the control group (42 patients) and 23 (21–24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24–25) and 24 (24–25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable. Conclusions: The smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit. [ABSTRACT FROM AUTHOR]

Background: The National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey. Methods: The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021–2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses. Results: Of the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and 'what works for me', a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor. Conclusions: This analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic impacted children, adolescents, and their families, with significant psychosocial consequences. The prevalence of anxiety, depression, and self-injurious behaviors increased in our youth, as well as the number of suicide attempts and hospitalizations related to suicidal ideation. Additionally, parents' mental health saw increasing rates of depression, irritability, and alcohol use combined with worsening family function, child-parent connectedness, positive family expressiveness, and increases in family conflict. In light of these statistics, we created CHATogether (Compassionate Home, Action Together), a pilot family-centered intervention using multi-faceted psychotherapeutic approaches to improve familial communication and relational health between adolescents and their parents. This paper discusses the implementation of the CHATogether intervention at the Adolescent Intensive Outpatient Program (IOP), providing an example of the intervention through an in-depth pilot case, and evaluation of the program's acceptability and feasibility. Methods: This paper describes a case in detail and evaluation from a total of 30 families that completed CHATogether in the initial pilot. Each family had 4–6 one-hour CHATogether sessions during their 6-week treatment course at the IOP. Before and after CHATogether, adolescents and their parents separately completed a questionnaire designed to explore their perceived family conflicts. After completion of the program, participants completed a brief quality improvement survey to assess their overall experience with CHATogether. In the reported case, the family completed Patient-Reported Outcomes Measurement Information System (PROMIS) depressive and anxiety symptoms scales, Conflict Behavior Questionnaires (CBQ), 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), and help-seeking attitude from adults during distress and suicide concerns. Results: The pilot case showed a trend of improvement in reported depressive and anxiety symptoms, child-parent conflicts, subfactors of suicide risk including pessimism, helplessness, and despair, help-seeking acceptability from parents for suicide concerns, and the establishment of individualized family relationship goals. Preliminary feedback from participating families demonstrated positive effects on intra-family communication and improvement in the overall family dynamic. Adolescents (n = 30/30) and their parents (n = 30/30) rated "strongly agree" or "agree" that their families had benefited from CHATogether and welcomed participation in future program development. Conclusion: This study presents CHATogether as a novel family-centered intervention to address post-pandemic family mental health stress, especially when a family system was disrupted and negatively affected the mental health of children and adolescents. The intervention facilitated positive child-parent communication on a variety of topics, through tools such as emotional expression and help-seeking behavior. The reported pilot case and evaluation suggested CHATogether's acceptability and feasibility in a clinical context. We also provided quality improvement feedback to guide future studies in establishing the efficacy of CHATogether and other similar models of clinical family interventions. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools. Methods: A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models. Results: Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition. Conclusions: The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821. [ABSTRACT FROM AUTHOR]

Background: Understanding environmental correlates of sedentary behaviour (SB) among young people is important as such data can identify approaches to limit sedentary time. This paper estimates associations of parent-reported neighbourhood and adolescent-reported home environments with SB among adolescents aged 11–19 years from 14 countries. Methods: In the International Physical activity and the Environment Network (IPEN) Adolescent Study (an observational, cross-sectional multi-country study), adolescents wore a triaxial accelerometer for seven days that assessed sedentary time (ST). Adolescents completed survey measures of sedentary behaviour (SB) related to recreational screen time and sitting time in motor vehicles. Parents and adolescents completed surveys assessing neighbourhood and home environments. Accelerometer based ST was available in 3,982 adolescents while survey data were available for 6,302 dyads. We estimated the total and direct effects of each environmental attribute on ST and SB. Sex of the adolescent and city/country were examined as moderators. Results: The average ST in adolescents from 14 countries ranged from 7.8 to 10.5 h/day. Personal social media was the only significant correlate of total ST across both sexes. With respect to self-reported SB, adolescents accumulated an average of 3.8 h of non-school screen time per day and nearly 40 min of transport-related sitting time. Screen time was associated with all home environment variables, including social media account, as well as land use mix—diversity, traffic safety, and crime safety. Transport-related sitting time was related to land use mix—diversity, recreation facilities, walking facilities, and pedestrian infrastructure, but no home environment variables. City/country and sex were significant moderators of several associations. Conclusions: Both home and neighbourhood environment features were related to ST and SB. Having social media accounts emerged as a major contributor towards sedentarism in adolescents. [ABSTRACT FROM AUTHOR]

Background: The proliferation of instruments that define instrument-specific metrics impedes progress in comparative assessment across populations. This paper explores a method to extract a common metric from related but different instruments and transform the original measurements into scores with a standard unit of measurement. Methods: Existing data from four assessment instruments of child development, collected from three different samples of children, were used to create "equate clusters" of items that measure the same behaviour in (slightly) different ways. A probability model was formulated to identify best items and groups to serve as anchors linking the instruments, assuming that items in an anchoring or "active" equate cluster are psychometrically equivalent. Quantification and inspection of item characteristic curves were used to resolve which equate clusters should be active. We simulated the impact of various analytic choices. Results: Simulation confirmed the feasibility of creating a common metric from data collected with different instruments from respondent samples with different abilities. The method performed as expected in an application in early childhood development. Conclusions: The use of equate clusters is an intuitive and flexible way to establish a common metric across instruments and facilitates the transformation of measurements obtained to a standardized scale. Standardizing instrument scores to a common metric allows for population-level comparisons on a global scale. [ABSTRACT FROM AUTHOR]

Background: The opening up of the laws to medicinal cannabis in recent years is a key factor in the growth of this therapy, but there is little information about what nurses know and think about it. The present paper seeks to analyze the knowledge, opinions, and experiences of nurses and nursing students in Portugal regarding the use of cannabis and to understand gender differences. Methods: A self-completion questionnaire was drawn up and published online. It received face and content validity and was approved by the Ethics Committee. The instrument includes socio-demographic data, questions about knowledge, opinions, experiences, and training in cannabis. The data was collected and processed by applying descriptive and inferential statistics using the chi-square test and Fisher's exact test on the SPSS platform. Results: The majority of the 610 participants were women. The therapeutic benefits of medical cannabis were appreciated by 79,6% of nurses and 84,3% of students. When asked about the functions of the endocannabinoid system, 71,7% of nurses and 79,5% of students had never heard of it. There is a statistically significant gender difference concerning personal experience of cannabis use to treat symptoms or illnesses. Conclusions: As the levels of knowledge were low and a minority had education on medical cannabis, there is a need for further education of nurses and for this emerging area to be included in the curricula. [ABSTRACT FROM AUTHOR]

Background: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the "Self-injury: Treatment-Assessment-Recovery" (STAR) collaboration, which aimed to address these gaps. Methods: We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper. Sample description: The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15–25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15–25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36). Conclusion: Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI. [ABSTRACT FROM AUTHOR]

Background: Screen-based simulation is a cost-effective educational modality that allows nursing students to comfortably acquire new skills as they become accustomed to digital environments. The aim of this study is to evaluate the effectiveness of a screen-based simulation tool in enhancing knowledge and skills related to medication administration and dosage calculation in nursing students. Methods: This multicenter, single-blind, stratified, randomized controlled trial initially enrolled 480 nursing students. The 351 students eligibles were randomly allocated to two groups. Using a screen-based simulation tool (SIMDOSE®), the intervention group was trained in drug administration and dosage calculation through four perfusion clinical cases. The control group underwent the same training content using the paper-and-pencil method. knowledge and skills acquisition, Students' satisfaction, self-confidence and anxiety were analyzed using Jamovi software (version 2.3.18). Results: 4 out of 5 main variables examined were significantly different, specifically in dosage calculation, where the simulation group excelled both in the knowledge post-test (post – pre = 1.00 (20%); p = 0.004) and in the objective structured clinical examination (p = 0.013). The intervention group reported higher levels of satisfaction and self-confidence than the control group (p < 0.001). Their moderate anxiety levels didn't differ significantly (0.161). Conclusion: The SIMDOSE® platform can be used as a supplementary teaching method of dosage calculation for nursing students. Screen-based simulation has benefits that nurse educators should be aware of, such as being a key to more satisfied and confident students. Trial registration: This Moroccan clinical trial was prospectively registered (16/05/2023) in the Pan African Clinical Trial Registry (pactr.samrc.ac.za) with trial registration number PACTR202305505743210. [ABSTRACT FROM AUTHOR]

