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Abstract Objective To outline the preliminary development and validation of a questionnaire for diagnosing epilepsy and distinguishing focal and generalized epilepsy among infants and children in Indonesia, where electroencephalography and pediatric neurologists are generally not available. Methods A 10‐question questionnaire comprising of 43 items was developed through literature review and expert panel discussions. Then, the questionnaire was administered by pediatricians to 75 children aged 1 month to 18 years old presenting with >1 episode of unprovoked seizures at an interval of >24 h. Subsequently, the questionnaire was assessed for content validity with item‐level and scale‐level content validity indices and ratio, construct validity with item‐total correlation tests, criterion validity with diagnostic parameter assessments, and inter‐rater reliability using Cohen's kappa (κ) and internal consistency with Cronbach's alpha (α) coefficient. Results The questionnaire exhibited favorable internal validity and reliability in diagnosing epilepsy and distinguishing focal and generalized epilepsy, with excellent content (both indices and ratio at 1) and construct validity (rcount > rtable at p

Abstract Objective The aims of this study were to translate the SAPE questionnaire (Scales of the Attitudes toward People with Epilepsy) questionnaire developed in Germany that assesses attitudes toward people with epilepsy (PWE) into Japanese and to examine its reliability and validity. Methods We crafted the Japanese version of SAPE (SAPE‐J) by drawing upon the original German version. On May 22nd and 23rd, 2023, we surveyed the general public registered with an online research survey service (Cross Marketing Group Inc., Tokyo, Japan) using an online questionnaire. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in Japanese, and the ability to comprehend the Japanese questionnaires. In addition to the translated SAPE‐J, we asked about knowledge of epilepsy, personal experience with epilepsy, and gathered information about age, gender, employment status, education level, marital status, and household income in accordance with the validation of the German version of the SAPE. Results 400 adults from the general public who had heard or read about epilepsy were asked to participate, granted informed consent, and completed the study questionnaire. The SAPE‐J questionnaire has 6 scales: 1. Social Distance; 2. Stereotypes; 3. Concerns when encountering a person with epilepsy (PWE) and emotional reactions differentiated by 4.1 Fear, 4.2. Anger, and 4.3 Pity; with a total of 26 items. The reliability of these scales ranged between acceptable to high (Cronbach's alpha 0.74–0.92) and confirmatory factor analyses (CFA) confirmed the presumed six‐factor structure of the SAPE (factorial validity). Multivariate generalized linear models (GLM) were used to investigate the construct validity and showed that, depending on subscale, different variables such as age, gender, education level, personal contact to PWE, and epilepsy specific knowledge were significant predictors of attitudes. Significance The Japanese version of the SAPE proved reliable and valid for assessing attitudes toward PWE in the Japanese public. Increasing understanding about how to deal with and accept persons with epilepsy may help reduce negative attitudes and fears about the condition. Plain Language Summary The study translated the German SAPE questionnaire, which measures attitudes toward people with epilepsy (PWE), into Japanese and tested its reliability and validity. The Japanese version (SAPE‐J) was created and surveyed online among 400 adults in Japan. The SAPE‐J has 6 scales covering social distance, stereotypes, and emotional reactions like fear, anger, and pity. Reliability was high (Cronbach's alpha 0.74–0.92), and factor analyses confirmed its structure. The study found age, gender, education, and personal contact with PWE influenced attitudes. The SAPE‐J is reliable and valid for assessing attitudes toward PWE in Japan, potentially reducing negative views and fears about epilepsy.

Abstract Aims Heart failure with reduced ejection fraction (HFrEF) significantly impacts health‐related quality of life (HR‐QoL). Existing HR‐QoL questionnaires can show inconsistencies, potentially misrepresenting patient self‐reports. This study examines the variation in HR‐QoL measurement tools for HFrEF patients, identifying related determinants. Methods and results We retrospectively analysed 134 hospitalized patients with acute decompensated HFrEF at a Taiwanese tertiary centre's Heart Failure Post‐Acute‐Care (HF‐PAC) programme. Participants completed the EuroQol‐5 dimension (EQ‐5D) questionnaire, the EQ‐5D visual analogue scale (VAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Utility values were obtained from the EQ‐5D questionnaire. Demographic features were depicted using descriptive statistics, while multivariate regression was used to ascertain relationships between HR‐QoL measurements and determinants. Average scores for EQ‐5D, MLHFQ, EQ‐5D utility, and VAS were 6.1 ± 1.6, 21.8 ± 21.3, 81.7 ± 27.0, and 59.5 ± 14.6, respectively. Significant correlations were observed among the three tools. The New York Heart Association functional class showed a notable association with all tool scores. Other associations encompassed EQ‐5D with coronary artery disease, mineralocorticoid receptor antagonists, and the 6 min walk test; EQ‐5D VAS with chronic kidney disease; and MLHFQ with age. Conclusions This study illuminates the variance in HR‐QoL measurement tools for Taiwanese HFrEF patients. Using a range of these tools is beneficial in unveiling diverse determinants and approaching comprehensive patient‐centred care. However, for a more precise HR‐QoL assessment in Taiwanese HFrEF patients, recalibrating the EQ‐5D‐derived utility scores might be necessary, emphasizing the importance of patient‐specific considerations within the HF‐PAC programme.

Abstract Anaemia among pregnant women remains a public health concern globally. One major cause of this persistent problem is iron deficiency, which may be the result of limited iron intake in the diet. Using the extended version of the theory of planned behaviour (eTPB), this study aims to develop and validate a questionnaire assessing psychosocial and environmental factors that could influence the consumption of iron‐rich foods (IRFs) among Senegalese pregnant women. A three‐step procedure was used. Six focus group discussions (FGDs) were held with 10 pregnant women each from a different region to identify salient beliefs related to each of the four constructs of the eTPB using a structured guide. Information from FGDs was used to develop a questionnaire, which was administered to the first group (n = 200) of pregnant women. Principal component analyses and exploratory factorial analyses were performed on the first set of data to identify latent factors for each construct namely the attitude, subjective norm and perceived behavioural control. A revised and shorter version of the questionnaire was administered to a second sample of pregnant women (n = 226) and confirmatory factorial analyses were conducted using this second set of data. Hancock and Muller's H reliability index was computed on the final model. The final questionnaire included 44 items. Most criteria for fit indices were met and H values were satisfactory. This study proposes a tool that could be used to explore determinants of the consumption of IRF among pregnant women. Further validation is still warranted in other contexts.

