Search

Background and Aims: Cardiac Implantable Electronic Device (CIED) infections pose significant mortality and morbidity despite optimal treatment. This survey aimed to understand whether and how the risk of CIED infection is assessed and mitigated in clinical practice in Europe, and to detect gaps with respect to EHRA recommendations., Methods: An Expert Group of 8 European cardiologists with specific expertise across CIED therapy designed and distributed electronically a survey to a number of European Cardiologists., Results: 302 physicians from 18 European countries responded to the survey. 288/302 (95%) physicians agreed that CIED-related infections represent a burden on healthcare resources and are associated with significant morbidity and mortality. 285/302 respondents (94%) primarily assess the risk of CIED infections by only evaluating the patient's clinical profile (137/302, 46%) or with the support of a risk score (148/302, 49%). Intravenous antibiotic prophylaxis is used by 282/302 (93%), followed by the implantation of the lowest number of leads possible (182/302, 60%), and by the use of an antibacterial envelope (173/302, 57%). 230/302 respondents (76%) declared that there is need for clear and concise guidelines and more sensitive risk-scores for CIED infection, to maximize the chances of preventative strategies., Conclusions: This survey demonstrates a high level of awareness about the multifaceted issue of CIED infection, however, it also highlights an incomplete penetration of scoring systems for risk stratification owing to their perceived limitations, and detects a strong commitment to increase the effectiveness of preventative strategies., Competing Interests: Declaration of competing interest Medtronic supported the survey project, however the views and opinions expressed are those of the authors and not Medtronic, therefore no relevant conflicts of interest are reported., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: With the recent advent of technology, it is important to confirm the health and safety of the youth. This study aimed to prospectively evaluate the relationship between Wi-Fi, cordless phones, and mobile phone usage patterns and behavioral problems., Methods: This study involved 2465 children aged 8-17 years from the Hokkaido Study on Environment and Children's Health from October 2020 to January 2021, with a follow-up from September 2021 to March 2022. The mother-child dyad provided information on the presence of residential Wi-Fi and cordless phones, cordless phone call duration, and mobile phone usage pattern (duration of calls using mobile network and internet, online audio streaming, online video streaming, and playing online games) via a baseline questionnaire. Based on the scores on Strength and Difficulties Questionnaire at baseline and follow-up, the children were categorized into four groups: normal, persistent, improved, and concurrent., Results: No significant association was found between Wi-Fi, mobile phone calls via mobile networks, and behavioral problems. Cordless phone at home had higher odds for improvement in total difficulty scores, and cordless phone for calling more than 4 min per week had lower odds of persistent problematic prosocial behavior. Longer duration of mobile phone calling via the internet (>40 min/week) had higher odds of concurrent total difficulties. Mobile phone calling via mobile network for <5 min per week had higher odds for improved total difficulty scores. Audio streaming via mobile phones for 60-120 min had lower odds of persistent total difficulties., Conclusion: Our results showed sporadic findings between residential RF-EMF indoor sources and mobile phone usage pattern. These observed findings could be affected by residual confounding and chance findings. Ongoing follow-up studies are necessary to further explore this association through detailed exposure assessment and addressing the potential limitations of our study., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Reiko Kishi reports financial support was provided by Japanese Ministry of Internal Affairs and Communications. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Education in basic life support is widely proposed to increase survival in out-of-hospital sudden cardiac arrest. The authors aimed to assess knowledge, skills, and attitudes, including willingness to help, regarding myocardial infarction and sudden cardiac arrest among university students of all fields of knowledge., Methods: An Ethical Research Committee approved this cross-sectional study. An electronic survey "KIDS SAVE LIVES BRAZIL" was sent to 58,862 students of 82 disciplines in three universities, aged ≥ 18 years. The survey covered three categories: knowledge, skills, and attitude. Each category was graded between 0 and 10 points (the highest)., Results: Among students, 4,803 undergraduates (8.2 %) answered the survey, and were divided into three groups of disciplines: medicine (219, ∼21.7 years, 38 % male), other-healthcare (n = 1,058; ∼22.9 years; 36 % male), and non-health-care (n = 3,526; ∼22.9 years; 35 % male). All three groups showed significant differences between them (p < 0.001). The non-health-care compared with medicine and other healthcare groups showed, respectively, the lowest median scores (25 %‒75 %) in knowledge (4.0 [0.0‒9.3], 4.0 [4.0‒8.0], and 4.0 [4.0‒4.7]), skills (2.4 [1.2‒3.3], 6.4 [4.0‒8.3], 4.0 [2.4‒6.2]), and attitude (5.9 [5.9‒6.8], 7.3 [5.9‒7.3], and 7.3 [5.9‒7.3])., Conclusion: University students who answered the e-survey have the willingness to help victims suffering from myocardial infarction or sustaining sudden cardiac arrest. However, non healthcare students markedly lack the knowledge and skills to perform cardiopulmonary resuscitation and automated external defibrillation. These findings reveal a stark difference in basic life support competencies between students in related healthcare fields and those in non-health fields, emphasizing the need for universal basic life support training., Competing Interests: Conflicts of interest Federico Semeraro is Chair-Elect of the European Resuscitation Council and an Emeritus Member of the ILCOR BLS Task Force. Maria José C. Carmona receives fees from Cristália Pharma Ind., Medtronic PLC, and União Química Pharma S.A. Editor of the Brazilian Journal of Anaesthesiology. Andrew Lockey is the President of the Resuscitation Council UK, Bernd W. Böttiger is the treasurer of the European Resuscitation Council (ERC); Chairman of the German Resuscitation Council (GRC); Federal Medical Advisor of the German Red Cross (DRK); Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR); Member of the Board of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Founder of the ERC Research NET and the German Resuscitation Foundation, Co-Editor of “Resuscitation”; Editor of the Journal “Notfall + Rettungsmedizin”, Co-Editor of the Brazilian Journal of Anaesthesiology. He received fees for lectures from the following companies: Forum für medizinische Fortbildung (FomF), Baxalta Deutschland GmbH, ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH, Bioscience Valuation BSV GmbH. Naomi K. Nakagawa is the Brazilian Coordinator of Kids Save Lives Brazil, a Member of the Science and Education Basic Life Support Committee of the European Resuscitation Council, and Co-Editor of Clinics., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Ectoparasites significantly impact the health and productivity of chickens, both directly and indirectly. From October 2022 to September 2023, a cross-sectional study was conducted in the East Gojam Zone of the Amhara region, North West Ethiopia to identifying the ectoparasite species infesting free-ranged chicken. Additionally, a questionnaire survey was used to assess farmers knowledge and attitudes towards control practices. The purposeful sampling method was utilized to select study districts and peasant associations (PAs), while the simple random sampling method was employed to select interviewed respondents (n = 90) and sampled chickens. Samples were collected from 384 chickens through visual examination of their entire bodies, including skin scraps, to expose any ectoparasites present. The ectoparasites were then identified according to diagnostic guidelines. Out of the 384 local chickens examined, 184 (47.9 %) were found to harbor one or more of ectoparasites. Four genera of ectoparasites were identified, with louse (Menacanthus stramineus) most prevalent species (N = 133/184) 72.3 % and fleas (Ceratophyllidae) being the least prevalent N = 3 (1.6 %). Lice species included Menacanthus stramineus (N = 98) 53.3 %, Lipeurus caponis (N = 15) 8.2 %, Goniocotes gallinae 7 (3.8 %), Menopon gallinae (N = 7) 3.8 %, and Cuclotogaster heterographus (N = 6) 3.3 %. Additionally, one species of ticks (Argas persicus, (N = 9) 4.9 %, mites (Knemidocoptes mutans, (N = 5) 2.7 %, and fleas (Echidnophaga gallinacean, (N = 3) 1.6 % were found. Statistically significant differences (p = 0.040) in prevalence were observed between age groups, breeds, management systems, and study areas. However, the prevalence was not statistically significant (p > 0.05) between sex categories. Results from the questionnaire survey revealed that most poultry farmers were female (N = 74) 82.2 % and illiterate (N = 52) 57.8 %. A majority of respondents (N = 55) 61.1 % lacked information regarding ectoparasite infestations in chickens, while (N = 36)36.7 % of respondents fed their chickens supplementary feed once a day. This study highlights the prevalence of ectoparasite infestations among chickens in the studied areas. Therefore, it is recommended to raise awareness among the community about control practices and conduct further studies focusing on the impacts of ectoparasites., Competing Interests: Declaration of competing interest All authors have seen and approved the final version of the manuscript being submitted. We warrant that the article is the author's original work, has not received prior publication and is not under consideration for publication elsewhere. Declaration of interests for the manuscript Prevalence of Domestic Chickens' Ectoparasites in the East Goejam, Amhara, Ethiopia. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Problem: Despite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women's perspectives on midwife-led care., Background: The Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services., Aim: This study explored women's attitudes and beliefs towards the implementation of midwife-led care in two southern states of India., Methods: A convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques., Findings: A total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women's acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced., Discussion: Most participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services., Conclusion: Insights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Problem: Retention of midwives across the career lifespan is essential to address workforce shortages., Background: While workplace factors are demonstrated to affect job satisfaction and turnover intention, there is little research investigating how workplace factors affect midwives at different career stages., Aim: To examine the effects of workload and practice climate on job satisfaction and turnover intention at different career stages., Methods: In a secondary analysis, we split a sample of US midwives into early-, mid-, and late-career stages. We used latent profile analysis to create profiles (called "classes") of workload (volume of women/individuals receiving care and acuity) and practice climate. Job dissatisfaction and turnover intention were compared between classes by career stages., Findings: Across all career stages, classes with negative practice climates had significantly higher turnover intention and job dissatisfaction, regardless of patient volume or acuity. Among early career midwives, high workload was not associated with high turnover intention or job dissatisfaction in the context of positive practice climates. The highest proportion of mid- career participants were in the class with high turnover intention and job dissatisfaction, while in the early career subsample the largest