Purpose: On average, about 50% of cancer patients use complementary and alternative medicine (CAM) in addition to conventional cancer treatment. Since there is a high need for information, patients often search for information about CAM and share experiences with peers, especially in self-help groups. In this study, we tested and evaluated an educational concept developed for group leaders of cancer self-help groups on how to approach the topic of CAM in their peer groups. Methods: The educational concept has been developed and piloted with health care professionals and representatives from different self-help organizations in Germany. It aims to inform and discuss the possibilities and limitations of CAM in terms of scientific evidence, to reflect user behavior, and to provide a guide on how to find and evaluate reliable and evidence-based information sources. First, self-help group leaders took part in an on-site training where they were educated on various CAM topics with the goal of being able to conduct the educational concept in their respective self-help groups. Then, the educated group leaders performed this concept in their groups. The educational concept was evaluated by both the group leaders and participants with respect to acceptance, usefulness, and satisfaction using paper-pencil questionnaires. The study was conducted in Germany based on an observational study design with a six-month follow-up. For the analyses, descriptive and univariate statistics for dependent samples were used. Results: A total of n = 50 interested group leaders conducted the educational program in their groups. The most common implementation barriers were organizational or structural problems, as well as the feeling of being overwhelmed with managing the program in their groups. A total of n = 423 participants were educated with this program by their respective group leaders. The majority felt satisfied with the educational program and improved their knowledge about CAM. At the six months follow-up (T2), significantly more participants had consulted their physicians to inform themselves about CAM and felt more confident in finding reliable information about CAM. Conclusions: In this observational study, we have managed to successfully implement an educational concept with respect to the topic of CAM in cancer self-help groups. Based on the results, the concept approach will be modified to include both a CAM- professional and group leader to train the self-help groups. In the future, the effects of the program should be tested by a randomized trial. [ABSTRACT FROM AUTHOR]

Background: New graduate nurses often have certain potential safety hazards for patients due to insufficient knowledge and lack of clinical practice ability. To address these challenges, China has implemented a standardized training strategy. The improvements in the quality of this training involve not only the intervention of teaching methods but also the consideration of personality traits. Methods: The application software based on the BFI-2 Chinese scale was utilized to administer personality tests to nursing students; nursing students were invited to scan the QR code and voluntarily fill in a questionnaire, including basic information, personality test results, and a professional self-efficacy test scale; offline paper-based theoretical examination results of nursing students were collected before and after training. The data was then analyzed using SPSS software version 26.0, which involved descriptive analysis, one-way between-groups analysis of variance (ANOVA) and Spearman correlation analysis. Results: Based on the data, there were no observable differences in the theoretical results before and after training across different personality traits. In terms of skill assessment, conscientiousness exhibited the highest score at 78.91 ± 2.98 points, while negative emotionality showed the lowest score at 74.59 ± 2.12 points. These differences between different personality traits are statistically significant (P < 0.001). In terms of professional self-efficacy, conscientiousness scored the highest at 98.48 ± 12.69, while negative emotionality scored the lowest at 85.89 ± 11.71, with significant differences between different personality traits (P < 0.001). Professional self-efficacy was negatively correlated with agreeableness (r = -0.150, P = 0.044) and positively correlated with conscientiousness (r = -0.310, P < 0.001). Skill scores were negatively correlated with negative emotionality (r = -0.257, P < 0.001) and positively correlated with conscientiousness (r = 0.182, P = 0.014). Conclusions: This study shows that personality traits affect the skills test results and professional self-efficacy of nursing students. Conscientiousness scored the highest in this study, while negative emotionality scored the lowest. Therefore, personalized training plans are recommended to improve the quality of care for such nursing students and to further enhance patient safety. [ABSTRACT FROM AUTHOR]

Background: The Turkish and Syrian earthquake on February 6th 2023, was one of the deadliest earthquakes in the last decade. It affected approximately 26 million people and left at least 50.000 dead. In this paper, we analyzed the psychological impact and the relationship between mental health factors, earthquake-related experiences and stressors, and resources related to the earthquake, 4 months after the event. Methods: We conducted an analytical cross-sectional study, applying a survey to 320 adults (18–93 years old) in Adiyaman, Turkey. Post-traumatic stress disorder (PTSD) symptoms were assessed using the PC-PTSD, general psychiatric morbidity using the GHQ-12, together with questions focusing on suicidality, drug abuse, as well as experiences, related stressors and received support related to the earthquake. Results: We found a high prevalence of general mental health symptoms, and of PTSD. Fear of aftershocks and the loss of close family members were found to be risk factors for such symptoms. We didn't find significant differences in the GHQ or the PC-PTSD scores when considering ethnicity, religion or financial income. Conclusions: High levels of general mental health symptoms and PTSD symptoms were found 4 months after the earthquake and need to be addressed in all groups, independently from potential religious, social or ethnic backgrounds. The results indicate a large psychiatric and material burden on the entire sample and some priority needs. [ABSTRACT FROM AUTHOR]

Background: Co-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings. Purpose: Our paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group. Methods: A randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c). Results: Of 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant. Conclusion: The SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation. [ABSTRACT FROM AUTHOR]

Background: Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women's decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare. Methods: A mixed-method realist study was conducted, comprising 22 in-depth interviews, four focus group discussions (total participants n = 44), and a self-administered questionnaire completed by 639 pregnant women. A parallel convergent model for mixed methods analysis was employed. Data were analyzed using the realist logic of analysis, an iterative process aimed at refining identified theories. Survey data underwent analysis using SPSS 22 and descriptive analysis. Qualitative data were analyzed using configurations of context, mechanisms, and outcomes to elucidate causal links and provide explanations for complexity. Results: Nearly half of pregnant women (43.5%) would try to hide their mental health issues and 38.3% avoid having help from a mental health professional, highlighting the substantial extent of stigma affecting health-seeking and accessing care. Four key areas highlight the role of stigma in maternal mental health: fear and stigmatizing language contribute to the concealment of mental illness, rendering it unnoticed; unconsciousness, normalization, and low literacy of maternal mental health; shame, household structure and gender roles during pregnancy; and the interplay of regulations, referral pathways, and access to mental health support services further compounds the challenges. Conclusion: Addressing mental health-related stigma could influence the decision of disclosure and health-seeking behaviors, which could in turn improve responsiveness of the local health system to the needs of pregnant women with mental health needs, by offering prompt attention, a wide range of choices, and improved communication. Potential interventions to decrease stigma and improve access to mental healthcare for pregnant women in Vietnam should target structural and organizational levels and may include improvements in screening and referrals for perinatal mental care screening, thus preventing complications. [ABSTRACT FROM AUTHOR]

Background: Time spent in sleep, sedentary behaviour (SB), and physical activity are exhaustive and mutually exclusive parts of a 24-h day that need to be considered in a combination. The aim of this study was to identify validated self-reported tools for assessment of movement behaviours across the whole 24-h day, and to review their attributes and measurement properties. Methods: The databases PubMed, Scopus, and SPORTDiscus were searched until September 2023. Inclusion criteria were: (i) published in English language, (ii) per-reviewed paper, (iii) assessment of self-reported time spent in sleep, SB, and physical activity, (iv) evaluation of measurement properties of all estimates across the full 24-h day, and (v) inclusion of adolescents, adults, or older adults. The methodological quality of included studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments checklist. Results: Our search returned 2064 records. After studies selection, we included 16 articles that reported construct validity and/or test-retest reliability of 12 unique self-reported tools – eight questionnaires, three time-use recalls, and one time-use diary. Most tools enable assessment of time spent in sleep, and domain-specific SB and physical activity, and account that sum of behaviours should be 24 h. Validity (and reliability) correlation coefficients for sleep ranged between 0.22 and 0.69 (0.41 and 0.92), for SB between 0.06 and 0.57 (0.33 and 0.91), for light-intensity physical activity between 0.18 and 0.46 (0.55 and 0.94), and for moderate- to vigorous-intensity physical activity between 0.38 and 0.56 (0.59 and 0.94). The quality of included studies being mostly fair-to-good. Conclusions: This review found that only a limited number of validated self-reported tools for assessment of 24-h movement behaviours are currently available. Validity and reliability of most tools are generally adequate to be used in epidemiological studies and population surveillance, while little is known about adequacy for individual level assessments and responsiveness to behavioural change. To further support research, policy, and practice, there is a need to develop new tools that resonate with the emerging 24-h movement paradigm and to evaluate measurement properties by using compositional data analysis. Systematic review registration: PROSPERO CRD42022330868. [ABSTRACT FROM AUTHOR]