Abstract The common hamster (Cricetus cricetus) occupies a controversial position among mammals inhabiting agricultural areas, as it is possibly the only critically endangered species that is legally targeted by lethal control methods, making it a conflict‐generating pest. We surveyed various stakeholders, agrarian consultants, wildlife rangers, and residents for the first time in Hungary, with two interrelated questionnaires to obtain accurate information about hamster populations, and to learn about the participants knowledge of, and attitude toward hamsters in order to provide fundamental information for planning and strengthening social embeddedness. Additionally, we prepared the current distribution map of the hamster. Based on the relatively wide distribution and locally high abundance of the species, Hungary has a key role in hamster conservation. We identified several factors, which can contribute to successful species protection. The results indicated that more than 60% of the respondent's liked hamsters. In contrast, only a few residents considered hamsters in their settlement to be beneficial. Our results suggest that the hamster's reputation is disproportionately negative due to vaguely known perceptions of harm as compared with actual reported damage. This imbalance could be rectified through enhanced communication efforts. Improving the species' reputation is integral to effective species conservation initiatives. Current pest control practices (poisons and snap traps) kill the hamsters, even though 82% of the residents would prefer to keep the hamsters alive, conforming to conservation efforts. The results also indicated that the hamster could be a flagship species in Hungary. Knowledge of the protected status of the hamster predicted a positive attitude toward the species and related to nature conservation consciousness. We conclude that requirements of residents should be included in the species action plan along with the experts' knowledge, as this could contribute to successful, long‐term conservation of the hamster.

Abstract Aim This study analysed and summarized the correlation between various indicators of ICU nurses' personal lives, hospital work situation, social opinion, psychological assessment, and their intention to resign. Design A descriptive quantitative study. Methods This study was a multicentre questionnaire on factors influencing intensive care unit (ICU) nurses' intention to resign. This study was completed through the Critical Care E Institute (CCEI) and China Calm Therapy Research Group Academic Organization (CNCSG) by contacting ICU nurses in three hospitals in 34 provinces in China. The questionnaire was in the form of a cell phone WeChat scan code. The survey included 22 indicators, including basic information about nurses (marital and child status, personal income, etc.), hospital work (weekly working hours, night shift, hospital environment, etc.), and psychological symptoms. Results A total of 1904 nurses were included in this study. Among them, 1060 (55.67%) had the intention to resign. In this study, among the 22 indicators involved, 16 factors, including hospital work hours, job title, satisfaction with current income, having children, and evaluation of the hospital, significantly impact nurses' intentions to resign (all p

Abstract Background In Ethiopia, ticks are the major threat to cattle productivity and production, leading to considerable economic losses. The current study was designed to estimate the prevalence of ixodid tick infestation, identify species, assess major risk factors associated with tick infestation and assess public awareness. Methods A cross‐sectional and questionnaire‐based study was conducted from January 2022 to June 2022 in the Aleltu district. The study animals were selected using a simple random sampling method. Results Of the 400 cattle examined, 303 (75.8%) were found to be infested by one or more tick species. Six species of ticks were identified that belonged to three genera: Amblyomma, Hyalomma and Rhipicephalus, and the subgenus Rhipicephalus (Boophilus). The most common tick species identified in terms of their prevalence and dominance were Rh. (Bo) decoloratus, Rh. evertsi, Am. variegatum, Hy. rufipes, Rh. bergeoni and Rh. praetextatus. In the present study, Rh. (Bo) decoloratus was the most prevalent (56.8%) in the study area. Among the risk factors considered, the prevalence of tick species had a statistically significant (p

Abstract Background It is not known how much information clients retrieve from discharge instructions. Objective To investigate client's understanding of discharge instructions and influencing factors. Animals Dogs and cats being hospitalized for neurological diseases. Methods Clients were presented questionnaires regarding their pet's disease, diagnostics, treatments, prognosis and discharge instructions at time of discharge and 2 weeks later. The same questions were answered by discharging veterinarians at time of discharge. Clients answered additional questions regarding the subjective feelings during discharge conversation. Data collected included: data describing discharging veterinarian (age, gender, years of clinical experience, specialist status), data describing the client (age, gender, educational status). Raw percentage of agreement (RPA) between answers of clinicians and clients as well as factors potentially influencing the RPA were evaluated. Results Of 230 clients being approached 151 (65.7%) and 70 (30.4%) clients responded to the first and second questionnaire, respectively (130 dog and 30 cat owners). The general RPA between clinician's and client's responses over all questions together was 68.9% and 66.8% at the 2 time points. Questions regarding adverse effects of medication (29.0%), residual clinical signs (35.8%), and confinement instructions (36.8%) had the lowest RPAs at the first time point. The age of clients (P = .008) negatively influenced RPAs, with clients older than 50 years having lower RPA. Conclusions and Clinical Importance Clients can only partially reproduce information provided at discharge. Only clients' increasing age influenced recall of information. Instructions deemed to be important should be specifically stressed during discharge.

ABSTRACT Objectives The primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT. Material and Methods General dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross‐sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient‐reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA). Results Most of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free‐text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management. Conclusion Almost two‐thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management.

ABSTRACT Objective This study aimed to evaluate the effect of orthognathic surgery on quality of life among Swedish patients. Materials and Methods Patients subjected to orthognathic surgery due to dentofacial deformity (DFD) and registered in the National Register of Orthognathic Surgery (NROK) in Sweden between 2017 and 2020 were eligible for inclusion in this study. The Swedish‐validated Orthognathic Quality of Life Questionnaire (S‐OQLQ) was used to evaluate patient quality of life before and after surgery. The S‐OQLQ measured each patient's subjective experience regarding social aspects. Results Eighty‐four participants were included in this cohort study, including 45 men (mean age 24.7 years), 48 women (mean age 23.4 years), and eight patients who stated no gender. Women generally graded several aspects of the S‐OQLQ higher than men, including facial aesthetics p = 0.029), oral function (p