proportion was in the class with low dissatisfaction and low turnover intention., Discussion: Across all career stages, the practice climate was the primary driver of turnover intention and job dissatisfaction. Practice climate is particularly important for early-career midwives working in high-volume settings. Mid-career midwives are an under-studied group at risk of leaving the profession., Conclusion: Efforts to retain the midwifery workforce would benefit from tailoring retention strategies to midwives at different career stages., (Copyright © 2024 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background/problem: To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed., Aim: To explore Belgian midwives' readiness for midwife-led care and understand the underlying processes., Methods: A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis., Findings: Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals' lack of awareness of available data of women's experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period., Discussion/conclusion: In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum services but face challenges in extending midwife-led care to antenatal and intrapartum services., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Intro: In Australia, little research has examined how women and people participate in decision-making about types of fetal monitoring, or their perceptions of information provided by caregivers., Methods: A national cross-sectional survey, the 'Women's experiences Of Monitoring Baby' (WOMB) Study, explored women's experiences of intrapartum fetal monitoring. This study reports on selected results., Results: There were 861 responses. Of respondents, 20 % reported receiving enough information about types of fetal monitoring from care providers and childbirth education, 35 % recalled being asked for consent, and 34 % were unaware they had a choice in monitoring. Most women (86 %) obtained information via 'other' sources or own reading, and where monitoring was discussed, it was most likely a 'brief discussion' with a midwife (43 %). Women who were monitored via wired CTG (35 %) were more likely to report facing barriers to choosing their preferred monitoring type, (p<0.001). Wired CTG was significantly associated with hospital type and primiparity and 70 % indicated they would not choose it again (p<0.001)., Conclusion: Women did not know they had a choice in the type of intrapartum monitoring received, and felt they had insufficient information to make informed decisions. While monitoring via intermittent doppler and wireless CTG was preferred, women experienced barriers to receiving these, especially in public hospitals in rural/regional areas and private metropolitan hospitals. Antenatal models of care and childbirth education are underutilised avenues for providing information however, it is incumbent on maternity systems to provide adequate information resources, access to equipment and appropriate models of woman-centred and humane care., Competing Interests: Declaration of Competing Interest Kate Levett and Deborah Fox are sub-editors for Women and Birth. Deborah Fox has received consultancy fees from Philips Healthcare for presentations to clinicians on mobility in labour, and research funding for two unrelated projects evaluating the Philips Avalon Beltless Solution (non-invasive fetal ECG). All other authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Given technology's rising importance in addressing alcohol issues, this study aimed to compare the effectiveness of web-based interventions and that of traditional paper-based methods for alcohol use screening and education administered by village health volunteers (VHVs) in Thailand., Methods: This cluster randomised controlled trial was conducted in two Thai villages with similar demographics and alcohol-use patterns. The villages were randomly assigned to either a web-based or a paper-based intervention group. The web-based group accessed screenings and interventions through a digital platform designed to facilitate participant interaction and data collection, whereas the paper-based group used conventional face-to-face screenings, paper questionnaires, and printed educational materials., Results: Of the 1396 participants, those in the web-based group (n = 421) demonstrated a significantly higher likelihood of abstaining from or discontinuing alcohol use by the third session compared to those in the paper group (n = 975) (adjusted odds ratio 1.88-8.11). Additionally, satisfaction among VHVs regarding the ease of use and data accuracy was notably higher in the web-based group, with scores averaging 20 % higher than those in the control group., Conclusion: Web-based interventions are more effective and efficient than traditional methods and provide a promising tool for expanding alcohol use disorder screening and education. This approach not only enhances participation rates but also improves the accuracy and reliability of health data collection., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: People who use drugs (PWUD) and people who use medication-assisted treatment (MAT) to treat opioid use disorder face severe stigma. Stigma may manifest in delayed health-seeking behaviors, which adversely affects health and increases disease risk. Few validated measures assess internalized drug use stigma or MAT disclosure concerns in sub-Saharan Africa. This study examines the performance of internalized drug use stigma scales and characterizes the prevalence of these stigmas among PWUD and people who use MAT in Dar es Salaam, Tanzania., Methods: We conducted a cross-sectional survey among 250 PWUD and 251 MAT clinic clients. Internalized drug use and MAT disclosure concerns were measured using scales adapted to the Tanzanian context. We conducted exploratory factor analysis to identify latent constructs and evaluate reliability of the scales. We then used confirmatory factor analysis to assess construct validity and reliability., Results: The six-item internalized drug use stigma scale (IDUSS) was unidimensional, reflected acceptable goodness-of-fit, and acceptable reliability (Cronbach's α = 0.79). The eight-item internalized drug use stigma scale for people using MAT (IDUSS-MAT) was bidimensional. Allowing error terms of related items to covary improved goodness-of-fit. The IDUSS-MAT demonstrated acceptable reliability (Cronbach's α = 0.79). Among PWUD and MAT clinic clients, higher levels of stigma were associated with increased depression and reduced social support and quality of life., Conclusions: Both the IDUSS and IDUSS-MAT demonstrated good construct validity and acceptable reliability. These validated scales provide the foundation for collecting data to inform the development of stigma reduction interventions in Tanzania and among similar Sub-Saharan populations of PWUD and the tools needed to assess those interventions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Rasmussen syndrome (RS) is marked by progressive unihemispheric atrophy, resulting in hemiparesis, refractory epilepsy, and cognitive/language decline. Detailed diagnostic and treatment algorithms are currently lacking. We aimed to survey medical providers on their current practices in the diagnosis and treatment of RS., Methods: A steering committee was formed to create the survey, which was disseminated to the international medical community. One hundred twelve surveys were completed. Descriptive statistics, as well as comparisons by level of experience, patient age group cared for, and geographic region using Fisher's exact test, were conducted., Results: Analysis of cerebrospinal fluid (82 %) and serum (78 %) for autoimmune encephalitis (AE) are completed by most, while approximately one-third obtain genetic and metabolic studies in all patients (36 % and 38 %, respectively). Providers in US and Europe more readily pursue serum AE antibody panels (85 % and 85 %, respectively, versus 67 %, p = 0.019) and genetic testing (56 % and 47 %, respectively, versus 14 %, p < 0.001) than the rest of the world. Thirty-six percent proceed to biopsy in patients otherwise meeting diagnostic criteria, and US providers are more likely to suggest this than others (73 % versus 14-41 %, p < 0.001). Opinions differed on the prioritization of hemispherectomy/hemispherotomy versus immunotherapy in 14 clinical scenarios with various neurologic deficit severity provided. Preferred immunotherapy regimens also varied, with US providers more often choosing IVIG as first-line (67 %) compared to others (28 %-32 %, p = 0.030). Surgical standard of care was identified as functional hemispherectomy or hemispherotomy by 90 %., Conclusion: The survey highlights trends but also significant variations in clinical practice that can serve as targets for future research and expert consensus guidelines., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Suresh Pujar has received honoraria for serving on advisory board for UCB, and speaker's fees from UCB and Danone. Coral M. Stredny receives grant support from the Pediatric Epilepsy Research Foundation. She is an unpaid member of the medical and scientific advisory boards of the Autoimmune Encephalitis Alliance and NORSE Institute. Claude Steriade receives institutional salary support from The Epilepsy Study Consortium, on behalf of Alterity, Cerebral, Cerevel, Eliem, Equilibre, Janssen, Longboard, Marinus, Neurocrine, Neuroelectrics, Receptor, SK Life Sciences, Supernus, UCB, and Xenon, serves as an Editor for Dynamed, receives grants from NINDS, Parekh Institute for Interdisciplinary Neurology, NORD, and UCB, has served as an Expert Witness for the DOJ, has received compensation for speakers bureau for SK Life Sciences and consulted for Epitel Inc. and Jazz Pharmaceuticals. Ronny Wickström has received honoraria for serving on advisory boards for Jazz Pharmaceuticals, GW Pharma and Octapharma and speaker's fees from EISAI, UCB, Sobi, Jazz Pharmaceuticals and Sanofi-Genzyme. Medical treatments discussed represent off-label uses., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Institutionalised birth settings do not meet the needs or wishes of all women. Current literature has reported on women's experiences of alternative birthplaces, however there is no published data on Australian birth houses. Birth houses are low-technology home-like birthplaces where women receive care from endorsed private practice midwives. Knowledge of women's perspectives and experiences of birth houses is unreported., Aims: To gain understanding of women's motivations for accessing and experiences of birth houses; and develop insight into the role of birth houses within Australian maternity services., Methods: A qualitative descriptive study was conducted in 2020. This methodology was chosen to centre women's voices of their experiences. Women who had utilised birth houses for labour and birth were invited to participate. Those who responded completed a brief questionnaire to support diversity in participant selection. Interviews were conducted via video-link, based on semi-structured open-ended questions. These were transcribed verbatim and thematically analysed., Findings: Ten women who utilised any of three known birth houses in Australia for labour and/or birth were interviewed. Four themes were revealed: "I knew there must be another way", "The best of both worlds", "Discovering a safe space" and "Transformation" with safety interwoven through each of these., Discussion: Women sought birthplaces and care congruent with their values and knowledge. Birth houses offered women a level of agency unavailable within hospital-based maternity care. While proximity to medical facilities was important, women's definitions of safety transcended biomedical perspectives to incorporate emotional and psychosocial wellbeing. Women described their experiences in birth houses as transformational, highly satisfying, and positive influences for future birthplace choices., Conclusion: Women sought birth houses for safety, convenience, agency and autonomy. This study demonstrated these needs were met within birth houses, highlighting these birthplaces as a middle ground between home and hospital. High levels of satisfaction illustrate the validity