Introduction: In orthodontics, the triage system is used to assess the preadolescents to rule out interventions needed earlier and to assess the nature of orthodontic problems as complex or moderate. The objective of this study was to determine the knowledge and awareness of orthodontic triage and its uses among dental healthcare professionals (DHCP). Materials and methods: A triage awareness questionnaire (TAQ) was formulated and validated as reliable by a panel of five orthodontic specialists which was then circulated online among 400 DHCP. The questionnaire consisted of nine sections that assessed the current knowledge and usage of orthodontic triage among the dental community. Frequencies and percentages were reported for all categorical variables. Chi-square was used to assess the association among the variables. Results: The response rate was 28.2% with the majority of participants being general dentists. Regarding the knowledge and use of triage, 40% of DHCP were only familiar with the word "orthodontic triage" while being unaware of how it works and 79% denied using orthodontic triage. Regarding the management of anomalies, 42% of DHCP preferred extraction as the management of supernumerary teeth (p = 0.013). Practitioners belonging to private setups performed visual inspection in growing patients for assessment of their facial features (p = 0.012). Clinicians with more than one year of experience referred young patients to orthodontic specialists for the management of crossbite (p = 0.024). Younger clinicians (25–35 years) with more than one year of experience referred adult patients to orthodontists for correction of their unesthetic smile (p = 0.013). Conclusions: This paper provides foundational data for the development of future policies and protocols supporting structured, evidence-based approaches to patient management via use of orthodontic triage. This study underscores the importance of targeted educational interventions to enhance understanding and implementation of orthodontic triage principles in clinical practice. Further probing is necessary to discern the disparity between understanding the orthodontic triage and effective employment of its components among practicing dental healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: There is limited research examining the views of general practice pharmacists (GPPs) on their role and their impact in general practice. The aim of this study was to explore GPPs' views regarding this role and its potential impact within general practice in Northern Ireland (NI). Methods: A paper-based self-administered questionnaire was mailed to 319 general practices in NI in 2022, directed to the GPP who spent most time at the practice. A variety of closed and open questions were included in six sections. Responses to closed questions were analysed descriptively whilst open question responses were analysed using content analysis. To ascertain associations between variables (e.g. GPP prescribing status, working arrangements and aspects of collaboration with GPPs), Fisher's exact test was employed with an a priori significance level of p < 0.05. Results: 155 responses were received equating to a response rate of 48.5%. Most participants (72.3%) were female, independent prescribers (71%), and 64.5% were currently using their independent prescriber qualification. Services that were provided by most GPPs were medication reconciliation (99.4%) and medication reviews (97.4%). The most common method of communication between GPPs and general practitioners (GPs) was face-to-face (89.0%). Telephone was the most common method of communication between GPPs, community pharmacists (97.4%) and patients (98.7%). Most GPPs (> 80%) showed positive attitudes towards collaboration with GPs and those who worked in multiple practices were more likely to agree with the Attitudes Towards Collaboration Instrument for pharmacists (ATCI-P) statements compared to those who worked in a single practice (p < 0.05). Less than 40% (36.8%) of GPPs agreed that patients were aware of the role they provided. The majority of GPPs (80.6%) expressed positive views on their impact on primary care. Analysis of the free-text comments revealed the need for more GPP patient-facing activities, GPP-specific training, and promotion of the GPP role. Conclusion: The findings indicated that GPPs had largely positive views about their role and their impact on primary care. The results may be helpful for practices and service commissioners. Further research is necessary to explore the perspectives of patients regarding the role of the GPP and to enhance patients' awareness of the GPP. [ABSTRACT FROM AUTHOR]

Background: Immersive technologies such as smart glasses can benefit nursing training and clinical practice. In this paper, we explore the views of nursing graduate students about their experience with smart glasses. Methods: Nursing graduate students (n = 13) were recruited using purposeful sampling. First, a virtual reality intervention for hyperglycemia in nursing care was shown. This was an attempt to introduce people to the technology and start discussions about how it might be used in nursing care. After that, participants underwent online interviews. Thematic analysis was used to examine the data. Results: The study findings indicated that the use of smart glasses as an enjoyable learning experience and immersive games positively affects nursing students. In addition, it was determined that they had negative experiences such as costs, lack of infrastructure, and smart glass side effects. Conclusions: Smart glasses indicate good usability and availability in nursing education and potential for use in hospital nursing practice. [ABSTRACT FROM AUTHOR]

Background: Primary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model. Methods: A one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement. Results: Experts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken. Conclusions: This study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future. [ABSTRACT FROM AUTHOR]

Background: In response to the COVID-19 pandemic, the World Health Organization established a number of key recommendations such as educational activities especially within primary care practices (PCPs) which are a key component of this strategy. This paper aims to examine the educational activities of PCPs during COVID-19 pandemic and to identify the factors associated with these practices across 38 countries. Methods: A "Patient Education (PE)" score was created based on responses to six items from the self-reported questionnaire among PCPs (n = 3638) compiled by the PRICOV-19 study. Statistical analyses were performed on 3638 cases, with PCPs with missing PE score values were excluded. Results: The PE score features a mean of 2.55 (SD = 0.68) and a median of 2.50 (2.16 – 3.00), with a maximum of 4.00, and varies quite widely between countries. Among all PCPs characteristics, these factors significantly increase the PE score: the payment system type (with a capitation payment system or another system compared to the fee for service), the perception of average PCP with patients with chronic conditions and the perception of adequate governmental support. Conclusion: The model presented in this article is still incomplete and requires further investigation to identify other configuration elements favorable to educational activities. However, the results already highlight certain levers that will enable the development of this educational approach appropriate to primary care. [ABSTRACT FROM AUTHOR]

Background: Preoperative education can improve postoperative quality of life in patients undergoing stoma surgery. However, the prevalence and when, where, and how preoperative education is implemented are unclear. Therefore, this study aimed to assess the current status of outpatient preoperative education for patients undergoing stoma surgery for rectal cancer as perceived by nurses. Additionally, it sought to identify the information provided by Japanese healthcare providers as a part of preoperative education. Methods: This cross-sectional study included 1,716 wound, ostomy, and continence nurses (WOCNs) in charge of stoma clinics at Japanese hospitals. Unsigned self-administered survey forms were mailed to the participants, and paper- or web-based responses were obtained. The main questions included: overview of the participants and their facilities, provision of outpatient preoperative education, status of implementation, and preoperative education components. To examine the factors associated with preoperative education, the independent variable was the presence or absence of preoperative education in the clinic, and the explanatory variables were the years of experience as a nurse, years of experience as a WOCN, type of hospital, number of beds, and number of intestinal stoma surgeries per year. Regression analysis was performed. Results: We received 773 valid responses (valid response rate: 45%). Duration of experience as a nurse and as a WOCN were 24.6 and 10.9 years, respectively. Outpatient preoperative education was provided by 24% of the participants. Most preoperative education sessions were conducted for patients or caregivers. Preoperative education took 31–60 min per patient, and one to five patients received preoperative education each month. Booklets, ostomy appliances, and stoma models/dolls were used as supplementary materials for preoperative education. The most frequently mentioned components of preoperative education were stoma care, daily life, social security, stoma clinic, traveling and going out, quality of life after stoma surgery, and precautions for medical treatment. In addition, education on the use of restrooms on the go, disaster preparedness, defecation disorders after restorative proctectomy, and complications after stoma closure were considered necessary. Conclusions: The implementation rate of outpatient preoperative education was low (24%). Future challenges include the development of specific educational content and procedures suitable for the Japanese medical environment and the establishment of preoperative medical care teams for stoma surgery to promote the provision of outpatient preoperative education. [ABSTRACT FROM AUTHOR]