Abstract Purpose To validate and assess the cross‐sectional adaptation of the modified Cincinnati knee rating system (MCRKS) Persian translation. Methods To assess test‐pretest reliability, 102 participants were asked to fill out the MCRKS (Per) scale after anterior cruciate ligament (ACL) reconstruction surgery. Internal consistency (Cronbach's α), reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patients completed other relevant measures as the ACL return to sports after injury (ACL‐RSI) survey, hospital for special surgery ACL satisfaction survey (HSS ACL‐SS), visual analogue scale (VAS) of pain and patient's satisfaction, Tegner activity score (TAS), single assessment numeric evaluation, and Lysholm score. Results Using MCRKS (Per), the internal consistency (Cronbach's α) was 0.9 (if item deleted: 0.81–0.86); the construct validity (Pearson's r) varied between –0.50 (for VAS pain scale) and 0.79 (for Lysholm score); the reliability (ICC value) varied between 0.82 and 0.97; furthermore, no ceiling or floor effect was present. Conclusion The MCRKS (Per) has adequate measurement properties and is considered a valid, reliable and sensitive instrument which can identify clinical outcomes after ACLR surgery. Level of Evidence Level IV.

Abstract Purpose The purpose of this study is to analyze the short anterior cruciate ligament return to sport after injury (ACL‐RSI) (Persian) version's cultural adaption and validity. Methods To assess test–retest reliability, 102 participants were filled out the short ACL‐RSI(Per) scale 6 months or more after ACLR surgery. Internal consistency (Cronbach's alpha), test–retest reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patient completed other relevant measures such as Lysholm scores, the hospital for special surgery ACL satisfaction survey (HSS ACL‐SS), the visual analogue scale (VAS) of pain and patient's satisfaction, the Tegner activity score (TAS), the single assessment numeric evaluation (SANE) and the Cincinnati Knee Rating System (CKRS). Results The short ACL‐RSI(Per) scale showed high internal consistency (Cronbach's alpha = 0.91) and test–retest reliability (ICC = 0.923). Significant correlations between short ACL‐RSI(Per) and other scales supported validity. There was a statistically significant connection between the short ACL‐RSI(Per) and the following outcomes: HSS ACL‐SS (r = 0.698, p

Abstract Aim To develop and psychometrically test an instrument to assess nurses' evidence‐based knowledge and self‐efficacy regarding insertion and management of venous access devices (short peripheral catheter (SPC), long peripheral catheter/midline (LPC) and PICC) and the management of totally implantable central venous catheter (Port) in adult patients. Design Multicenter cross‐sectional observational study with questionnaire development and psychometric testing (validity and reliability). Methods An evidence‐based instrument was developed including a 34‐item knowledge section and an 81‐item self‐efficacy section including four device‐specific parts. Nineteen experts evaluated content validity. A pilot study was conducted with 86 nurses. Difficulty and discrimination indices were calculated for knowledge items. Confirmatory factor analyses tested the dimensionality of the self‐efficacy section according to the development model. Construct validity was tested through known group validity. Reliability was evaluated through Cronbach's alpha coefficient for unidimensional scales and omega coefficients for multidimensional scales. Results Content validity indices and results from the pilot study were excellent with all the item‐content validity indices >0.78 and scale‐content validity index ranging from 0.96 to 0.99. The survey was completed by 425 nurses. Difficulty and discrimination indices for knowledge items were acceptable with most items (58.8%) showing desirable difficulty and most items (58.8%) with excellent (35.3%) or good (23.5%) discrimination power, and appropriate to the content. The dimensionality of the model posited for self‐efficacy was confirmed with adequate fit indices (e.g., comparative fit index range 0.984–0.996, root mean square error of approximation range 0.054–0.073). Construct validity was determined and reliability was excellent with alpha values ranging from 0.843 to 0.946 and omega coefficients ranging from 0.833 to 0.933. Therefore, a valid and reliable tool based on updated guidelines is made available to evaluate nurses’ competencies for venous access insertion and management.

Abstract Aim Given the escalating prevalence of autism spectrum disorder (ASD), the persistent paucity of child psychiatrists in Japan, and the need to prepare for unforeseen situations, such as the COVID‐19 pandemic, it is essential to establish a reliable screening tool. This study aims to validate the Infant Behavior Checklist (IBC) developed by Japanese experts and determine its appropriate cut‐off score. Methods A total of 354 clinic‐referred children, along with their caregivers, participated in this research. Clinical records, including diagnoses established through the sub‐structured diagnostic interviews, and the IBC assessments, were subjected to rigorous statistical analysis. Results Among the 24 items, six failed to reach significance to differentiate ASD from non‐ASD cases. The Cronbach's alpha coefficient for the IBC was calculated at 0.77. The IBC total score for ASD cases was significantly higher than that of non‐ASD cases. With the chosen cut‐off score, the IBC demonstrated an area under the ROC curve of 0.803, along with sensitivity, specificity, positive predictive value, and negative predictive value of 8.03, 0.79, 0.69, 0.34, and 0.94, respectively. Conclusion The IBC exhibits satisfactory internal consistency and content and discriminant validity. The high sensitivity and other associated indices for the optimal cut‐off score of the IBC affirm its validity as a screening instrument for ASD. Nevertheless, further investigations are warranted to ascertain the clinical utility of the IBC.

Abstract Background Little is known about factors that influence footwear selection by field hockey players. Methods An online survey was used to collect data on participant demographics and physical characteristics, factors influencing footwear selection, perceptions regarding footwear design features on injury and performance, and experiences regarding usability. Nominal and ordinal data were described as absolute frequencies and relative frequencies. Free text responses were analysed using content analysis. Sex‐related differences in quantitative and qualitative data were explored. Results A total of 401 hockey players completed the survey. Participants reported that fit, comfort, support, and cushioning were the most important factors when selecting hockey footwear. Most hockey players believed that stud design could influence athletic performance (65%) and injury risk (63%) but reported having no preference on outsole design or stud shape. Most participants (63%) used hockey‐specific footwear, but 46% of female hockey players did not, with 40% using trail running footwear instead. Qualitative analysis revealed that hockey players, particularly female participants, encounter difficulties finding properly fitting footwear. They desire more options for wide or narrow feet and face challenges in accessing suitable hockey shoes due to limited choices and availability. Conclusions With over a third of field hockey players not using hockey‐specific footwear, future research should attempt to understand the reasons and assess the impact of different footwear features on comfort, performance, injury risk, and usability.