of birth houses and reiterate the call for greater birthplace choice for all women., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Older adults with cancer value the perspectives of significant others and their carers regarding decision-making about treatment. Understanding the support provided by carers, and their perspectives on involvement in treatment decision-making, can help us improve our communication with patients and their supports. We aimed to describe the roles, burden, and decision-making preferences of carers of older adults with cancer., Materials and Methods: We performed a cross-sectional survey of carers of older adults (≥65y) with cancer at three centres in Sydney, Australia. Type, frequency, and perspectives on providing care were evaluated using Likert scales. Preferred and perceived role in treatment decision-making by modified Control Preferences Scale, and carer burden by Zarit Burden Index (ZBI-12), were evaluated. Preferred role in decision-making and carer burden were compared between groups (culturally and linguistically diverse backgrounds [CALD], sex, and carer age ≥ 65) by chi-squared or t-tests., Results: One-hundred and fourteen returned surveys were included (23 partially completed). Carer characteristics: median age 55y (range 24-90), female (74 %), child (49 %) and spouse (35 %) of the care-recipient. Care-recipient characteristics: median age 75y (range 65-96), receiving anti-cancer treatment (85 %), and CALD background (44 %). Carers were frequently involved in communication and information gathering (45 % -80 %) and supported instrumental activities of daily living (IADLs) (43 % - 81 %) more frequently than basic activities of daily living (ADLs) (2-13 %). Most (91 %) preferred to be present when treatment options were discussed. Their preferred role in treatment decision-making was passive in 66 %, collaborative in 30 %, and active in 4 %, with most (72 %) playing their preferred role. The preferred role was associated with carer age (p = 0.01) and CALD background (p = 0.04), with younger (<65y) carers and those caring for CALD older adults preferring a more passive role. Carer burden was 'low' in 29 %, 'moderate' in 31 %, and 'high' in 39 %, and providing psychological support was rated most challenging., Discussion: Carers of older adults with cancer play varied support roles, particularly in communication and information gathering. Carers prefer to be present for discussions about treatment options, though favour a passive role in treatment decision-making, upholding patient autonomy. Understanding the communication preferences of carers is an important consideration when supporting the patient in deciding treatment options and direction of care., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: Sleep plays an important role in children's behavior, emotional control, and cognitive development. There is a higher prevalence of sleep problems in children with neurodevelopmental disorders (NDDs) compared to those without disease. There are a few studies regarding sleep problems among Thai preschoolers with NDDs. This study examined sleep problems in preschoolers with NDDs, compared with typically developing children (TD), and studied the association between sleep problems and behavioral problems among preschoolers with NDDs., Methods: Sleep problems in 140 children aged 2 to 6 years with NDDs; autism spectrum disorders, attention deficit/hyperactivity disorder, global developmental delay, and developmental language disorder were evaluated by using the Thai version of Japanese Sleep Questionnaire for Preschoolers (TH-JSQ-P) and compared with 285 TD children at the same age. Behavioral problems in the NDDs group were evaluated by using the Child Behavioral Checklist (CBCL). Sleep and behavioral problem scores were analyzed by adjusted age, sex, underlying diseases, and medications used and compared between the two groups., Results: The study found that 48 % of the TD group and 71 % of the NDDs group were identified as having sleep problems. The NDDs group had significantly higher total TH-JSQ-P score and in five subscales, including obstructive sleep apnea, restless leg syndrome-motor, parasomnias, daytime behaviors, and insomnia/circadian rhythm disorders. Total TH-JSQ-P score was found to have a moderate correlation with internalizing and externalizing behavioral problems., Conclusion: Findings suggest that sleep problems are more common in preschool children with NDDs than in TD children and are associated with internalizing and externalizing behavioral problems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background and Purpose: Hypnotherapy has shown promise in cancer care for alleviating pain, managing nausea, reducing anxiety and fatigue, and improving overall quality of life. Despite its potential benefits, there remains a significant gap between evidence and clinical practice. One way to bridge this gap is to assess healthcare professionals' perceptions and address them accordingly. While survey tools assessing perceptions in healthcare exist, they often are outdated, lack contemporary focus and specificity to complementary therapies like hypnotherapy, particularly in the context of cancer care. This study aimed to develop, psychometrically evaluate, and pilot a survey designed to assess Australian healthcare professionals' (psychologists, counselors, medical practitioners, and nurses) perceptions of hypnotherapy in cancer care., Materials and Methods: A cross-sectional survey was developed to assess healthcare professionals' perceptions of hypnosis/hypnotherapy in cancer care. The survey, informed by a comprehensive literature review, consisted of three sections: (1) demographics, 2) interest, experience and knowledge of hypnosis, and (3) attitudes towards its integration in cancer care. Instrument validation involved an expert panel (n = 5) review for content validity and a pilot study with 89 healthcare professionals for reliability. Internal consistency was measured using Cronbach's alpha and factor analysis., Results: Psychometric analysis demonstrated high internal consistency with a Cronbach's alpha of 0.850. Factor analysis revealed two distinct factors: perceived benefits of hypnotherapy in cancer care (explaining 49.23 % of variance) and concerns/misconceptions about hypnosis (explaining 19.50 % of variance). These factors showed strong item loadings (0.692-0.889 and 0.529-0.850, respectively) and a moderate correlation (r = 0.464). The survey tool proved feasible and applicable with a high completion rate among participants. The survey pilot results highlighted significant knowledge gaps and varying levels of acceptance of hypnotherapy, underscoring the necessity for targeted education and training initiatives. Despite these gaps, there was a notable interest in learning more about hypnotherapy's potential benefits in cancer care. However, limitations to sample diversity and generalizability should be noted, as the vast majority of respondents were female nurses., Conclusion: A novel survey tool to evaluate healthcare professionals' perceptions of hypnotherapy in cancer care was developed and tested for its validity and reliability. Results of this study revealed significant knowledge gaps and varied acceptance levels by healthcare professionals to using hypnotherapy in cancer care. We identified respondents have a strong interest in hypnotherapy's potential benefits, highlighting the need for targeted education and suggesting a promising foundation for its future integration into holistic and patient-centered cancer care., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To describe the use of total intravenous anaesthesia (TIVA) in dogs and cats by veterinary anaesthesiologists., Study Design: A cross-sectional online, voluntary, anonymous survey., Population: Data from 153 answered questionnaires., Methods: An anonymous questionnaire was sent via e-mail to diplomates, residents and residency-trained individuals from the American and European Colleges of Veterinary An(a)esthesia and Analgesia, to gather information on the use, perceived advantages, reasons for the use or not of TIVA and attitudes towards this technique in dogs and cats. Descriptive statistics and logistic regression analysis to detect significant associations were performed. The effect size was estimated using the odds ratio (OR) and 95% confidence interval (CI). A significance level of p < 0.05 was used., Results: We obtained 153/703 responses (66% diplomates, 34% residents; overall response rate of 21.7%). Although 99% and 94% of respondents used TIVA in dogs and cats, respectively, only 14% used it frequently (several times a week) in dogs, and < 1% in cats. Most respondents used propofol (97%, dogs) and alfaxalone (85%, cats), mostly combined with opioids. Reasons for not using TIVA more frequently included prolonged recovery (49%, dogs; 61%, cats), higher cost (46%, dogs) and concerns about drug accumulation (44%, cats). Frequent TIVA use was driven by clinical indications (100%) and greater haemodynamic stability (87%). A higher proportion of respondents using TIVA frequently reported the high stability of the anaesthetic plane (20%; OR = 5.0; 95% CI: 1.4-17.8; p = 0.013) and disagreed with using TIVA only when a specific clinical indication existed (OR = 3.3; 95% CI: 1.4-10.0; p = 0.013)., Conclusions and Clinical Relevance: Although occasional, TIVA use is reported among veterinary anaesthesiologists. Clinical indications for TIVA are the most likely reason for its use, whereas factors such as a prolonged recovery or higher cost might limit its use., (Copyright © 2024 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Background and Purpose: Bronchiectasis is characterized by chronic cough, acute exacerbations, and excessive sputum production, along with symptoms such as shortness of breath and fatigue, which impair respiratory functions and quality of life. This study aims to investigate the effects of yoga on dyspnea, sleep quality, and overall quality of life in patients with bronchiectasis., Materials and Methods: Forty-eight participants with bronchiectasis were included in the study. The patients were randomly divided into two groups, the yoga group (n = 24) or control group (no placebo or sham intervention) (n = 24). The yoga group participated in a total of 24 sessions over 8 weeks, with three sessions per week. No intervention was performed on the patients in the control group. The Modified Medical Research Council (mMRC) questionnaire was used to assess patients' dyspnea level, and the Pittsburgh Sleep Quality Index (PSQI) and St. George's Respiratory Questionnaire (SGRQ) were used to assess sleep quality and health-related quality of life, respectively., Results: It was observed that the yoga intervention affected the intergroup change in dyspnea severity score over time (p < 0.05) (x̄ yoga  = 2.64-1.50 = 1.14; x̄ control 2.24-1.95 = 0.29). The decrease in the mean PSQI score of the yoga practice group (16.41-13.18 = 3.23) was significantly higher compared with the control group (14.90-14.57 = 0.33). Post-practice SGRQ activity scores were significantly different from pre-practice SGRQ activity scores. Similar to the change in SGRQ activity and symptom scores, the impact score also changed significantly over time (x̄ yoga 12.55-9.09 = 3.46; x̄ control 12-11.52 = 0.48)., Conclusion: The results indicate that yoga may have a positive effect on dyspnea, sleep, and quality of life in patients with bronchiectasis., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Insight, words of wisdom and advice to the future generations are shared through storytelling and introspection from women radiologists who have personally impacted my own career and journey as a woman radiologist. Through historical data review and self-reported narratives on an electronically submitted questionnaire, noteworthy accomplishments of female radiologists whom I personally know or know through association over the last hundred and twenty-nine years are described, as well as the obstacles they had faced throughout their academic years of training and practice of radiology., Competing Interests: Declaration of competing interest The authors of this manuscript certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Low- and middle-income countries have increasingly banned e-cigarettes, as in Mexico. In these countries, little is known about where adults obtain e-cigarettes or who uses e-cigarettes with nicotine., Methods: Data were analyzed from eight online surveys of Mexican adults who both smoked and used e-cigarettes (November 2018-March 2021; n = 2,060). For the e-cigarette they used most often, participants reported how they acquired it (social sources=reference; online purchase; vape shop purchase; other retail purchase) and if it contained nicotine (no=reference group; yes; don't know). Multinomial models regressed each of these outcomes on smoking- and e-cigarette-related factors, as well as sociodemographics., Results: Almost half the sample (45.9 %) reported obtaining their e-cigarettes from social sources, with online purchase being the second most common source (28.7 %). Being male, having recently attempted to quit smoking, and more frequent e-cigarette use were positively associated with purchasing e-cigarettes (vs social sources) across all venues. Most reported that their e-cigarettes contained nicotine (58.2 %), a third reported using e-cigarettes without nicotine (35.9 %), and some did not know (5.8 %). More frequent smoking and e-cigarette use, using closed e-cigarette devices and purchasing e-cigarettes online were positively associated with using e-cigarettes with nicotine., Conclusions: Despite Mexico's e-cigarette ban, adults who smoke access e-cigarettes through multiple sources, including online and vape shop purchases. Most participants reported using e-cigarettes with nicotine, though many did not or did not know., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Research published during the early fentanyl period exposed a growing concern of unwitting fentanyl exposure and a general willingness to use fentanyl test strips (FTS). A paucity of FTS studies over the last several years has restricted our ability to understand FTS use in the late fentanyl era. The South Atlantic FTS Study (SAFTSS) was established to investigate contemporaneous changes in FTS use and drug use behavior among a rural cohort of PWID., Methods: Between June 2021 and March 2022, a total of 541 PWID completed an in-person survey. Baseline survey questions included demographics, socioeconomic characteristics, and drugs used. FTS questions covered lifetime use, past 6-months, and past 30-day use and included reasons for using FTS, levels of access, and confidence testing illicit opioids and stimulants. Multivariable analyses examined significant baseline correlates of lifetime and 30-day FTS use., Results: Overall, more than half (58%; N=315) used FTS in their lifetime. Among lifetime FTS users, almost half (47%) used FTS in the past 6 months and 30% in the past 30 days, with an average of 13 months from last FTS use and the baseline survey. The most common reason for not using FTS was "not having them with me when I use drugs." Less frequent reasons were "I already know it's fentanyl" followed by "FTS take too much time to use." Among past 30-day FTS users, 74% used FTS on heroin, 55% on methamphetamine, and 33% on fentanyl. Consumer confidence using FTS was higher with illicit opioids (66%) but lower for methamphetamine (43%). In both the lifetime and past 30-day models, PWID with FTS use were more likely than non-users to have witnessed an overdose in the past six months (lifetime aOR = 2.85, p<.001; 30-day aOR=2.57, p<.01). Virtually no differences in drug use behaviors were found when comparing past 30-days FTS use to no FTS use. Women (aOR=1.68, p<.05) and non-white PWID (aOR=2.43, p<.05) were more likely than men and white PWID to have used FTS., Conclusions: Declines in FTS use are consistent with what syringe services programs have been signaling for years. Needs assessments to gauge interest in FTS before scaling up can help ensure funding better spent on naloxone and syringes is not allocated to idle FTS. Increased FTS among women and racial minorities presents opportunities for tailored interventions. Recognizing trauma associated with witnessing overdoses as a growing component of the opioid epidemic is a critical first step toward addressing the full spectrum of drug-related harm., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The sinking and combustion of the MV X-Press Pearl in May 2021 caused severe marine pollution, releasing toxic materials and billions of plastic nurdles. Nurdle pollution threatens sensitive coastal habitats and negatively impacts social welfare. This study aimed to 1) conduct a citizen science program to quantify nurdle distribution during the disaster, and 2) evaluate the societal impact, attitudes, knowledge, and perceptions in the disaster's aftermath. Results derived via the citizen science study indicated that Colombo, Gampaha and Puttalam districts to be hotspot areas with the highest nurdle densities of 50,789 ± 1139 m -2 , 48,107 ± 3408 m -2 and 33,231 ± 689 m -2 , respectively. Results from the public perception survey showed that the majority (80 %) of the respondents were affected by the incident. Over 70 % of the survey participants were either not satisfied or neutral towards the compensation provided for livelihood loss. Nearly 60 % took a neutral stance when questioned about the country's readiness to respond to marine disasters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Conversion practices are associated with psychological morbidity, yet few studies have evaluated differences between efforts to change gender identity, sexual orientation, or both. We aimed to examine the individual and joint association of conversion practice recall targeted at gender identity or sexual orientation, or both, with current mental health symptoms among sexual and gender minority people., Methods: This cross-sectional study used data from The PRIDE Study, a US-based, online, prospective cohort study of sexual and gender minority adults who were recruited through social media, digital advertisements, and sexual and gender minority community-based events and organisations. For this analysis, we included participants who completed a lifetime questionnaire in 2019-20 and a subsequent annual questionnaire in 2020-21 without missing outcome data. All questionnaires were in English. The exposure was lifetime recall of conversion practice targeting gender identity alone, sexual orientation alone, or both (versus no conversion practice). Mental health outcomes were continuous measures: Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item (depression) scale, Post-Traumatic Stress Disorder Checklist 6-item scale, and Suicide Behaviors Questionnaire-Revised scale. We used linear regression to analyse the associations of conversion practice recall and mental health symptoms, controlling for demographic and childhood factors and stratified between cisgender and transgender and gender diverse groups. Sensitivity analyses evaluated the potential impact of unmeasured confounding. Analyses were conducted in R. We included people with related lived experience in the design and implementation of this study., Findings: Of 6601 participants who completed the lifetime questionnaire in 2019-20, 4440 completed the subsequent annual questionnaire in 2020 or 2021, and 4426 did not have missing outcome data. Of the 4426 included participants, 4073 (92·0%) identified as White (either alone or in combination with other ethnoracial options), 460 (10·4%) identified with multiple ethnoracial identities, and 1923 (43·4%) were transgender and gender diverse. Participants' age ranged from 18 years to 84 years (median 31·7 years, IQR 25·5-44·1). 149 (3·4%) participants reported sexual orientation-related conversion practice alone, 43 (1·0%) reported gender identity-related conversion practice alone, and 42 (1·0%) reported both. Recalling both forms of conversion practice was most strongly associated with greater post-traumatic stress disorder (PTSD; β 2·84, 95% CI 0·94-4·74) and suicidality (2·14, 0·95-3·32) symptoms. Recall of only sexual orientation-related conversion practice was associated with greater symptoms of PTSD (1·10, 0·22-1·98). Recall of gender identity-related conversion practice alone was most strongly associated with greater depressive symptoms (3·24, 1·03-5·46). Only associations for suicidality differed between cisgender and transgender and gender diverse participants, although the latter showed higher mental health symptoms overall. Findings were moderately robust to potential sources of unmeasured confounding in sensitivity analysis., Interpretation: Recall of conversion practice exposure was associated with a range of mental health symptoms among sexual and gender minority people. These findings support calls to ban conversion practices because of their effects as a structural determinant of mental health., Funding: Gill Foundation, Dona Rockstad, and Patient-Centered Outcomes Research Institute., Competing Interests: Declaration of interests CGS received consultation fees from EverlyWell, The Texas Health Institute, and L'Oreal, and is the current President of the United States Professional Association for Transgender Health. JO-M has received consultation fees from Ibis Reproductive Health, Hims, Folx Health, Sage Therapeutics, and Upstream on topics unrelated to this work; and participates in the Quality Family Planning 2.0 Advisory Board in the Office of Populations Affairs and Contraception: Medical Advisory Board in the Center for Disease Control and Prevention. MRL received consultation fees from Otsuka Pharmaceutical Development and Commercialization, and the American Dental Association on topics unrelated to this work; and is a Scientific Advisory Board member for SPARK and Simons Foundation. NKT is a Resource Access Board member for the All of Us Research Program. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Objectives: Child health is a social and economic development indicator. Pakistan is one of the countries with a high rate of under-five mortality. This research aims to examine several demographic, geographical, socioeconomic, health-related, and environmental factors related to under-five mortality in both rural and urban areas of Punjab, Pakistan., Study Design: This is a cross-sectional study., Methods: We used data from the Multiple Indicator Cluster Survey 2017-18 of children aged between 0 and 59 months (n = 39,024), steered by the Punjab Bureau of Statistics. Children who died before reaching the age of five were considered as outcome variables. The bivariate relationship of the outcome variable with each socio-economic, demographic, health-seeking, and environmental variable is estimated with a P-value of <0.01. We used logistic regression analysis separately. Inclusive descriptive statistics were used for the detailed analysis, i.e., compare means, cross-tabulations, independent sample t-tests, and comparison across rural-urban areas., Results: Results showed that in the mother-level variables, mother education plays a substantial role in reducing mortality; the higher the level of education, the lower the mortality rate., Conclusion: The study revealed that improving drinking water sources, such as tap and bottled water, can reduce the incidence of mortality, particularly in low-income households. Therefore, interventions targeting children are likely to be most effective for reducing the under-five mortality rate in Pakistan., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: In this study, we investigated the fear of disease progression in Chinese PBT patients and examined the correlation between sociodemographic, clinical, and psychological variables of patients with the fear of progression (FoP). Additionally, the study also evaluated the subjective experience of FoP in patients with primary brain tumors (PBT)., Methods: A mixed-methods study was conducted between March 2022 and December 2023, consisting of two phases: a quantitative approach in phase I, and a qualitative approach in phase II. In phase I, 305 patients with PBT filled in several questionnaires. An analysis was performed to identify potential predictors associated with FoP. In phase II, semi-structured interviews were conducted with 16 participants whose