Background: Accurate estimation of the specialized pediatric palliative care (PPC) burden and the definition of the extent and quality of PPC service in Italy represent urgent needs to enable the proper allocation of PPC resources and the definition of prevention and educational plans. The PalliPed project aimed to provide the first comprehensive assessment of the characteristics of Italian patients requiring PPC, the quality and extent of regional PPC networks/facilities, and the number of dedicated resources. In this paper, we present the results of the second part of the project, regarding the implementation and quality of PPC services in Italy. Methods: The PalliPed study had an observational cross-sectional design. All Italian specialized PPC centers/facilities were invited to participate in the project and complete a survey on the characteristics of PPC centers/facilities in different care settings, reporting data as of 24 October 2022. Data were collected online. Results: 19 PPC specialized centers/facilities from 12 Italian regions and two autonomous provinces responded to the survey. Among them, 11 are regional referral centers. Seven Italian regions out of 20 reported no PPC centers/facilities, mainly in central-southern Italy. Less than half (45%) of the regional referral centers cover the entire regional territory, and three offer 24/7 service. Ten centers have a dedicated team. Half of the eight non-referral centers offer 24/7 service and have a dedicated team. A total of 1,092 patients were reported by 18 centers as of 24 October 2022. Over the years, an increasing number of patients has been reported, rising from 1,202 (2019) to 1,544 (2021). The dedicated staff is inadequate, and most healthcare providers are not recognized at an institutional level. A shortage of 'young' staff and a lack of specific training was reported, particularly among nurses (77% had no training in PPC). Conclusions: The results obtained show how training, information, and research interventions are still necessary for the reorganization of the available resources and definition of proper strategies to respond dynamically to the new emerging needs of these populations. At the same time, our study represents a first step in defining a national registry of PPC models, useful for monitoring evolutions, and critical issues and planning any new or corrective strategy. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP. Methods: The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors' GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen's kappa (κ) coefficients for each category of cardiovascular problems. Results: We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32). Conclusions: Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR). Methods: The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression. Results: Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction. Discussion: Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people. [ABSTRACT FROM AUTHOR]

Background: While research has explored the risk of periodontal disease in various eye conditions, the link between dry eye and periodontal disease remains underexplored, especially in Japanese adults. This study aims to investigate the association between dry eye and periodontal disease in community-dwelling Japanese adults. Methods: This study is a subset of the Uonuma cohort study, which includes Japanese adults aged 40 years and older residing in the Uonuma area of Niigata Prefecture, Japan. Participants completed a self-administered, paper-based questionnaire. Statistical analyses, including the chi-square test, independent t test, ANOVA test, and logistic regressions, were employed to assess the association of periodontal disease with independent variables. Results: Among 36,488 participants (average age 63.3 years, 47.4% men), 39.3% had a history of periodontal disease, and gender differences were statistically significant (p < 0.001). Significant associations were found between periodontal disease and dry eye diagnosis or symptoms. Univariable logistic regression revealed links between periodontal disease and age, gender, living status, alcohol consumption, remaining teeth, bite molar availability, and history of dry eye disease or symptoms. Multiple-adjusted regression found that doctor-diagnosed dry eye was associated with a higher likelihood of periodontal disease (odds ratio, 1.12; 95% confidence interval, 1.03–1.22). Participants who never experienced dryness or foreign body sensation had lower ORs of periodontal disease than those who always experienced such symptoms across all models. Conclusion: A significant correlation was found between dry eye and periodontal disease in Japanese adults. Regular check-ups, early detection, and effective management of both conditions are strongly recommended. [ABSTRACT FROM AUTHOR]

Background: The organizational climate that fosters and supports the implementation of evidence is a key factor influencing the effective implementation of evidence-based practice (EBP). Nurses, being the largest group of medical staff, play a crucial role in EBP implementation. The perception of the climate for EBP implementation among nurses in their organizations is unknown, especially among Chinese nurses. Aims: To clarify the implementation climate of EBP among Chinese nurses and identify the factors associated with the implementation and development of evidence-based nursing practices. Methods: This study employed a descriptive cross-sectional study design. From March 2023 to April 2023, a sample of nurses (n = 1260) from two Tertiary care hospitals in central China were selected and surveyed by self-designed social-demographic questionnaire and Implementation Climate Scale. Multiple linear stepwise regression analysis was conducted to determine the predictors of implementation climate. Results: The nurses achieved a mean ICS score of 59.10 ± 11.22, with mean scores exceeding 3 points for each sub-dimension and item. In the results of multiple linear regression, income satisfaction, implementation of evidence-based nursing practice project(s) within the unit, experience of evidence-based nursing practice during working life, and specific training or courses in evidence-based nursing practice were predictors of ICS. Of these, income satisfaction was the most significant predictor. These factors could explain 17.5% of the total variance in implementation climate. Conclusion: The climate for implementing EBP in Chinese nursing organizations was relatively strong. Nursing managers can enhance the climate for implementing EBP in their organizations by actively improving salary and enhancing EBP-related trainings and practices. Relevance to clinical practice: Understanding nurses' perceptions of the EBP implementation climate in their organizations can help to identify specific barriers and facilitators to the development of EBP and facilitate its successful implementation. Patient or public contribution: Clinical nurses were involved in data collection and completed the questionnaires on EBP implementation climate. What does this paper contribute to the wider global clinical community?: The number of studies on the organization and implementation climate of evidence-based nursing practice is limited, especially in China. According to the results of this study, nurses exhibited a positive perception and recognition of the organized EBP implementation climate. Income satisfaction, implementation of evidence-based nursing practice project(s) within the unit, experience of evidence-based nursing practice during the working life and specific training or courses undertaken in evidence-based nursing practice were factors of nurses' perception of implementation climate. Organizational managers should actively provide comprehensive resource support to enhance the implementation climate of evidence-based nursing practice. [ABSTRACT FROM AUTHOR]

Aim: To design a digital template for form building, data collection and data management to assess the diet and oral health of elite athletes. Subject and methods: A web-based open-source platform, KoboToolbox (KBTB), was used to aid design and manufacture of a digital data collection form for use in oral health surveys. KBTB frontend form builder was used to create a customised questionnaire. Dental charting systems for the chosen indices were designed using XLSForms, converted to XForm and uploaded to the KBTB interface to create a single form for digital data input. This template was used to collect data for a cross-sectional study investigating the diet and oral health of a convenience sample of elite athletes in Ireland. Results: A digital data collection (DDC) form was designed for use in oral health surveys. The customised form was then used to collect data for a survey of 88 elite athletes on the KBTB platform. Dietary behaviours were recorded by the participants using KBTB. Following data collection, the dataset was downloaded from KBTB and cleaned for subsequent analysis. Conclusion: The design of a versatile form and oral health questionnaire template using digital tools customised for elite athletes was useful for efficient, comprehensive field data collection. DDC tools are convenient for data form design, collection, and storage. This template can be easily modified for use by other researchers planning oral health surveys. [ABSTRACT FROM AUTHOR]