Abstract Introduction Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. Methods We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision‐making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. Results A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self‐awareness; (5) consideration skills; (6) self‐efficacy; (7) emotional distress; and (8) experienced time. We developed the 20‐item ReadySDM to retrospectively measure these elements in an oncological setting. Conclusion We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM. The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. Patient or Public Contribution Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire.

Abstract Objective Currently, there is no up‐to‐date guideline for the treatment of buccal mucosal squamous cell carcinoma (BMSCC) in the Netherlands. A questionnaire was used to investigate the opinions of Dutch head and neck surgeons on BMSCC of the cheek treatment. Methods A questionnaire was sent to all 91 head and neck surgeons in the Netherlands. Their opinions on surgical tumor‐free margins, through‐and‐through defects, and indications for local adjuvant therapy were questioned. Results The response rate was 51%. To prevent a through‐and‐through defect, 67% of the surgeons would accept a deep clinical (macroscopic) margin of ≤5 mm. The less adverse histological characteristics a tumor has, the less consensus there is amongst the surgeons for local adjuvant treatment in case of close margins. Conclusion There is no consensus amongst Dutch head and neck surgeons about the optimal treatment for BMSCC of the cheek. There are different opinions on acceptable resection margins, indications for a through‐and‐through defect, and indications for adjuvant treatment. BMSCC of the cheek treatment should be more uniform and less surgeon dependent. Level of evidence N/A

Abstract Aim To investigate the status and influencing factors of health information literacy in patients with intermediate‐stage chronic kidney disease (CKD). Design A prospective clinical study. Methods We used a CKD health information literacy questionnaire to survey 130 patients with intermediate‐stage CKD and valuate their health needs and health knowledge. We performed the study in strict accordance with the Guidelines for Clinical Trial Protocols. We registered the study in the Chinese Clinical Trial Registration Center (registration No. ChiCTR2100053103; approval No. K56‐1). Results The overall health information literacy of CKD was relatively low. Low education level, advanced age and unemployment were influencing factors. The scores of assessment ability, literacy awareness, application ability, integration ability and CKD health knowledge reserve were relatively low. The generalized linear model showed that the older the men, the lower their health information literacy.

Abstract Purpose We aim to understand the knowledge of and attitudes toward pregnancy issues among women with epilepsy (WWE) and their caregivers and analyze the answers from the questionnaire to expose topics that require educational activities; thus, WWE experiences pregnancy better. Methods WWE at their childbearing age and/or their caregivers who entered the Fourth Affiliated Hospital of Zhejiang University for treatment of their condition were invited to fill out a questionnaire between March 1 and November 31, 2022. Results A combined total of 205 WWE and 142 caregivers completed the questionnaires. Among the surveyed WWE, a majority (63.74%) reported experiencing at least one miscarriage or induced abortion. However, a significant proportion (84.62%) of these WWE were still able to successfully give birth to at least one child. Furthermore, the offspring of these WWE showed no significant differences compared to the offspring of women without epilepsy, as reported by 93.51% of the participants. The participants’ knowledge regarding the impact of epilepsy on pregnancy was found to be comparable, with average scores of 7.74 and 7.84, respectively. The participants exhibited a limited comprehension of antiseizure medications (ASMs)‐related knowledge, specifically pertaining to ASMs adjustment during pregnancy (17.56% vs. 16.90%) and offspring outcomes (30.24% vs. 26.06%). Statistical analysis revealed significant correlations between the overall score and education level (p

Abstract Background During the early months of the COVID‐19 pandemic, decreases in physical activity (PA) and increases in sedentary behavior (SB) were reported among children in the United States (U.S.). This follow‐up analysis examines 13‐month effects of the COVID‐19 pandemic on children's PA and SB one year into the pandemic. Methods Parents of 5–13‐year‐old children in the U.S. (N = 71) reported on their child's PA and SB during the early COVID‐19 period (April‐May 2020) and again 12–14 months later (June‐July 2021). Results Paired t‐tests showed significant within‐subject reductions in SB minutes per day (Mdiff = −86.20, t = 3.26, p

Abstract Background Many individuals worldwide continue to take benzodiazepine receptor agonists (BZRAs) long term (≥3 months). The aim of this study was to conduct a content analysis of the views and experiences of discontinuing long‐term BZRA use as documented in the free‐text responses of respondents to an online questionnaire examining mediators of behaviour change relating to the discontinuation of long‐term BZRA use. Design The questionnaire was disseminated via online BZRA support groups to community‐based adults with either current or previous experience of long‐term BZRA use. The four free‐text questions focused on (1) barriers and (2) facilitators to discontinuing BZRA use; (3) additional supports required to discontinue BZRA use; and (4) additional comments regarding BZRA use. Response data were analysed using summative content analysis. Results The most commonly reported barrier to BZRA discontinuation related to the consequences of stopping the medication, including withdrawal symptoms and the possibility of return of the original symptoms. The most common facilitator that respondents reported would help them in discontinuing BZRA use was support, primarily from medical professionals. Many respondents reported having been harmed or negatively affected in some way because of BZRA use. Several respondents expressed regret over ever taking BZRAs and/or reported that, with the benefit of hindsight, they should never have taken BZRAs in the first instance. Conclusion The findings highlight the range of barriers faced by those attempting BZRA discontinuation and the importance of additional supports. Holistic and person‐centred approaches are needed to support discontinuation of long‐term BZRA use that considers an individual's personal circumstances and wider social context. Patient or Public Contribution ‘Experts by experience’ with previous experience of long‐term BZRA use were involved in developing the questionnaire and writing the manuscript as collaborators. Individuals with lived experience of taking BZRAs completed the questionnaire.

Abstract Objective The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9‒16. Methods The CEDAM was translated into Persian following the guidelines of the IQOLA project. A ‎sample of children completed the measure in a clinical setting, with a subgroup completing it ‎again to assess test–retest reliability. Concurrent criterion validity was evaluated by having all ‎participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the ‎CEDAM. Construct validity was examined using exploratory and confirmatory factor ‎analyses.‎ Results The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM ‎exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test–retest ‎reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and ‎positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p

Abstract Aim The aim of this study is to determine the reliability and validity of the Humour Styles Questionnaire (HSQ) in a sample of Spanish healthcare professionals. Design A cross‐sectional study. Methods The version of HSQ translated into Spanish by Cayssials and Pérez was used to validate on a sample of healthcare professionals (N = 250). The reliability analysed the Crombach's α coefficient and Pearson's correlation coefficient between the factors and the total scale score. The Exploratory Factor Analysis was carried out with Kaiser's criteria for the extraction of factors with Varimax rotation. Results HSQ in this study sample reproduced the similar structure of the original version with four factors (affiliative, self‐enhancing, aggressive and self‐defeating humour). These factors explained 44.46% of the total variance and Cronbach's ranged from 0.64–0.79. Global HSQ scale reliability was 0.82. Conclusion The HSQ is a valid and reliable instrument for assessing humour in healthcare professionals.