FoP scores were ≥ 34 in phase I to obtain information on their personal experiences with FoP., Results: The results of the quantitative study showed that 192 (63 %) patients experienced high levels of FoP. The mean score of fear of progression was (34.02±6.78). Young age, high disease uncertainty, low social support, high negative coping and low positive coping are important factors affecting FoP in PBT patients. Qualitative research focused on three themes: triggers, coping styles, and the help needed., Conclusion: Enhanced screening and assessment of FoP is essential to identify dysfunctionin PBT. Meanwhile, the implications of these predictors for enhanced healthcare professional education and patient self-management may help healthcare providers implement relevant interventions promptly and help patients reduce their FoP. However, due to limitations such as sample, reporting bias, and specific mechanisms between predictors and FOPs that have not yet been explored in depth, further exploration is needed in the future., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: People with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSDs) are at greater risk of developing temporomandibular disorders (TMDs), perhaps due to the general joint hypermobility. There is, however, no information on how oral health-related quality of life (OHRQoL) is affected in people with hEDS or HSD with TMD. The authors' aim was to assess OHRQoL via the 14-item, short version Oral Health Impact Profile (OHIP-14), as well as associated risk factors in women with TMD symptoms and confirmed hEDS or HSD., Methods: A digital questionnaire was sent to members of The Swedish National EDS Association who reported having a confirmed or suspected EDS or HSD diagnosis in the health care system from January through March 2022. Then, a sample of 133 women with confirmed hEDS or HSD and TMD symptoms was constructed, and information on the following variables was collected: TMD symptoms, age, general health, oral health-related factors, comorbid symptoms, and psychological factors. Linear regression analysis was conducted to investigate the association between these variables and the OHIP-14 summary score as the outcome., Results: Most participants reported TMD pain symptoms (93.9%), temporomandibular joint clicking (89.5%), and crepitation (55.6%). The mean (SD) total OHIP-14 summary score was 21.0 (13.2). Oral function had the lowest impact (2.0 [2.4]) and orofacial pain had the highest impact on OHRQoL (3.9 [2.5]). Self-reported bruxism, poor general health, and comorbid symptoms were significantly associated with impaired OHRQoL., Conclusions: Women with confirmed hEDS or HSD and TMD symptoms have a considerably impaired OHRQoL., Practical Implications: The multidimensional phenomenon of OHRQoL in this group needs to be considered in management strategies., Competing Interests: Disclosure None of the authors reported any disclosures., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: The gold standard approach to diagnose periodontitis is based on clinical examination and radiographic investigations. This, however, is expensive, tedious, and not feasible in population-level assessments. The self-reported periodontitis questionnaire offers great benefit to facilitate larger epidemiological surveys. There is limited evidence on cognitive validation of self-reported periodontitis questionnaire. This study employed a think aloud approach to investigate if participants interpreted, comprehended, and understood the items in a self-reported periodontitis questionnaire, in the same way as researchers' intended., Methods: 20 adults, resident of the UK and fluent in English participated in online recorded think aloud interviews. The self-reported periodontitis questionnaire consists of 15 questions and 2 open ended questions. The interviews were then transcribed and coded by two independent researchers according to predefined categories representing comprehension and conventional content analysis was used to analyse open-ended data., Results: The think aloud approach revealed that most of the questions in the self-reported periodontitis questionnaire were well understood by the participants. Two items, however, were identified as problematic: one was misinterpreted, and another question was not understood by most of the participants. Qualitative conventional content analysis of open-ended questions reiterated and complemented the findings of the think aloud study. Further questions coded as problematic for 3 or more participants were then considered for rephrasing., Conclusions: This study revealed the interpretation and understanding of self-reported periodontitis questions by English speaking UK residents and highlighted the probable reason for lower sensitivity values of the self-reported periodontitis questionnaire., Clinical Significance: This study employed think-aloud approach to capture the thought process of the participants as they answered questions on self-reported periodontitis questionnaire. Overall, the questionnaire was well received by the participants, however, some questions were misunderstood/misinterpreted. This study highlights the potential information bias if participants do not understand the questions in epidemiological surveys., Competing Interests: Declaration of competing interest We the authors declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. We have nothing to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: This study investigated the prevalence of water filtration and purification system (WFPS) use among residents of central Indiana (USA) and determined the effects of WFPS on the concentrations of fluoride, calcium, magnesium, potassium, and sodium in tap water., Methods: A census-based questionnaire collected data on demographics, water use, and water sources. Participants were also asked to provide water samples from their tap water or the WFPS they used. Water samples were analyzed using ion-specific electrodes (fluoride) and atomic absorption spectrometry (metals). Mineral concentration comparisons between water sources used nonparametric tests; questionnaire associations were testing using correlations, chi-square tests, and nonparametric tests., Results: One hundred and one participants completed the study, of which 71 % used some type of WFPS. Blacks were less likely to use WFPS than Asian or White participants (p = 0.045). Those with bachelor's degrees or higher were more likely to use WFPS (p = 0.003). The most used WFPS were pitcher filters (31 %), water softeners (21 %), reverse osmosis systems (11 %), faucet-mounted filters (4 %), and whole-house carbon filters (1 %). Reverse osmosis systems resulted in the lowest mineral concentrations (median, ppm; F-0.08, Ca-2.30, Mg-0.46, Na-4.60, P-0.35). Pitcher filters were largely comparable to unfiltered tap water. Water softeners resulted in the highest sodium concentrations (78.40 ppm)., Conclusion: A large proportion of study participants use WFPS, with pitcher filters being the most common. Reverse osmosis systems had the most significant impact on reducing mineral levels in tap water, while pitcher filters do not adversely affect mineral concentrations., Clinical Significance: Understanding how different WFPS affect the various minerals in tap water is essential for helping consumers in choosing the right system and for oral care providers to guide patients on water consumption and the need for fluoride supplementation, especially for those at high risk of dental caries., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To examine associations among experiences of racial discrimination, perceived stress, and birth satisfaction and to test if perceived stress mediates the relationship between racial discrimination and birth satisfaction among Black women in the postpartum period., Design: Secondary analysis of data from the Biosocial Impact on Black Births study., Setting: A postpartum unit of a large hospital in Central Florida., Participants: Black women (N = 154) in the postpartum period., Methods: Participants completed the lifetime Experiences of Discrimination scale, Perceived Stress Scale and Birth Satisfaction Scale-Revised between 24 hours and 23 days after birth. We calculated descriptive statistics and Spearman's ρ correlation coefficients to evaluate associations among variables. We used multiple linear regression to evaluate perceived stress as a mediator between racial discrimination and birth satisfaction., Results: Racial discrimination had a positive association with perceived stress (β = 2.445, p = .03), and perceived stress had a negative association with birth satisfaction (β = -0.221, p = .02). Racial discrimination had no significant direct effect on birth satisfaction (β = -0.091, p = .94); therefore, perceived stress did not mediate the relationship., Conclusion: More experiences of discrimination over the life span were associated with higher levels of perceived stress. Participants who reported higher levels of perceived stress reported lower levels of birth satisfaction. Our study adds to the body of knowledge regarding associations between racial discrimination and perceived stress and perceived stress and birth satisfaction., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Problem: Women pregnant during the COVID-19 pandemic may be at risk of elevated postpartum mental health problems., Background: Social support protects maternal mental health during a pandemic. It is possible that formal supports, such as continuity maternity models of care, may also support maternal wellbeing., Aim: To investigate whether model of care moderates the association between prenatal maternal stress from the COVID-19 pandemic, and postpartum (a) depression and (b) anxiety., Methods: Women in Australia, pregnant during the COVID-19 pandemic (n = 3048), completed a survey detailing their COVID-19-related objective hardship and subjective distress during pregnancy and completed depression and anxiety measures at birth to six weeks ("Early"), seven to 21 weeks ("Moderate"), and/or 22-30 weeks ("Late") postpartum., Findings: Higher subjective distress was associated with elevated depression and anxiety at all timepoints. Model of care did not moderate the association of objective hardship or subjective distress and depression or anxiety at any timepoint. Compared with Standard Care, women receiving private midwifery care had a 74 % reduction in the odds of elevated anxiety in early postpartum., Discussion: Women receiving private midwifery may have experienced lower anxiety due to a greater duration of postpartum in-home care, fewer changes to service delivery, and the option of homebirth. Women pregnant during a pandemic should be screened for higher subjective distress about the event., Conclusion: These results suggest that continuity of private midwifery care may be beneficial for supporting postpartum mental health during a pandemic, with implications for practice and policy for the current and future pandemics., Competing Interests: Declaration of Competing Interest We have no conflict of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Purpose: Epidemiological studies show the prevalence of attention deficit hyperactivity disorder (ADHD) in adolescents is around 5 %. There is strong evidence for psychosocial interventions and medication for treatment of ADHD core symptoms, but these alone do not always reach a satisfactory outcome. The aim of this small-scale study was to evaluate the impact of tactile massage on ADHD core symptoms in adolescents in a clinical setting. Secondary outcome measures addressed pain perception, ability to fall asleep, and stress levels before, during, and after the intervention., Materials and Methods: Fourteen adolescents aged 15-17 and previously diagnosed with ADHD received tactile massage sessions in an experimental, single-subject ABA study combined with a group-based evaluation using descriptive statistics. The adolescents and their parents answered questionnaires to follow up on the primary and secondary outcomes., Results: The results showed a statistically significant reduction in hyperactivity/impulsivity and inattention, as well as oppositional defiant disorder (ODD). Participants reported