Background: Public health nutrition recommendations and clinical dietary interventions emphasize eating healthy food at home, implicitly requiring household foodwork. Household foodwork is defined as the physical and mental tasks a household does for eating meals and snacks. Because no tools exist to measure it, how much time people spend doing household foodwork and the foodwork barriers they experience remain unknown. The objective of the present research was to develop the first stand-alone household foodwork assessment tool. Methods: Through informal interviews with partners with lived experience, clinicians, and researchers, a literature review, a stakeholder meeting of advisors, and a two-round electronic Delphi process including face/content validation by expert panelists (n = 21), we developed the 10-question household foodwork interactional assessment questionnaire (FIA-Q10). An optional accompanying module was developed to collect self-identified demographic data to provide context for understanding how social-structural positionality factors may interact to influence foodwork. Results: The FIA-Q10 assesses the domains of household composition, frequency of eating at home, special diets within a household, foodwork stress intensity, foodwork barriers, desired supports related to foodwork, and time use for foodwork. The FIA-Q10 measures time use for four subdomains of foodwork among individuals and their households: (1) planning, (2) getting, (3) preparing/cooking, and (4) cleaning up food. In the second Delphi round, the FIA-Q10 scored 95% for language appropriateness, 67% for visual appropriateness, 95% for relevance, 95% for representativeness, and 95% for distribution. Suggested improvements were implemented. All Delphi panelists (100%) reported they would consider using the FIA-Q10. Conclusions: The FIA-Q10's development is the first step towards a standardized assessment of foodwork, enabling examination of challenges in foodwork that may impact nutrition and nutrition equity. Future research will focus on FIA-Q10 validation in multiple populations. [ABSTRACT FROM AUTHOR]

Background: Direct and indirect associations have been identified among health literacy, health behavior, and health status. Thus, we aimed to investigate the influence of oral health literacy and behaviors in parents on their children's oral health status. Moreover, we aimed to analyze the mentioned mediating effects through oral health behavior management. Methods: Oral health information of 1,102 preschool children aged 3 to 6 years was collected from five primary schools in Jinjiang District, Chengdu City, Sichuan Province, China. The decay-missing-filled teeth (DMFT) index and soft scale plaque index (PI) were used by professional dentists aided by school teachers to assess caries and periodontal health among the children. Simultaneously, we conducted a questionnaire-based survey among the parents to determine their oral health literacy and health behavior and their children's oral health behavior. The probit model, instrumental variables, and mediation effect model were used to evaluate the association of parents' oral health literacy and behavior with their children's oral health status. Results: The DFMT index was 1.58 among the children, with zero caries in 646 (58.6%) children. The PI was 0.68, with zero gum disease in 517 (46.9%). The univariate analysis suggested that the parents' health literacy and behavior were correlated with their children's oral health status (P < 0.01). Parents' oral health behavior significantly affected their children's oral health status. Simultaneously, a stronger correlation was observed upon using parents' health literacy as an instrumental variable to assess the endogeneity, indicating endogeneity problems. Parents' health-related behaviors exerted a mediating effect on children's oral health, with parents helping children brush their teeth demonstrating the strongest effect. Conclusion: Parents' oral health-related behaviors can affect their children's oral health status. We recommend enhancing parents' oral health literacy to improve children's oral health status. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction (AMI) is the most serious manifestation of coronary artery disease. At present, existing treatments cannot change the risk factors for the occurrence of the disease, so patients are prone to fear of progression or recurrence, and studies have shown that excessive fear will cause patients to over-examine, mental abnormalities, suicide and other behaviors, increase unnecessary medical care costs and the social medical burden. Thus to investigate the current situation of progression fear in patients with Acute Myocardial Infarction (AMI) admitted to hospital in stable stage and analyze its influencing factors. Methods: This is a cross-sectional study. In this study, 160 AMI patients admitted to the Department of Cardiology of a 3 A hospital in Changchun from November 2022 to April 2023 were selected as the research sample by a convenient sampling method. Patients completed the general information questionnaire, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Brief Illness Perception Questionnaire (BIPQ), the Medical Coping Modes Questionnaire (MCSQ), the Social Support Rating Scale (SSRS), and the Positive Psychological Questionnaire (PPQ) at the time of stable condition. Using SPSS 25.0 software for data analysis, statistical methods mainly include descriptive statistics, analysis of variance, Pearson correlation analysis and multiple linear regression analysis. Results: A total of 160 subjects were included, among which the score of simplified fear of progression scale was (33.43 ± 7.09), and the incidence of disorder of fear of progression was 50.60%. The influencing factors included gender (Beta = 0.118, P<0.05), disease perception (Beta = 0.445, P<0.001), psychological capital (Beta=-0.252, P<0.05) and resignation (Beta = 0.167, P < 0.05). Conclusion: The overall level of fear of progression in patients with AMI at the stable stage of hospitalization is above the medium level. Nursing staff should focus on AIM patients suffering from multiple diseases and lacking awareness of their own diseases, and provide personalized health guidance and psychological nursing targeted to improve patients' rehabilitation, quality of life and FoP level. [ABSTRACT FROM AUTHOR]

Background and objectives: Conduct disorders are associated with deficits in interpersonal behaviour. Both, callous-unemotional traits and social anxiety are often elevated in patients with conduct disorder and are associated with aggressive approach or disproportional avoidance. Previous studies have focused mainly on questionnaire reports of interpersonal behaviour, whereas direct explicit and implicit interpersonal behaviour in social contexts has not been considered sufficiently. Therefore, explicit and implicit interpersonal behaviour were investigated in children and adolescents with conduct disorder in the current study. Methods: Forty male adolescent inpatients with conduct disorder and 30 typically developing controls (Mage = 12.5, SD = 1.39) took part in a virtual reality task in which they approached virtual agemates, displaying different facial expressions under the pretext of a cover story while interpersonal distance and walking speed were assessed (indirect condition). In addition, they were asked to move to a comfortable distance for conversation toward the agent (direct condition). Callous-unemotional traits and social anxiety were assessed via questionnaires. Results: In the indirect condition, no differences between the groups emerged. In the direct condition, typically developing children adjusted their interpersonal distance to the respective expression that the virtual classmate displayed. They showed significantly greater interpersonal distances to angry classmates than to happy classmates. In contrast, conduct disorder patients' interpersonal distance, did not differ between emotions. Interpersonal distance preferences were also associated with social anxiety and callous-unemotional traits. Conclusion: The findings suggest that conduct disorder patients fail to adjust their interpersonal behaviour to the facial expression of social interaction partners and that this is associated with social anxiety and callous-unemotional traits. A lack of adjustment to social cues might contribute to and maintain problems with peers in individuals with conduct disorder. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the interrelationship of risk factors for suicidal behaviour and their influence on attempt severity in a sample of adolescents who have recently attempted suicide. For it a network analyse was performed. Method: Data from a sample of adolescents from 12 to 17 years of age with documented suicide attempts were collected and analysed in the context of a larger study conducted in Spain called SURVIVE. Several factors were examined including age, sex, depression, trauma, impulsivity, and substance abuse. Graph analysis was performed to identify relationships and centrality measures among these factors. Results: A total of 267 participants were enrolled: 233 females and 34 males with a mean age of 15.00 years (SD = 1.52). The results indicate that age and sex do not have a notable relationship with attempt severity in adolescents. Emotional and behavioural difficulties, measured by the Strengths and Difficulties Questionnaire (SDQ), have the greatest influence on other variables. Depression and childhood trauma show varying degrees of association with suicidal behaviour, as does motor impulsivity. Substance use does not appear to be strongly related to suicide attempt severity. The number of suicide attempts is strongly correlated with emotional and behavioural difficulties, depression, and childhood trauma. Lethality of suicide attempts and intensity of suicidal ideation do not show significant associations with the other variables. Conclusion: This study identifies significant risk factors for adolescent suicide. Emotional and behavioural symptoms, depression, and childhood trauma are strongly linked to suicidal behaviour. However, age, sex, and substance abuse show minimal correlation. Assessing emotional difficulties and depressive symptoms using specific questionnaires could be crucial in evaluating suicidal behaviour in adolescents. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders with a specific focus on fear of childbirth (FOC) are the most common mental health challenges in perinatal women. The accurate measurement of FOC is important for correctly identifying women with FOC, as well as for identifying the target population for treatment. We aimed to review FOC scales and evaluate their psychometric properties via the COSMIN methodology to identify the most suitable available instruments. Methods: We conducted this systematic review via a comprehensive search of databases, including PubMed, Web of Science, Scopus, Science Direct and ProQuest, to identify articles published from inception to May 2024 via combined keywords related to tools that assess FOC in women during pregnancy or postpartum period. The quality of the psychometric properties of the included studies was evaluated via the COSMIN checklist. Results: Of the 1160 records found initially, 47 articles were included in this review, 24 of which were related to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). According to the recommended categorization of the COSMIN methodology, among the 18 assessed scales, the Fear of Childbirth Questionnaire (FCQ) was categorized as A, and 11 scales, including the Fear-of-delivery Questionnaire (FDQ), W-DEQ-A & B, Delivery Fear Scale (DFS), Fear of Birth Scale (FOBS), Birth Anticipation Scale (BAS), Childbirth Fear Questionnaire (CFQ), Childbirth Fear Scale (CSF), Slade–Pais Expectations of Childbirth Scale (SPECS), and unnamed tools by Melender et al. (2005) and Eriksson et al. (2005) were categorized as B. Conclusion: According to the findings, the FCQ can be recommended for evaluating pregnant women with FOC. The measures categorized as B are potentially recommended for use, but further research is needed to evaluate the quality of this group. [ABSTRACT FROM AUTHOR]