Abstract Background Clinical decision‐making for patients with myelodysplastic syndromes (MDS) is challenging, and both disease and treatment effects heavily impact health‐related quality of life (HRQoL) of these patients. Therefore, disease‐specific HRQoL measures can be critical to harness the patient voice in MDS research. Methods We report a prospective international validation study of the Quality of Life in Myelodysplasia Scale (QUALMS) with a main focus on providing information on the psychometric characteristics of its three subscales: physical burden (QUALMS‐P), emotional burden (QUALMS‐E), and benefit finding (QUALMS‐BF). The analysis is based on patients enrolled from three European countries and Israel, participating to the MDS‐RIGHT Project. The scale structure and psychometric properties of the QUALMS were assessed. Results Overall, 270 patients with a median age of 74 years were analyzed and the majority of them (60.3%) had a low MDS‐Comorbidity Index score. Results of the confirmatory factor analysis supported the underlying scale structure of the QUALMS, which, in addition to a total score, includes three subscales: QUALMS‐P, QUALMS‐E, and the QUALMS‐BF. The QUALMS‐P exhibited the highest Cronbach's alpha coefficients. Discriminant validity analysis indicated good results with the QUALMS‐P and QUALMS‐E distinguishing between patients with different performance status, comorbidity, anemia, and transfusion dependency status. No floor and ceiling effects were observed. Responsiveness to change analysis supported the validity of the measure. Patients with a hemoglobin (Hb) level of

Abstract Objective The aim of this study is to evaluate the Chinese Version of the Tinnitus Primary Function Questionnaire (TPFQ). Methods One hundred and sixteen patients who had been suffering from tinnitus for over 3 months were included in this study. Those tinnitus patients were administered the TPFQ, the Tinnitus Handicap Inventory (THI), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI). Additionally, the magnitude estimate of tinnitus loudness, pure tone audiogram, and tinnitus matching was obtained. The factor structure was measured using the Kaiser–Meyer–Olkin test. The internal consistency was examined using Cronbach's α coefficient. The relationships between the TPFQ scores and other measurements were compared using Spearman's rank correlation coefficient. Results The Cronbach's α of the 20‐item version of TPFQ was 0.94, and that of the 12‐item version of TPFQ was 0.92. Both the 20‐ and 12‐item versions of TPFQ were significantly correlated with magnitude estimation of tinnitus loudness, THI, PSQI, BDI, and BAI. The average pure tone hearing threshold was significantly correlated with the hearing subscale. Conclusion The 20‐ and 12‐item Chinese versions of TPFQ are reliable and valid measures of tinnitus. The TPFQ can be applied to the assessment and management of tinnitus among the Chinese‐speaking population.

Abstract Objective Antiseizure medications (ASMs) remain the mainstay of epilepsy treatment. These ASMs have mainly been tested in trials in adults with epilepsy, which subsequently led to market authorization (MA). For treatment of – especially young – children with epilepsy, several ASMs do not have a MA and guidelines are lacking, subsequently leading to “off‐label” use of ASMs. Even though “off‐label” ASM prescriptions for children could lead to more adverse events, it can be clinically appropriate and rational if the benefits outweigh the risks. This could be the case if “on‐label” ASM, in mono‐ or polytherapy, fails to achieve adequate seizure control. Methods The Medical Therapies Task Force of the International League Against Epilepsy (ILAE) Commission for Pediatrics performed a survey to study the current treatment practices in six classic, early life epilepsy scenarios. Our aim was not only to study first‐ and second‐line treatment preferences but also to illustrate the use of “off‐label” drugs in childhood epilepsies. Results Our results reveal that several ASMs (e.g. topiramate, oxcarbazepine, benzodiazepines) are prescribed “off‐label” in distinct scenarios of young children with epilepsy. In addition, recent scientific guidelines were not always adopted by several survey respondents, suggesting a potential knowledge gap. Significance We report the relatively common use of “off‐label” prescriptions that underlines the need for targeted and appropriately designed clinical trials, including younger patients, which will also result in the ability to generate evidence‐based guidelines.

Abstract Aim The aim of the study was to evaluate the psychometric properties of the Chinese version of the Self‐Directed Learning Readiness Scale. Design A cross‐sectional survey was designed. Methods A convenience sample of 659 participants was recruited. Exploratory and confirmatory factor analyses were used to evaluate the factorial structure. In addition, the concurrent validity was assessed using the Critical Thinking Disposition Inventory. Results The exploratory factor analysis revealed that the scale was a 6‐factor structure, named love of learning, active learning, effective learning, independent learning, learning motivation and creative learning, which explained 53.30% of the total variance. The findings of the confirmatory factor analysis showed that a 37‐item six first‐order model produced the best‐fit statistics. Internal consistency for the scale was satisfactory, ranging from 0.71 to 0.88. Concurrent and predictive validities also reached significant levels. The utility of the instrument was suggested.

Abstract Aim The aim of this study is to investigate child health care nurses' cultural competence in health visits with children and their families of foreign background. Design A cross‐sectional design combined with a qualitative explorative design. Methods The nurses assessed their cultural competence using a modified version of the Clinical Cultural Competency Questionnaire. Interviews were used to obtain a detailed description of the nurses' cultural competence. Results The nurses assessed themselves as rather culturally competent. They scored above mid‐score in the total score for cultural competence and on all subscales. Education in cultural diversity at the nurses' workplace had the highest association to cultural competence. The nurses described their awareness as recognizing each child and her/his family rather than their cultural background, and viewing the child as a unique part of her/his cultural context. Despite their high scores on cultural competence, the nurses described a lack of cultural knowledge and explained their need of further knowledge.