that it was significantly easier to fall asleep. There was also a tendency to perceive less pain, but these results were not statistically significant. The compliance in this study was excellent., Conclusion: In this study, tactile massage appears to have had a significantly positive impact on ADHD core symptoms and the ability to fall asleep. The absence of adverse physiological changes and the excellent compliance, coupled with positive results, supports the idea that tactile massage may be considered safe and beneficial for adolescents with ADHD. Our findings need to be further investigated in future research., Competing Interests: Declaration of competing interest The authors have declared that no competing interests exist., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In the dynamic realm of practical clinical scenarios, Continual Learning (CL) has gained increasing interest in medical image analysis due to its potential to address major challenges associated with data privacy, model adaptability, memory inefficiency, prediction robustness and detection accuracy. In general, the primary challenge in adapting and advancing CL remains catastrophic forgetting. Beyond this challenge, recent years have witnessed a growing body of work that expands our comprehension and application of continual learning in the medical domain, highlighting its practical significance and intricacy. In this paper, we present an in-depth and up-to-date review of the application of CL in medical image analysis. Our discussion delves into the strategies employed to address specific tasks within the medical domain, categorizing existing CL methods into three settings: Task-Incremental Learning, Class-Incremental Learning, and Domain-Incremental Learning. These settings are further subdivided based on representative learning strategies, allowing us to assess their strengths and weaknesses in the context of various medical scenarios. By establishing a correlation between each medical challenge and the corresponding insights provided by CL, we provide a comprehensive understanding of the potential impact of these techniques. To enhance the utility of our review, we provide an overview of the commonly used benchmark medical datasets and evaluation metrics in the field. Through a comprehensive comparison, we discuss promising future directions for the application of CL in medical image analysis. A comprehensive list of studies is being continuously updated at https://github.com/xw1519/Continual-Learning-Medical-Adaptation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Resident-Applicant Buddy Programs (RABPs) are a new initiative designed to improve resident recruitment. This study aims to evaluate the impact and perceived value of RABPs and to identify areas for improvement for future recruitment cycles., Design: Anonymous online survey study of RABP participants with mixed-methods approach to evaluate participants' experience and perceived impact of the program. The survey queried demographics, Likert responses, and open-ended responses. Qualitative thematic analysis of open-ended responses was performed with inductive coding in an iterative fashion by 2 raters., Setting: This study was conducted at a general surgery residency program at a tertiary academic institution during 2022-2023 recruitment cycle., Participants: Of 125 RABP participants (n = 39 residents and n = 86 interviewed applicants), surveys from n = 45 participants (n = 19 residents, 66%; n = 26 applicants, 30%) were completed and analyzed., Results: Applicants were predominantly female (65%) and first-generation physicians (69%). Buddy pairings were 65% gender concordant and 48% race/ethnicity concordant. Many applicants (60%) participated in RABPs at other institutions. Buddies connected for a mean (SD) of 52 (28) minutes. Majority of applicants agreed the program decreased stress/apprehension about interviewing (70%, 4.0 [1.1]), helped understand resident life at the program (91%, 4.3 [1.0]), and increased desire to match in the program (65%, 4.0 [1.1]). Residents agreed they enjoyed participation (89%, 4.5 [0.7]), the program should be continued (100%, 4.8 [0.4]), and desired to participate again (100%, 4.8 [0.4]). Thematic analysis revealed applicants valued the program as an approachable source of information, illumination of program culture, aid in interview preparation, and connection between applicant and program. Applicants appreciated the intentionality of the program to create a RABP., Conclusions: RABP decreased applicants' stress, improved understanding of resident life, and for the majority, increased desire to match at the program. Resident engagement and desire for ongoing participation in the RABP was high. Overall, RABPs can increase applicant interest and program transparency., (Published by Elsevier Inc.)

Objective: To improve the well-being and sense of community of surgical trainees., Design: Residents were invited to participate in confidential discussion groups during protected education time to have a safe space to support each other through common struggles. The groups were facilitated by licensed mental health professionals with experience working with medical trainees. An anonymous voluntary wellness survey and a qualitative feedback survey were used to understand residents' experience participating in these discussion groups., Setting: Single large academic institution., Participants: General surgery and obstetrics and gynecology residents., Results: 677 resident responses to the wellness survey were collected between 2020 and 2023. Compared to residents who participated in < 5 discussion group sessions, residents participating in ≥ 5 sessions reported improved self-perception of their own competency and capability (p = 0.012), and in their ability to contribute to others' well-being (p = 0.045). They also reported considering more of their co-residents as friends (p = 0.002), increased willingness to discuss personal problems with their co-residents (p < 0.001), and were more likely to report recently working with peers to solve a common problem (p = 0.041). In a second qualitative survey (n = 53), resident feedback revealed an appreciation for the opportunity to discuss shared experiences, creating community, having a safe space and dedicated time for introspection, and receiving input from a therapist. Opportunities for improvement included providing more structure to the discussion, increasing the frequency of group meetings, and focusing on developing coping skills., Conclusion: Therapist-facilitated discussion groups can improve aspects of trainees' mental well-being and help foster relatedness, community, and shared problem solving with peers. Residency programs should consider incorporating similar programs into their wellness initiatives., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the prevalence and associated risk indicators for dentine hypersensitivity (DH), erosive tooth wear (ETW), gingival recession (GR), and gingival inflammation (bleeding on probing, BOP), with clinical and questionnaire data from seven European countries., Methods: A cross-sectional, observational, seven-European country, epidemiological study in systemically healthy adults. Participants completed a questionnaire regarding oral hygiene, diet and lifestyle factors. A clinical examination, by calibrated examiners, measured DH (Schiff; participant yes/no), ETW (basic erosive tooth wear examination, BEWE), GR (mm), and BOP (yes/no)., Results: 3551 participants completed the study, mean age 44 ± 17.4, 43.6 % male, 26.1 % rural dwellers. DH (Schiff ≥ 1) was seen in 75.9 % of participants, ETW (BEWE ≥ 1) in 97.6 %, GR (≥1 mm) in 87.9 %. 65.7 % participants had BOP ≥ 10 % sites, 34.3 % BOP<10 % with probing depths ≤3 mm. DH, ETW, GR and BOP increased markedly during young adult life. Thereafter, GR and ETW continued to increase, DH declined after around age 38-47, and BOP plateaued after age 48. DH was significantly associated with ETW (p < 0.001) and GR (p < 0.01); GR was significantly associated with BOP on lingual surfaces (p = 0.017). There were significant associations between increased full mouth BOP ≥ 10 % and reduced brushing duration and exercise frequency (p < 0.001); increased DH and heartburn (p < 0.001); decreased DH (p < 0.001), ETW (p < 0.001) and BOP ≥ 10 % (p = 0.002) with powered toothbrush use., Conclusions: Prevalence of oral conditions assessed was high, greater than in the majority of the GR, DH and ETW literature. Periodontal health was seen in a third of sampled individuals. All these conditions varied markedly by country and age., Clinical Significance: Oral diseases and conditions were highly prevalent throughout the seven European countries investigated. For the majority, these conditions are eminently preventable and treatable by changing behaviours. Upstream policy changes are needed to address these health challenges, to raise awareness and to empower individuals with oral health education and support., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nicola West reports financial support was provided by Haleon plc. Jonathan Creeth reports a relationship with Haleon plc that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: In response to Covid-19, the Association of American Medical Colleges (AAMC) recommended for residency interviews to take place virtually. Benefits of virtual interviews include substantial cost saving and scheduling flexibility. However, it is more difficult to understand program culture and there is concern that more emphasis will be placed on board examination scores and class rank. Programs are split in their decision to keep virtual interviews in the future. This study aims to provide more clarification on students' perspectives and explore the role of an optional second look day to bridge the gap left by the lack of in-person interaction., Design: This cross-sectional study surveyed applicants at our general surgery residency program during the 2022 to 2023 cycle. An optional second look day event was held after submission of the program's rank list. The first survey was sent to all applicants who interviewed with the residency program and asked to pick an interview style that they favored (in person vs virtual) and then asked to rate factors that impacted their decision. It also asked if an optional second look day event was made available, what factors would applicants consider to be important in their decision to attend. The second survey was sent to applicants who attended second look day and asked applicants to state importance of factors that led to their decision to attend., Results: About 50/110 completed the first survey. Applicants preferred virtual over in-person interviews (52% vs 28%). Those who chose virtual selected factors of time commitment and financial burden to be very important compared to those who chose in-person. Applicants who preferred in-person interviews placed most importance on avoiding technical issues and having personal interactions such as: with attending surgeons, with residents, assessment of program culture, visiting facilities, and visiting the town. Applicants were asked to pick important factors if they were to attend an optional second look day after their virtual interview. The following factors were chosen as very important: time commitment, financial burden, interaction with program leadership, interaction with attending surgeons, interaction with residents, visiting facilities, and visiting the town. We then held a second look event after the submission of our rank list. 34/110 attended and 17 complete the survey. Cost and time commitment were not as important to this group who actually attended; they chose in-person interactions with leadership and residents and assessing the program culture to be most important., Conclusion: This study aimed to determine the best interview method based on student perceptions. We also piloted an optional second look day to determine whether or not it fills the gaps left by the suspension of in-person interviews. We recommend continuing with virtual interviews as this is what applicants prefer. It alleviates the financial burden of travel and allows for better time management. However, the significance of in-person