Background: Reverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA. By understanding these factors, clinicians can better anticipate which patients are at higher risk and develop tailored preoperative and postoperative pain management strategies to improve overall outcomes. Methods: In this retrospective cohort study, 703 patients with complete data undergoing primary RTSA performed between 2011 and 2022 were analyzed. Persistent postsurgical pain was defined as a pain score ≥ 3 on a numeric rating scale. Multivariable regression models were used to identify patient-related and disease-related predictors of persistent postsurgical pain. Results: The cohort comprised 445 women (63%) and 258 men (37%) with a mean age of 74 ± 8 years at the time of surgery. Persistent postsurgical pain was reported by 18% of patients. Preoperative pain scores averaged 6.0 ± 2.5 on the NRS scale, which decreased to 1.2 ± 1.8 postoperatively. Key predictors included higher preoperative pain levels (β = 0.10, p < 0.001), worse preoperative QuickDASH scores (β = 0.09, p = 0.002), mild symptoms of anxiety or depression (β = 0.52, p = 0.001), prior contralateral TSA surgery (β = 0.34, p = 0.018) and greater number of previous ipsilateral shoulder surgeries (β = 0.44, p < 0.001). In contrast, patients with rheumatoid arthritis (β = − 0.85, p < 0.001) or primary osteoarthritis (β = − 0.82, p < 0.001) experienced lower pain levels. Conclusion: Our study offers important insights into the predictors of persistent postsurgical pain two years after RTSA. Key factors, including higher preoperative pain scores, poor mental health, elevated QuickDASH scores, prior contralateral TSA surgery and a history of prior ipsilateral shoulder surgeries, were identified as significant risk indicators for persistent postsurgical pain. [ABSTRACT FROM AUTHOR]

Aim: To investigate potential gender-related differences in the utilization of scope of practice (range of duties and responsibilities) across acute, community and long-term geriatric-care settings, by considering activities authorized for all registered nurses and those restricted to advanced post-basic certification graduates. Design: A cross-sectional approach, using a convenience sample. Methods: A total of 286 registered nurses [207 females (72.4%) and 79 males (27.6%)] with advanced geriatric training, completed a self-administered questionnaire addressing socio-demographic and occupational characteristics, utilization of the scope of practice, and professional satisfaction. Chi square, two-sample t-test, and a multiple regression model were used to analyze the data. Results: Male nurses reported implementation of a statistically significantly broader scope of practice than female nurses, outperforming them in 8 out of 16 activities for all registered nurses and in 5 out of 9 activities for advanced nurses with post-basic certification. Conclusion: Our findings suggest that gender-related differences in the utilization of nursing scope of practice exist, with implications for professional satisfaction and potentially for patient care outcomes. Our results highlight the need to address these differences at multiple levels, ranging from healthcare organizations, and educational institutions, to policy-making bodies. Future research should use longitudinal studies with diverse samples from various settings and include factors like organizational culture, time since certification, and patient demographics in order to better understand any influences on nursing practice. [ABSTRACT FROM AUTHOR]

Background: First-year nursing students are at a critical juncture in their education. They are transitioning from laypersons to healthcare professionals, and students are frequently exposed to medical information in academic settings and through personal research. This exposure can sometimes lead to cyberchondria; improving health literacy and managing health anxiety are critical strategies for reducing the incidence of cyberchondria. Aim: Investigate the mediating effect of health anxiety on cyberchondria and health literacy among first-year nursing students. Methods: A cross-sectional correlational research design was used in this study. The study was conducted with 475 students in October 2023 during the first semester of the academic year 2023–2024. Results: Cyberchondria and health literacy levels were both moderate. In addition, the degree of health anxiety among first-year Nursing Students was mild, too. The results showed that the association between Cyberchondria and Health Literacy was partially mediated by health anxiety. Conclusion and implications: This study highlights the sophisticated relationship between cyberchondria, health literacy, and anxiety among first-year nursing students. It demonstrates that lower health literacy can lead to increased health anxiety, which in turn exacerbates cyberchondria. To mitigate these issues, it is essential to enhance health literacy and provide support for managing health anxiety within nursing education programs. By doing so, we can help nursing students navigate online health information effectively and reduce unnecessary health-related anxieties, promoting better educational outcomes and overall well-being. [ABSTRACT FROM AUTHOR]

Background: The European Health Literacy Survey only included individuals aged 15 years and older, and the competencies of adolescents in Health Literacy remain unknown. This study aimed to explore the development of Health Literacy in secondary education students and examining the relationship between this competency and relevant sociodemographic variables. Methods: A multicenter, quantitative, observational, and descriptive study with a cross-sectional design was carried out, involving the participation of all high schools in Melilla, Spain. A total of 590 students participated in the study. A validated Spanish version of the HLS-EU-Q16 questionnaire and questionnaire on sociodemographic characteristics were used. Bivariate data analysis and multivariate ordinal logistic regression were used to evaluate the association between sociodemographic characteristics and Health Literacy. Results: The findings highlight the distinct coexistence of two cultures: European and Berber. Cultural background did not prove to be a statistically significant factor. The General Health Literacy of adolescents fell within the "problematic" range of the scale, with particularly low scores in the domain of Disease Prevention and Critical Health Literacy skills. The multivariate ordinal logistic regression analysis identified a significant association between country of birth (European vs. non-European) and a substantial increase in Health Literacy (OR: 2.65; 95% CI 1.13–6.24; p = 0.026). Conclusion: Large-scale surveys with multidimensional instruments are useful to reveal areas of Health Literacy in which adolescents feel most insecure and consequently need to be reinforced with educational interventions. The findings underscore the importance of considering cultural and contextual factors in Health Literacy interventions and highlight the need for targeted public health strategies to address Health Literacy disparities based on country of birth. [ABSTRACT FROM AUTHOR]

Background: Whether gastrointestinal hormones in patients with postprandial distress syndrome (PDS) are altered by acupuncture, and whether such alterations are related to the autonomic nervous system (ANS), remains an open question. Objective: This study aims to investigate the effects of acupuncture on symptoms, serum hormones, and ANS in PDS patients. Methods: This randomized controlled clinical trial was conducted at Beijing Hospital of Traditional Chinese Medicine affiliated with Capital Medical University. Sixty-two PDS patients were randomly assigned equally to acupuncture or sham acupuncture arm (3 sessions per week for 4-week). The main outcome measures which were evaluated at baseline and 4-week included cardinal symptoms, serum hormones including ghrelin, vasoactive intestinal peptide (VIP), substance P (SP), and ANS. Results: Among the 62 randomly assigned participants, 51 (82%) were included in the baseline characteristics and outcome analysis. Gastrointestinal symptoms including response rate (p = 0.001) and dyspepsia symptom severity (p = 0.002) were significantly improved after acupuncture treatment. Serum ghrelin concentration was significantly higher in acupuncture group than in sham acupuncture group (8.34 ± 3.00 ng/ml versus 6.52 ± 2.00 ng/ml, p = 0.022) after 4-week treatment, instead of VIP and SP (p > 0.05). The acupuncture group had significantly higher vagal activity, showing with increasing of high-frequency component (HF, p ≤ 0.001) and decreasing of the ratio of low-frequency and HF (p ≤ 0.001). In relationship analysis, the HF component exhibited a significant inverse correlation with symptom severity (R = − 0.501, p ≤ 0.001), but not with ghrelin level (R = 0.026, p = 0.865). Conclusion: Acupuncture may improve the symptoms and increase the ghrelin level of PDS patients, the therapeutic effect of acupuncture was associated with the alteration of vagal activity. Trial registration: The trial is registered with the ISRCTN registry, ISRCTN12511434. Registered 31 March 2017, https://www.isrctn.com/. [ABSTRACT FROM AUTHOR]