Abstract Objectives Model configuration is important for mental health data harmonization. We provide a method to investigate the performance of different bifactor model configurations to harmonize different instruments. Methods We used data from six samples from the Reproducible Brain Charts initiative (N = 8,606, ages 5–22 years, 41.0% females). We harmonized items from two psychopathology instruments, Child Behavior Checklist (CBCL) and GOASSESS, based on semantic content. We estimated bifactor models using confirmatory factor analysis, and calculated their model fit, factor reliability, between‐instrument invariance, and authenticity (i.e., the correlation and factor score difference between the harmonized and original models). Results Five out of 12 model configurations presented acceptable fit and were instrument‐invariant. Correlations between the harmonized factor scores and the original full‐item models were high for the p‐factor (>0.89) and small to moderate (0.12–0.81) for the specific factors. 6.3%–50.9% of participants presented factor score differences between harmonized and original models higher than 0.5 z‐score. Conclusions The CBCL‐GOASSESS harmonization indicates that few models provide reliable specific factors and are instrument‐invariant. Moreover, authenticity was high for the p‐factor and moderate for specific factors. Future studies can use this framework to examine the impact of harmonizing instruments in psychiatric research.

Abstract Objectives Oral hygiene plays an important role in eliminating biofilms and preventing dental caries. However, the implementation of oral health knowledge that children learn from their parents and through school dental health programmes remains poorly studied. This study aimed to investigate oral hygiene knowledge and its practical utilization in children and young adolescents (CYAs) aged 2–15 years. Material and methods This was a questionnaire‐based, interview‐style community survey and on‐site practical assessment of CYAs' toothbrushing skills conducted during two 1‐day public science‐promoting events held at a major German university hospital in consecutive years. CYAs first answered questions on toothbrushing frequency, dental aids used, and dental care. They subsequently underwent diagnostic staining and demonstrated their brushing technique and method. CYAs' responses (percentages) to questionnaire items addressing oral hygiene knowledge and practice, and on‐site assessment of toothbrushing skills served as the main outcome measures. Results Of 244 participating CYAs, 178 (73%) CYAs had no caries experience, the percentage increasing with age from 5% in 2–5‐year‐olds to 40% in those aged > 10 years. Of 117/244 (48%) indicating that teeth should be brushed three times daily, 80/117 (68%) self‐reported twice‐daily brushing, 32/117 (27%) reported brushing three times, and 4/117 (3%) stated doing so only once. Although 131/244 (54%) considered that teeth should be brushed for 3 min, 77/131 (59%) self‐reported actually doing so and 41/131 (31%) reported brushing for 2min. Seventeen of 42 (40%) participants aged > 10 years showed no systematic brushing method, with 21/42 (50%) failing to clean their teeth completely. Participants aged 6–10 years exhibited the highest proportion (97/134, 72%) of complete cleaning. One hundred and forty‐six of 244 (60%) of CYAs knew about floss; 63/134 (43%) reported using it. Good adherence to oral health recommendations (i.e., brushing ≥ 2/day for ≥2min) was observed in 212/244 (87%) CYAs, the remaining 32/244 (13%) exhibiting poor adherence. Conclusion CYAs knew about the importance of oral hygiene and cleaned their teeth frequently. However, translation of their knowledge into practice showed deficiencies. Repeated encouragement to put oral health knowledge into practice is important.

Abstract Background Patient‐reported outcome measures (PROMs) are widely recognized as important tools for achieving a patient‐centred approach in health research. While PROMs are subject to several stages of validation during development, even questionnaires with robust psychometric properties may challenge patient comfort and understanding. Aim Building on the experience of patient engagement in the PriCARE research programme, this paper outlines the team's response to concerns raised by patient partners regarding the administration of the questionnaire. Methods Based on a participatory action research design and the patient engagement framework in the Strategy for Patient‐Oriented Research of the Canadian Institutes of Health Research, PriCARE team members worked together to discuss concerns, review the questionnaires and come up with solutions. Data were collected through participant observation of team meetings. Results This paper demonstrates how patient partners were engaged in PriCARE and integrated into the programme's governance structure, focusing on the challenges that they raised regarding the questionnaires and how these were addressed by PriCARE team members in a six‐step approach: (1) Recognizing patient partner concerns, discussing concerns and reframing the challenges; (2) Detailing and sharing evidence of the validity of the questionnaires; (3) Evaluating potential solutions; (4) Searching the literature for guidelines; (5) Creating guidelines; and (6) Sharing and refining guidelines. Conclusion This six‐step approach demonstrates how research teams can integrate patient partners as equal members, develop meaningful collaboration through recognition of individual experiences and expertise and ensure that the patient perspective is taken into consideration in research and healthcare innovation. Patient or Public Contribution All patient partners from the PriCARE programme were actively involved in the six‐step approach. They were also involved in the preparation of the manuscript.

Abstract Introduction The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient‐reported outcomes and experiences. Methods The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes‐specific instrument. A mixed‐methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi‐structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador. Results Forty‐two and four hundred and eighty‐nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient‐centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between .81 and .93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data. Conclusion The EPD Questionnaire is probably the first instrument developed to assess patient‐reported experiences and perceived outcomes in a middle‐income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region. Patient or Public Contribution The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations.

Abstract Background and Aims Our goal was to develop an online questionnaire to survey the prevalence of suicidal behavior. Methods We developed a questionnaire with 51 variables and proceeded with validations. Validations were performed using face validity, content validity, and construct validity. Reliability was performed by test−rest. Results The face validity was 1.0 and the content validity was 0.91. The exploratory factor analysis got Kaiser−Meyer−Olkin = 0.86 and extracted one principal factor. The confirmatory factor analysis demonstrates root mean square error of approximation = 0.000 and comparative fit index = 1.000. The test−retest had an intraclass correlated coefficient of 0.98. Conclusion The adequate development questionnaire was validated, and we have an instrument to survey suicide behaviors during the pandemic time. Patient or Public Contribution The general population of Marília voluntarily responded to the questionnaire, as well as patients from the principal investigator's office.