interactions cannot be ignored. We propose that second look days should be incorporated after submission of the program's rank list to allow applicants the opportunity for in-person interactions, exploration of the town, and enhance their overall interviewing experience., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To compare pain, quality of life, sleep, anxiety and depression, central sensitization, and functionality between chronic migraine (CM) patients with comorbid fibromyalgia syndrome (FMS) and patients with CM alone., Method: Thirty three female patients with CM and thirty three female patients with CM+FMS were enrolled in the study. Demographic and clinical characteristics of the patients were recorded. FM was diagnosed based on the 2016 American College of Rheumatology diagnostic criteria. All participants were evaluated with Allodynia Symptom Checklist, Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) questionnaires, and Central Sensitization Inventory (CSI). FM patients were also evaluated with Fibromyalgia Impact Questionnaire (FIQ)., Results: The average number of headache days was significantly higher in patients with CM+FMS (p = 0.006). Among migraine accompanying symptoms, the number of patients with phonophobia was significantly higher in patients with CM+FMS (p = 0.008). While CSI score was 39.0 ± 11.7 in CM patients, it was 52.2 ± 9.2 in CM+FMS patients. CSI scores were higher in CM+FMS patients (p < 0.001). SF-36 sub-cores, including physical function, energy/fatigue, emotional well-being, and general health scores, were lower in CM+FMS patients (p < 0.05). Sleep duration was significantly lower and use of medication to sleep was more common in same group (p < 0.05). FIQ score in CM+FMS patients was associated with quality of life scores, sleep quality, anxiety, and central sensitization scores (p < 0.05)., Conclusion: In patients with chronic migraine, FMS comorbidity negatively affects the quality of life and significantly increases central sensitization., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Data on adverse childhood experiences (ACEs) among teens is collected using a single informant, a parent-proxy, or teen self-report. Little is known about alignment between these approaches., Methods: Surveys were administered online to teens ages 15-17 and their parents (n = 522 dyads) using the AmeriSpeak panel. We present descriptive statistics on the prevalence and measures agreement for 18 ACEs based on teen self-report and parent-proxy report. We fit multivariable models examining associations between teen and household demographic characteristics and discordance in ACE report., Results: Based on teen-self report and parent-proxy report, cumulative and individual ACE prevalence was overall similar. However, discordance was found in individual ACE reports within teen-parent dyads (discordance ranged: 2.9-21.2 %). Lowest agreement was among ACEs related to abuse, neglect, and violence victimization and highest among household challenges. Furthermore, parent-teen dyads with LGB+ youth (vs. heterosexual) and Black, Hispanic, and multiracial or another race (vs. White) youth were more likely to have discordant responses among several ACEs., Conclusions: Surveillance and programmatic efforts should consider the type of ACE and the reporter when using data to inform prevention strategies. Teen self-report for abuse, neglect, and violence victimization and community challenges ACEs are particularly important to capture., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Objectives: This systematic review attempted to assess patient acceptance of repairs instead of complete replacement for partially defective restorations and to identify factors affecting patients' decision-making for or against repairs., Study Selection: Observational and qualitative studies reporting on (1) the proportion of patients accepting or preferring repairs, (2) the proportion of dentists / dental students / dental schools stating that their patients accept or prefer repairs, (3) factors affecting patients' decision-making for or against repairs., Sources: Electronic databases (MEDLINE via PubMed, Scopus, EMBASE via Ovid, and Web of Science) were last searched in August 2024 (PROSPERO database: CRD42023449437)., Data: Twenty-one sources reporting on 20 survey studies addressing individual dentists / dental students and dental schools were included. None of the included studies directly addressed patients (e.g., by interviewing patients). Of the surveyed dentists and dental students, 86.3 % (95 %-CI: 77.8-91.8 %) reported that their patients accept or prefer repairs. Dental schools rated patient acceptance as high as 93.0 % (95 %-CI: 82.3-97.4 %). None of the included studies reported factors affecting patients' decision-making for or against repairs., Conclusions: Repairs of partially defective restorations instead of complete replacement seem to be associated with a high level of patient acceptance as most dentists, dental students, and dental schools stated that their patients accept or even prefer repairs instead of complete replacement., Clinical Significance: Within the shared decision-making process, dentists can expect their patients to accept or even prefer repairs instead of complete replacement., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Frailty is a common geriatric syndrome in older adults; however, its relationship with digital factors is underexplored. This study aimed to examine the association between digital skills, eHealth literacy, and frailty to provide insights for developing frailty interventions in the digital age., Design: Cross-sectional study., Setting and Participants: Data were collected from a cross-sectional survey of older adults aged ≥60 years in China., Methods: We used a digital skills questionnaire, the eHealth Literacy Scale, and the Tilburg Frailty Indicator to measure digital skill, eHealth literacy, and frailty, respectively. Linear regression and logistic models were established to explore the association between digital skill, eHealth literacy, and frailty. Finally, we used a structural equation model and the Karlson-Holm-Breen method to test the mediation., Results: A total of 2144 older adults were included in this study. The rates of adequate digital skill, adequate eHealth literacy, and frailty were 4.1%, 11.9%, and 38.3%, respectively. Digital skill (β = -0.108; 95% CI, -0.151 to -0.065) and eHealth literacy (β = -0.153; 95% CI, -0.195 to -0.112) were negatively associated with frailty score (P < .05), and adequate digital skill (odds ratio, 0.367; 95% CI, 0.170-0.793) and adequate eHealth literacy (odds ratio, 0.455; 95% CI, 0.298-0.694) were associated with a lower prevalence of frailty. eHealth literacy had a mediating effect on the association between digital skills and frailty., Conclusions and Implications: Better digital skill and eHealth literacy are associated with a lower prevalence of frailty among older adults. The association between digital skill and frailty was found to be completely mediated by eHealth literacy., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: Night float rotations are associated with decreased feedback, educational conference attendance, and operative time. Interns are also more isolated and spend less time on teams. We therefore developed a novel post night shift initiative to address these shortcomings and examined its impact on the educational experience and sense of belonging among interns., Methods: A program of weekly senior resident-led post night shift sessions was instituted at a university-based general surgery residency program for the first quarter of the academic year. Four interns and one senior resident participated in each session. Feedback surveys were administered. A previously validated Belonging in Surgery survey was also administered to all general surgery interns at the end of the quarter., Results: Eleven interns had night float rotations within the first 3 months of the academic year. The intern feedback survey response rate was 93% (10/11). All intern respondents attended at least 3 sessions. Interns felt that the sessions increased familiarity with each other (85%) and senior residents (92%), improved clinical decision making (77%), and provided a safe space for discussion (69%). The senior resident survey response rate was 86% (n = 14). All senior residents enjoyed teaching the sessions and felt that they improved their familiarity with interns. The intern belonging survey response rate was 84% (16/19). Categorical interns had significantly higher belonging scores than preliminary interns at the end of the first quarter (mean 48.1 vs 41.6, p = 0.009). There was a trend toward decreased belonging scores for interns who had night float rotations early in the year which did not meet statistical significance (42.9 vs 47.4, p = 0.059)., Conclusion: This novel program improved intern decision-making, familiarity with other residents, and comfort calling senior residents for assistance overnight. There was no statistically significant difference in belonging between interns who started residency on night float versus those who did not. Similar programs may help address concerns regarding missed learning opportunities and decreased sense of community during these rotations., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Coronary heart disease remains one of the leading causes of morbidity and mortality, and is responsible for significant social costs. Resumption of work is an essential objective when this pathology concerns working patients. French data remain patchy and relatively old. The French Society of Cardiology's Exercise, Rehabilitation, Sport and Prevention Group has proposed a multicentre study to update these data., Methods: Following an acute coronary syndrome (ACS), the cardiology team asked the patient, who was currently working, to complete a questionnaire on his or her pathology, occupation and plans to return to work. An interview after 6 months enabled the clinical and professional situation of the patient to be analyzed, in order to study the factors predictive of a return to work., Results: 364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (n = 295), 93% of them in the same position, with a mean delay of 106 ± 56 days. The cardiologic independent factors for non-return were left ventricular ejection fraction, the presence of an anticoagulant, angina or heart failure, and occupational factors, shift work, exposure to cold, and imposed work rates. Factors that lengthened the time taken to return to work included delayed access to rehabilitation, the carrying of heavy loads, difficult postures and imposed work rates, as well as the patient's lack of a project, the absence of a cardiologist's opinion and the request for a modified workstation., Conclusion: The rate of return to work remains fairly stable despite the evolution of disease management, and the time to return to work relatively high. One way of improving the situation is to enhance access to cardiac rehabilitation programs, for example by offering alternatives such as tele-rehabilitation for a proportion of patients. This will free up more time for more severe patients, to better prepare them physically and psychologically for a return to work, which will also have a beneficial economic effect., Competing Interests: Déclaration de liens d'intérêt Les auteurs déclarent ne pas avoir de lien d'intérêt avec cet article, (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Workplace violence in health care has gained attention with its rising incidence and its impact on patient safety and clinician well-being. Legal and regulatory organizational requirements related to workplace violence are broadening, including updated Joint Commission standards. Although workplace violence surveys have been administered across health care settings, the few that have focused on the perioperative environment have predominantly been single-profession surveys., Methods: This cross-sectional, prospective survey focused on perioperative care was conducted by the Anesthesia Patient Safety Foundation using simultaneous convenience sampling across professional societies representing anesthesiologist assistants, certified