Background: Wearable-generated data yield objective information on physical activity and sleep variables, which, are in turn, related to the phenomenology of depression. There is a dearth of wearable-generated data regarding physical activity and sleep variables among youth with clinical depression. Methods: Longitudinal (up to 24 months) quarterly collections of wearable-generated variables among adolescents diagnosed with current/past major depression. Latent class analysis was employed to classify participants on the basis of wearable-generated: Activity, Sleep Duration, and Sleep efficiency. The Patient Health Questionnaire adapted for adolescents (PHQ-9-A), and the Ruminative Response Scale (RRS) at study intake were employed to predict class membership. Results: Seventy-two adolescents (72.5% girls) were recruited over 31 months. Activity, Sleep Duration, and Sleep efficiency were reciprocally correlated, and wearable-generated data were reducible into a finite number (3 to 4) of classes of individuals. A PHQ-A score in the clinical range (14 and above) at study intake predicted a class of low physical activity (Acceleration) and a class of shorter Sleep Duration. Limitations: Limited power related to the sample size and the interim nature of this study. Conclusions: This study of wearable-generated variables among adolescents diagnosed with clinical depression shows that a large amount of longitudinal data is amenable to reduction into a finite number of classes of individuals. Interfacing wearable-generated data with clinical measures can yield insights on the relationships between objective psychobiological measures and symptoms of adolescent depression, and may improve clinical management of depression. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effect of social media-supported learning on the academic achievement of nursing students and their social media usage levels in nursing education. Background: Using social media in nursing education enables students to experience interactive learning, strengthening learning outcomes and creating an enriched learning environment with up-to-date information. Method: The study was conducted as a randomized controlled study. CONSORTchecklist was completed. The subject of parenteral drug administration was explained interactively to all students by the same instructors for a total of 12 h for weeks. After the theoretical course, each skill was demonstrated by the instructor in the laboratory setting in a 24-h laboratory course with the demonstration method in line with the checklists. After the training was completed, the students filled out the necessary forms. Videos and informative images about parenteral drug applications were shared with the intervention group for 4 weeks through an Instagram page created for social media-supported learning. Questions and answers were shared on the subject every day in the story section. The answer to the question was shared in the story section the next day with explanations. At the end of the 4th training week, the students were asked to complete the necessary forms as a post-test. Changes in academic achievement and social media usage after the intervention were measured using achievement tests and the Social Media Scale in Nursing Education. Data were analyzed with SPSS 23.0. Normality was tested using the Shapiro–Wilk test. Independent t-tests and the Chi-Square test for categorical variables were used for normally distributed continuous variables. Pre-test and post-test comparisons within groups were evaluated with the Paired t-test if normality was met, or the Wilcoxon test. The effect size was calculated using Cohen's d. Results: After social media-supported learning, it was found that the difference between the post-test mean scores of the nursing students in the intervention and control group was statistically significant(p < 0.001). It was also found that the average of the exam results after the training increased compared to the average before the training, and the difference between the two scores was statistically significant(p < 0.001). Conclusion: Social media-supported education positively affected the academic achievements of nursing students and the level of social media use in nursing education. [ABSTRACT FROM AUTHOR]

Background: Traditional complementary and alternative medicine (TCAM) are products and practices that differ from conventional allopathic medicine. There continues to be an increase in the use of these methods of treatment in developed and developing countries worldwide. This often owes to the perceived ability of these treatment methods to cure chronic medical conditions like HIV. However, TCAM use among PLHIV may be associated with reduced compliance with antiretroviral medications, resulting in poor viral load suppression and increased risk for opportunistic infections. The concomitant use of antiretroviral drugs and TCAM practices may be influenced by some sociodemographic and health-related factors. Objective: To determine the prevalence of TCAM use and examine the sociodemographic and health-related factors associated with its use among PLHIV on antiretroviral medications at the Infectious Disease unit of Korle-Bu Teaching Hospital in Ghana. Methods: A cross-sectional study was conducted among attendants at an adult HIV clinic. 420 study participants were selected by systematic sampling. Data related to TCAM use, sociodemographic and health-related factors were collected using a standardized questionnaire and patient chart review. Multivariate logistic regression model was used to determine the association between TCAM use, sociodemographic and health-related factors. Results: Of the 420 study participants, majority were female (76.2%) and urban community dwellers (77.9%). 77.4% of participants had been diagnosed with HIV for 5 years and had been on anti-retroviral medications for more than 5 years. The prevalence of TCAM use among PLHIV was 25.2%. No sociodemographic or HIV-related health factor was significantly associated with TCAM use in the study population. Conclusion: TCAM use was high among PLHIV. No sociodemographic or health-related factor was found to be associated with TCAM use. Further studies employing a qualitative approach using key informant interviews and focused group discussions are needed to explore reasons for its use. Care providers and policy-makers should look beyond sociodemographic and health-related factors in addressing TCAM use among PLHIV. [ABSTRACT FROM AUTHOR]

Background: The global nursing shortage, driven by high turnover rates, significantly impacts healthcare quality. Workplace psychological violence severely affects nurses' mental health and job satisfaction, leading to increased turnover. Despite extensive research on workplace violence, the specific impact of psychological violence on nurses' turnover intentions remains insufficiently explored. This study investigates the mediating role of job satisfaction in the relationship between workplace psychological violence and nurses' turnover intentions. Methods: A workplace psychological violence scale, a job satisfaction scale, and a turnover intention questionnaire were utilized to survey 206 clinical nurses in a tertiary-level hospital in Guangzhou City. The study employed a convenience sampling method. Statistical analyses included correlation, mediation analyses., descriptive statistics, multivariate linear hierarchical regression analyses, Pearson correlation analyses, and structural equation models. Results: Clinical nurses reported a workplace psychological violence score of 0.97 ± 0.79, job satisfaction of 3.16 ± 0.58, and turnover intention of 2.22 ± 0.92. Workplace psychological violence was negatively correlated with job satisfaction (r = -0.516, P < 0.01) and positively correlated with turnover intention (r = 0.418, P < 0.01). Turnover intention was negatively correlated with job satisfaction (r = -0.477, P < 0.01). Mediation analysis indicated that Job satisfaction partially mediated the association between workplace psychological violence and turnover intention. The total effect (β = 0.489) of workplace psychological violence on turnover intention included its direct effect (β = 0.274) and the indirect effect mediated through job satisfaction (β = 0.215), with the mediating effect accounting for 43.97% of the total effect. Conclusions: Workplace psychological violence directly predicts nurses' turnover intention, with job satisfaction serving as a mediator in this relationship. Healthcare managers can mitigate psychological violence by improving mental health support, work environments, and organizational culture to enhance job satisfaction and reduce nurse turnover. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study is to explore the current level of nursing students' study skills self-efficacy, and whether general self-efficacy and self-directed learning ability mediate the relationship between perceived stress (including positive stress and negative stress) and study skills self-efficacy. Methods: The survey was conducted among 1,289 nursing students including 795 students from Jinzhou Medical University and 494 students from Dalian University. Participants completed a self-designed questionnaire, which included the Study Skills Self-Efficacy Scale, Perceived Stress Scale, General Self-Efficacy Scale, Self-Directed Learning Instrument, gender, age, academic year, and other demographic characteristics. Descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analyses, and the bootstrap method were used for data analysis. Results: Positive stress significantly positively predicted students' study skills self-efficacy, with an effect size of 0.686. Moreover, general self-efficacy and self-directed learning mediate the relationship between positive stress and study skills self-efficacy in nursing students, with effect sizes of 0.235 and 0.245, respectively. The direct effect of negative pressure on students' study skills self-efficacy is not statistically significant, but it has a significant negative predictive effect on study skills self-efficacy under the mediation of general self-efficacy and self-directed learning, with effect sizes of -0.337 and -0.238, respectively. Conclusion: This study explains how stress affects students' study skills self-efficacy, and the results have certain enlightenment significance for improving the stress management ability and study skills self-efficacy of college students in the future. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs. Methods: This study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs. Results: Primary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs' use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14). Conclusions: Digital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies. [ABSTRACT FROM AUTHOR]