Abstract Purpose This study investigates views and beliefs of current and preservice teachers regarding martial arts (MA) and the inclusion of martial arts in schools. Methods Participants completed an anonymous, 28‐item questionnaire made available online via Qualtrics (August–November 2020). Data was analysed using SPSS software to compare mean scores by sex, and between qualified teachers and preservice teachers. Qualitative data in the form of quotes was drawn upon and used to complement the quantitative results. Results Results indicate teachers and preservice teachers view MA as a worthwhile and beneficial activity for school‐aged students, and support the inclusion of MA into school settings. Conclusion These findings may be useful to inform policy and practice in schools, and the development of teacher education programs, professional development courses, and school‐based education programs utilizing MA to meet physical education learning outcomes.

Abstract Objectives We surveyed and reported low protective equipment usage and insufficient knowledge among endoscopy‐fluoroscopy departments in Japan in 2020. Two years later, we conducted a follow‐up survey of doctors, nurses, and technologists in Japan. Methods We conducted a questionnaire survey on radiation protection from May to June 2022. The participants were medical staff, including doctors, nurses, and radiological and endoscopy technicians in endoscopy‐fluoroscopy departments. The questionnaire included 17 multiple‐choice questions divided into three parts: background, equipment, and knowledge. Results We surveyed 464 subjects from 34 institutions. There were 267 doctors (58%), 153 nurses (33%), and 44 technologists (9%). The rate of wearing a lead apron was 98% in this study. The rates of wearing a thyroid collar, lead glasses, and radiation dosimeter were 27%, 35%, and 74%, respectively. The trend of the protective equipment rate was similar to that of our previous study; however, radiation dosimetry among doctors was still low at 58%. The percentage of subjects who knew the radiation exposure (REX) dose of each procedure was low at 18%. Seventy‐six percent of the subjects attended lectures on radiation protection, and 73% knew about the three principles of radiation protection; however, the concept of diagnostic reference levels was not well known (18%). Approximately 60% of the subjects knew about the exposure dose increasing cancer mortality (63%) and the 5‐year lens REX limit (56%). Conclusions There was some improvement in radiation protection equipment or education, but relatively little compared to the 2020 survey of endoscopy departments.

Abstract Purpose Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and persistent respiratory symptoms. Several symptom‐related questionnaires have been validated to improve understanding for patient with COPD. We aimed to systematically translate the English version of the Lung Information Needs Questionnaire (LINQ) into Korean and to verify the reliability, validity and clinical implications in comprehensive pulmonary rehabilitation (PR). Methods The original version of LINQ was translated into Korean by two translators and reviewed by the translation committee. It was then reverse translated back into English. The committee compared the reconciled version in Korean and the original version in English. A cognitive debriefing was performed on the pre‐final version, and a final version, K‐LINQ, was obtained. A test‐retest method for the analysis of reliability was performed within 2 weeks. Concurrent validity analysis was performed using Pearson correlation test of the K‐LINQ and other evaluation tools. Results A total of 110 patients were enrolled. The length, readability, understanding and suitability of the questionnaire rated well in scores for face validity of 52 Korean patients with COPD. No significant correlation was derived from the total K‐LINQ and each domain with other scales such as mMRC, K‐CAT and K‐LCADL. The intra‐class correlation coefficient of total score K‐LINQ showed high reliability. Patients who attended PR showed significantly poor pulmonary function or more severe symptoms. In addition, a significantly lower score in total score and exercise domain of K‐LINQ were confirmed in the group of PR attendees. Conclusions We translated the LINQ into Korean, implemented cross‐cultural adaptation and verified its validity and reliability. K‐LINQ can now be useful in various clinical and research fields in the Republic of Korea and could serve a complementary role and become an axis of successful treatment strategies, including a comprehensive PR programme.

Abstract Aims A patient's understanding of his or her own comorbidities is part of the recommended patient education for those with heart failure. The accuracy of patients' understanding of their comorbidities and its prognostic impact have not been reported. Methods and results Patients hospitalized for heart failure (n = 1234) aged ≥65 years (mean age: 80.1 ± 7.7 years; 531 females) completed a questionnaire regarding their diagnoses of diabetes, malignancy, stroke, hypertension, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD). The patients were categorized into three groups based on the number of agreements between self‐reported comorbidities and provider‐reported comorbidities: low (1–2, n = 19); fair (3–4, n = 376); and high (5–6, n = 839) agreement groups. The primary outcome was a composite of all‐cause mortality or heart failure rehospitalization at 1 year. The low agreement group had more comorbidities and a higher prevalence of a history of heart failure. The agreement was good for diabetes (κ = 0.73), moderate for malignancy (κ = 0.56) and stroke (κ = 0.50), and poor‐to‐fair for hypertension (κ = 0.33), COPD (κ = 0.25), and CAD (κ = 0.30). The fair and low agreement groups had poorer outcomes than the good agreement group [fair agreement group: hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.01–1.56; P = 0.041; low agreement group: HR: 2.74: 95% CI: 1.40–5.35; P = 0.003]. Conclusions The ability to recognize their own comorbidities among older patients with heart failure was low. Patients with less accurate recognition of their comorbidities may be at higher risk for a composite of all‐cause mortality or heart failure rehospitalization.

Abstract Objective Questionnaires that assess dietary habits, eating behaviors, and relevant psychosocial constructs are routinely used in obesity research and clinical practice. The 6 factor questionnaire (6FQ) was previously developed as an assessment tool for psycho‐behavioral phenotyping. The primary purpose of this study was to confirm and validate the original findings in a large diverse adult population. Methods A total of 5399 self‐selected participants (mean age of 48 ± 13 years and body mass index of 32 ± 8 kg/m2) completed the 6FQ online. The association between self‐reported demographic data and 6FQ responses was assessed using linear regression models. Results Mean factor score and odds ratio analyses consistently demonstrated a statistically significant relationship between factors and body weight even after adjusting for age, sex, and race/ethnicity. Conclusions Although the study was correlational in design, the results demonstrate that the 6FQ, an instrument that represents multidimensional unhealthful lifestyle patterns associated with diet, physical activity, cognition, and self‐perception worsen with increasing body weight. Psycho‐behavioral phenotyping may be a useful approach when assessing and treating patients with obesity.

Abstract Aim To evaluate missed nursing care and patient safety during the first wave of the COVID‐19 pandemic at in‐patient cardiology wards. Design A cross‐sectional design with a comparative approach. Method Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey‐Swedish version, and questions on patient safety and quality of care during the COVID‐19 pandemic. The data were compared with a reference sample. Results A total of 43 registered nurses and nurse assistants in the COVID‐19 sample and 59 in the reference sample participated. The COVID‐19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID‐19 sample reported more missed nursing care in wound care and in basic nursing.