registered nurse anesthetists, physicians, and registered nurses. Descriptive statistics were used to summarize responses, and multivariable regression was used to model the odds of experiencing or witnessing physical or nonphysical workplace violence. Open-text entries were analyzed using thematic analysis., Results: Of 4,662 survey respondents, 3,645 (78.2%) reported some form of workplace violence: 1,446 (31.0%) experienced physical workplace violence, 1,718 (36.9%) witnessed physical workplace violence, and 3,226 (69.2%) experienced nonphysical workplace violence. Fewer than half (49.8%) of the respondents experiencing physical workplace violence and fewer than one third (31.4%) of the respondents experiencing nonphysical workplace violence felt that the "situation was addressed and resolved to their satisfaction.", Conclusion: Workplace violence is commonplace and reported by all perioperative professionals. There is a pressing need for actions at multiple levels to respond to and eventually eliminate perioperative workplace violence, preventing harm to both patients and staff., (Copyright © 2024 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Background: Step 1 has historically been a major criterion to evaluate students for residency match. With Step 1 now being pass/fail (P/F), students are uncertain how to distinguish their applications. We aim to understand student's opinions surrounding the scoring change as this is the first class of students applying to residency in the P/F era., Materials and Methods: An electronic survey was sent to 3rd and 4th year American medical students., Results: Of the 255 students surveyed, 61.6% prefer Step 1 in the P/F format. Students applying for highly competitive specialties (HCS) preferred numerical scoring (55.6%). On a 5-point Likert scale, students entering HCS believed more strongly that they would have a better chance at matching if Step 1 was graded numerically (3.47 vs 2.71) and creates an unfair advantage for those who can afford to pursue a research year (3.46 vs 2.95). Students entering HCS felt finances played a significant role in whether they took a research year and felt added pressure to engage in research. Respondents believe that students from prestigious medical schools, well-connected students, and MD students will benefit most., Conclusions: While students mostly prefer P/F scoring, there were differences of opinion between those going into HCS and LCS. Students indicated that those who have financial means are at a distinct advantage as they can afford to utilize a research year to distinguish their applications. Future efforts should be made to address student concerns and unintended consequences of the scoring change to create an equitable system., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Design: Cross-sectional study., Objectives: Suboptimal health status (SHS) is a third state between health and disease. Long-term being SHS will be detrimental to one's ability development. Previous studies have demonstrated the associations of lifestyle behaviors or work stress with SHS, but few studies have comprehensively analyzed the underlying factors and mechanisms between the three. This study aimed to investigate whether lifestyle behaviors mediated the relationship between self-perceived work stress and SHS., Methods: A total of 4238 urban workers, who participated in a cross-sectional survey conducted from December 2018 to October 2019, were included. A general linear model was used to explore the associations between lifestyle behaviors and self-perceived work stress with SHS after adjusting for demographic variables. Structural equation modeling was performed to examine the mediation by lifestyle behaviors., Results: The mean transformed scores of physical, mental, and social SHS were 70.98, 67.17, and 61.72, respectively. Unhealthy lifestyle behaviors and high self-perceived work stress positively affected SHS (P < 0.001). Self-perceived work stress imposed negative effects on physical SHS (β = -0.228, P < 0.001), mental SHS (β = -0.237, P < 0.001), and social SHS (β = -0.092, P < 0.001). The indirect effects of self-perceived work stress on physical SHS (β = -0.139, 95% CI: -0.178 to -0.106), mental SHS (β = -0.106, 95% CI: -0.134 to -0.082), and social SHS (β = -0.121, 95% CI: -0.154 to -0.092) were statistically significant., Conclusions: Lifestyle behaviors and self-perceived work stress were significantly associated with SHS among Chinese urban workers. The mediating effects of unhealthy lifestyle behaviors were found in the relationship between high self-perceived work stress and SHS. Future longitudinal research may verify these associations and elucidate the underlying mechanisms., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Introduction: Literature suggests that patients from deprived backgrounds are less likely to adhere to their treatments, continue to expose themselves to risk factors and, as a result, have poorer health outcomes. It is therefore crucial to identify these vulnerable populations early on, in order to provide them with tailored and reinforced care. The primary aim of this research is to construct and validate a systematic screening tool for identifying patients at highest risk of social vulnerability due to deprivation, through the use of psychometric techniques. This tool is intended to be easily used by healthcare professionals, to provide tailored and targeted care throughout the patient's journey., Method: This study involves the development and assessment of a screening tool, along with a self-questionnaire and a decision support tool incorporating an artificial neural network. It is a prospective, monocentric, 2-stage psychometric validation study., Results: This study has demonstrated the successful development of the self-questionnaire using psychometric methodology. The tool was found a good performance in screening social vulnerabilities., Discussion: This validated self-questionnaire is an easy-to-use tool, allowing systematic screening for social vulnerabilities for cancer patients. This early identification allows to reinforce patient's pathway in order to avoid disruption. The integration of the tool in an artificial neuron network system allows to automate and disseminate this method of deprived patients' detection, while limiting the workload for the staff., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Despite increasing interest in the use of nicotine pouches in Australia - where retail sale of the products is illegal - research exploring patterns of pouch use and reasons for use is lacking. Accordingly, this study explored young Australians' experiences with nicotine pouches., Methods: An online survey was administered to 1598 Australians aged 16-39 years (53 % women). We assessed (i) awareness and use (lifetime and past 30-day) of nicotine pouches, (ii) patterns of use (e.g., flavours and nicotine strength used), (iii) product source, and (iv) reasons for use. Regression analyses were conducted to assess socio-demographic predictors of awareness and use., Results: Just over three-quarters (77 %) of the sample reported being aware of nicotine pouches. Lifetime use was reported by 26 % of respondents and past 30-day use by 19 %. Among those who reported past 30-day use, fruit (35 %) and menthol/mint (34 %) flavours were most commonly used. In terms of pouch source, one-third (33 %) reported obtaining the product from a tobacconist. The most common reasons for use were "they come in flavours I like" (34 %) and "to help me quit smoking" (32 %). Awareness, lifetime use, and past 30-day use of nicotine pouches were more likely among men, those who reported current use of tobacco products, and those who reported current use of e-cigarettes., Conclusions: Awareness and use of nicotine pouches among young Australians may be substantial enough to warrant the inclusion of items measuring pouch use in national surveys. Efforts should be made to better enforce existing laws regarding the sale of nicotine pouches., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Internationally, traditional medicine approaches are used to support humanised childbirth practices. Labour support issues in low- and middle-income countries (LMICs), include limited resources, staffing, and escalating pharmaceutical interventions. There is a strong interest in evidence-based acupressure programs, however, training and experience to implement them is limited. Maternity professionals at the Fernandez Foundation (FF) including associated hospitals in the Hyderabad region, India, sought training in acupressure to support humanised childbirth., Aims: To evaluate the implementation of the 'Acupressure for childbirth training program' at FF hospitals, up to 6-months post-training, including barriers and facilitators, as well as determining pregnancy and labour conditions for which the techniques are most useful., Methods: Pre- and post-training, and 6-month surveys, were distributed to participants., Results: Participants included a diverse group of 88 midwives, doulas, physiotherapists, educators and obstetricians. There were significant improvements in participant skills and knowledge, which persisted up to 6-months post-training (p<0.01). Participants indicated they were 'highly satisfied' with the training, and found it valuable, easy to implement, and reported extremely positive responses from women and support people. Facilitators to implementation included 'strategies and ideas', 'effectiveness of pain relief', and 'aiding labour progress'. Barriers included 'other staff and institutional challenges', 'needing more training', 'women's attitudes'., Conclusion: Acupressure training as part of a humanised approach to childbirth, demonstrates significant skill and knowledge gain, usefulness of training and skills, ease of implementation, and a highly positive reception within the clinical environment. Implementation of these practices should be widespread and supported by policy makers and clinicians., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors., Design: We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods., Setting: Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics., Participants: Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys., Results: Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001)., Conclusions: With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Patient safety culture (PSC) fosters an environment of trust where people are encouraged to share information to promote psychological safety. To measure PSC, the Veteran's Health Administration (VHA) developed a PSC survey consisting of 20 items administered to all VHA employees. The survey comprises four scales: (1) risk identification and Just Culture, (2) error transparency and mitigation, (3) supervisor communication and trust, and (4) team cohesion and engagement. Our objective was to compare the PSC survey data to qualitative data regarding high reliability organization (HRO) implementation from four purposively selected VHA hospitals to assess how it manifests and converges., Methods: Qualitative data focused on understanding HRO implementation efforts were collected from key informants between 2019 and 2020 at 4 of the 18 VHA HRO implementation hospitals. To explore the extent and manifestation of each of the PSC scales among the 4 sites, we combined the qualitative data with the PSC survey data from each hospital using a joint display., Results: Survey responses were significantly different between the 4 hospitals for all 4 PSC scales. Of the 20 PSC survey items, 12 (60.0%) significantly differed across the 4 hospitals. For example, we saw cross-hospital differences in the following survey items: "We are given feedback about changes put into place based on event reports" and "We take the time to identify and assess risks to patient safety." Qualitative data supported manifestations for 80.0% (16/20) of PSC individual survey items among hospitals., Conclusion: The authors found that the qualitative data manifestations were well aligned with the VHA PSC scales, but relationships were not always consistent between data sources. Further research is necessary to elucidate these relationships., (Published by Elsevier Inc.)