Background: The intestinal epithelial barrier is the first line of defense against pathogens and noxious substances entering the body from the outside world. Through proliferation and differentiation, intestinal stem cells play vital roles in tissue regeneration, repair, and the maintenance of intestinal homeostasis. Inflammatory bowel disease (IBD) is caused by the disruption of intestinal homeostasis through the invasion of toxic compounds and pathogenic microorganisms. Hylotelephium erythrostictum (Miq.) H. Ohba (H. erythrostictum) is a plant with diverse pharmacological properties, including antioxidant, anti-inflammatory, antidiabetic, and antirheumatic properties. However, the roles of H. erythrostictum and its bioactive compounds in the treatment of intestinal injury are unknown. Methods: We examined the protective effects of H. erythrostictum water extract (HEWE) and H. erythrostictum butanol extract (HEBE) on Drosophila intestinal injury caused by dextran sodium sulfate (DSS) or Erwinia carotovoracarotovora 15 (Ecc15). Results: Our findings demonstrated that both HEWE and HEBE significantly prolonged the lifespan of flies fed toxic compounds, reduced cell mortality, and maintained intestinal integrity and gut acid‒base homeostasis. Furthermore, both HEWE and HEBE eliminated DSS-induced ROS accumulation, alleviated the increases in antimicrobial peptides(AMPs) and intestinal lipid droplets caused by Ecc15 infection, and prevented excessive ISC proliferation and differentiation by inhibiting the JNK, EGFR, and JAK/STAT pathways. In addition, they reversed the significant changes in the proportions of the gut microbiota induced by DSS. The bioactive compounds contained in H. erythrostictum extracts have sufficient potential for use as natural therapeutic agents for the treatment of IBD in humans. Conclusion: Our results suggest that HEWE and HEBE are highly effective in reducing intestinal inflammation and thus have the potential to be viable therapeutic agents for the treatment of gut inflammation. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Objectives were to assess the mouth opening ability (MOA) among patients with systemic sclerosis (SSc) in comparison to a healthy control population. The impact of microstomia (decrease in any of the MOA parameters) on physical performance and long-term survival was also investigated. Methods: Interincisal (ID), interlabial (LD), the intercommissural distances at both opened mouth and closed mouth (OW, CW) and the oral area (OA) and circumference (OC) all were assessed in 131 SSc patients. Microstomia was defined based on the oral aperture values of a healthy control group (n = 63) with similar median age and sex distribution. Tests evaluating functional performance were performed. Survival analysis by univariate and multivariate Cox regression analysis was performed. Results: Microstomia was present in 56.5% of the entire SSc cohort. Patients with microstomia had higher number of contractures compared to those with preserved oral aperture parameters (median 10 vs. 7, p < 0.01). LD, OA and OC correlated negatively with the number of joint contractures, both in the entire SSc cohort and separately in the diffuse (dcSSc) and limited cutaneous subsets (lcSSc), (rho: between − 0.267 and − 0.516, p < 0.05). Reduced ID was associated with worse Health Assessment Questionnaire Disability Index (HAQ-DI) only in dcSSc while reduced LD was linked to increased HAQ-DI scores in both SSc subsets. Decreased OA upon enrollment was associated with an increased risk in mortality by multivariate Cox regression analysis (HR: 2.74; 95% CI, 1.15–6.53). Conclusions: Microstomia was associated with joint damage, and higher overall disability based on HAQ-DI. Interlabial distance was a beneficial, convenient measurable parameter to characterize oral aperture. Oral area was an independent poor prognostic factor regarding long-term survival. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) is a significant oral health issue affecting children under six years old. This study aimed to determine the prevalence and distribution of ECC in Nigeria through a systematic review and meta-analysis. Methods: A systematic search was conducted across multiple databases for studies on ECC prevalence in Nigeria. The Joanna Briggs Institute (JBI) checklist was used to assess study quality. A random-effects model was employed to calculate pooled prevalence estimates and mean dmft scores. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity. Results: Twenty-three studies met the inclusion criteria, comprising 7,362 participants. The pooled ECC prevalence in Nigeria was 17% (95% CI 11–24%), with significant heterogeneity (I2 = 97%). Subgroup analyses revealed variations across geopolitical zones and study settings. The pooled mean dmft score was 0.44 (95% CI 0.24–0.74). Age group and gender showed minimal impact on ECC prevalence. Conclusion: With a 17% prevalence rate, ECC remains a significant public health concern in Nigeria. The study highlights the need for targeted interventions, standardized national surveys, and further research into region-specific risk factors to address ECC effectively. [ABSTRACT FROM AUTHOR]

Background: The inclusion of family therapy in residential treatment centers (RTCs) has increased over time. However, there is little data on whether empirically-supported family therapies (ESFTs) are being adopted and if they contribute to treatment effectiveness. This study aimed to test whether Attachment-Based Family Therapy (ABFT), an ESFT integrated into a large residential psychiatric system, would improve perceived attachment insecurity (anxiety and avoidance) and contribute to decreases in depression for adolescents. Method: ABFT was integrated into the clinical program of a large, residential psychiatric system. All family therapists were trained to a level of certification. Improvement was measured by changes in adolescent's perceived attachment to caregivers and reduction in depressive symptoms. The sample included 4786 patients. Attachment insecurity and depressive symptoms were measured at intake, week 3, and week 5. A random-intercept, cross-lagged panel model was used to examine the relationships between attachment and depression over time. Results: The results generally supported hypotheses. Attachment insecurity and depressive symptoms improved over the five weeks of treatment. Improvements in attachment avoidance preceded improvements in depressive symptoms within subjects, over time. Simultaneously, improvements in depressive symptoms preceded those in both dimensions of attachment. Thus, improvement in perceived attachment was associated with a reduction in depressive symptoms. Conclusion: RTCs that can generate improvements in attachment insecurity and depressive symptoms, via ABFT or other ESFTs, might improve treatment outcomes, and ideally, adolescents' successful transition back home to families. More research is needed to disentangle the contribution of ABFT and other treatment elements in a multimodal, residential treatment program. The study supports the call for increased incorporation of families into the RTC treatment process. [ABSTRACT FROM AUTHOR]

Background: In clinical settings, continuous changes lead to increased professional stress, affecting the quality of life of nurses. Some complementary interventions may influence the improvement of the quality of life. This study aimed to determine the effect of Benson's relaxation technique on the operating room nurses' quality of life. Methods: In this clinical trial, 180 operating room nurses were randomly allocated to two groups: intervention (Benson's relaxation technique) and control (routine activity). The study was conducted from December 2021 to March 2022 in hospitals affiliated with Shiraz University of Medical Sciences. Benson's relaxation technique was performed twice daily by the intervention group for 8 weeks. Quality of life was measured before and after the intervention using the SF-36 questionnaire. Data were analyzed using SPSS version 21 software, with a significance level set at a P < 0.05. Results: After the intervention, the results showed that Benson's relaxation technique led to an increase in the quality of life in the intervention group (P < 0.0001). In terms of quality-of-life dimensions, significant improvements were observed in the intervention group in the domains of physical problems (P < 0.05), emotional problems (P < 0.05), general health (P < 0.05), pain (P < 0.0001), and social functioning (P < 0.05). However, no significant differences were found in the dimensions of physical functioning, energy, and emotional well-being. Conclusions: Benson's relaxation technique can serve as a complementary method to improve various dimensions of the operating room nurses' quality of life. Trial Registration Number: IRCT20211002052650N1 with the Clinical Trial Registry (26.10.2022). [ABSTRACT FROM AUTHOR]