Abstract Activity‐based working (ABW) is attracting attention as a new style of working to improve workplace productivity in Japan. The purpose of this study is to clarify the changes in the working style of office workers by implementation of ABW. In this paper, a questionnaire survey was conducted in a research facility; once before the ABW renovation and twice after the renovation. We found that accustoming to the ABW leads to changes in the style of working, such as the choice of seats, and that being able to work where you want to work leads to increased workplace productivity.

Abstract Objectives To assess patients' opinion on the use of 2 generations of power‐driven water flossers and their impact on gingival inflammation. Material & Methods In the present prospective cohort study 24 periodontitis patients under regular supportive periodontal therapy used daily 2 generations of a power‐driven water flosser (Sonicare AirFloss [SAF] and Sonicare AirFloss Ultra [SAFU]) for 12 weeks each. Patients were instructed to position the nozzle interproximally from the buccal aspect at each interproximal space. Patients' opinion was assessed by a questionnaire and interproximal bleeding on probing (BoP) was recorded. Results Overall satisfaction with SAF/SAFU was rated high, by about 80% of the patients. About 66% of the patients preferred SAF/SAFU compared to their previous interdental cleaning device and indicated that they would continue using SAF/SAFU after the study; none of the patients reported any discomfort or pain. Compared to only tooth brushing, daily use of SAF/SAFU caused a significant reduction of interproximal BoP values, which were well maintained over 6 months; that is, BoP at interproximal buccal and oral sites (pooled), as well as at interproximal buccal and oral sites separately, was proportionately reduced by 29.1%, 41.2%, and 24.8%, respectively (pooled: p = 0.027; buccal sites: p = 0.030; oral sites: p = 0.030). Conclusion Patients were very fond of the power‐driven water flossers tested herein, and daily use of the devices for 6 months (i.e., each device was used for 3 months) resulted in a significant reduction of gingival inflammation interproximally.

Abstract Micro‐ and macroparasites are a leading cause of mortality for humans, animals, and plants, and there is great need to understand their origins, transmission dynamics, and impacts. Disease ecology formed as an interdisciplinary field in the 1970s to fill this need and has recently rapidly grown in size and influence. Because interdisciplinary fields integrate diverse scientific expertise and training experiences, understanding their composition and research priorities is often difficult. Here, for the first time, we quantify the composition and educational experiences of a subset of disease ecology practitioners and identify topical trends in published research. We combined a large survey of self‐declared disease ecologists with a literature synthesis involving machine‐learning topic detection of over 18,500 disease ecology research articles. The number of graduate degrees earned by disease ecology practitioners has grown dramatically since the early 2000s. Similar to other science fields, we show that practitioners in disease ecology have diversified in the last decade in terms of gender identity and institution, with weaker diversification in race and ethnicity. Topic detection analysis revealed how the frequency of publications on certain topics has declined (e.g., HIV, serology), increased (e.g., the dilution effect, infectious disease in bats), remained relatively common (e.g., malaria ecology, influenza, vaccine research and development), or have consistently remained relatively infrequent (e.g., theoretical models, field experiments). Other topics, such as climate change, superspreading, emerging infectious diseases, and network analyses, have recently come to prominence. This study helps identify the major themes of disease ecology and demonstrates how publication frequency corresponds to emergent health and environmental threats. More broadly, our approach provides a framework to examine the composition and publication trends of other major research fields that cross traditional disciplinary boundaries.

Objective: The Eating Disorder Examination Questionnaire (EDE-Q) is a widely-used measure of eating-disorder symptoms. However, inconsistent replication of the subscale structure raises concern about validity. To provide a rigorous test of the EDE-Q's dimensionality and item-quality, we applied modern and classical test theory approaches to data obtained from a large, transdiagnostic sample of people with clinical eating disorders., Method: We analyzed data from 1197 individuals (M age  = 27.9 years, SD = 10.08, 95% female) with various eating disorders, who had been assessed for treatment at a specialized program. Exploratory analyses (including Parallel Analyses), Confirmatory Factor Analyses (CFA) and graded-response Item Response Theory (IRT) analyses, were conducted with Mplus., Results: Factor analyses showed inappropriate fit to the original EDE-Q subscales, as well as for alternative 1,2,3, and 4-factor solutions. Parallel analyses suggested a one-dimensional structure as best fit. IRT analyses showed substantial variability in EDE-Q-item quality and indicated that five items (fear of weight gain, feeling fat, desire to lose weight, importance of weight, importance of shape) were most pertinent to determining severity. The construct validity of the five EDE-Q items was confirmed by a CFA, showing excellent fit., Discussion: Our results suggest that EDE-Q scores are best interpreted as spanning a one-factor continuum. IRT results suggest that some items are more pertinent than others for determining eating-disorder severity. Results could be useful for establishing short EDE-Q versions, such as a five-item version, which, in turn, would be helpful for measurement-based clinical practice and for data-collection in epidemiological and experimental studies., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: This study examines the factorial structure and psychometric properties of the Eating Disorder-15 questionnaire (ED-15) in a large clinical sample, as well as the instrument's sensitivity to early clinical change in therapy and ability to measure remission., Method: Participants with eating disorders (N = 278) referred to the Flinders University Services for Eating Disorders in South Australia completed the ED-15 as well as other measures of eating disorder symptoms and co-occurring psychopathology, including depression, anxiety, and stress., Results: Confirmatory factor analysis (CFA) revealed a two-factor model for the ED-15. The ED-15 had good internal consistency. It showed satisfactory concurrent validity with moderate correlations with the EDE-Q global score and contribution of unique variance to that score. Correlations indicated good convergent validity with clinical impairment and good divergent validity from depression, anxiety, and stress. The ED-15 showed a significant medium effect size change within the first four sessions of therapy. Good discriminant validity was indicated by cut-off scores used for remission, with significantly different levels of ED psychopathology and other impairments between the two groups., Discussion: This study adds to the four previous psychometric studies of the ED-15, confirming robustness of the English version in a clinical sample. The brevity and psychometric robustness of the ED-15 makes it a preferable measure to the Eating Disorder Examination for sessional assessment of progress in treatment., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Introduction: Maternal-neonatal healthcare services were severely disrupted during the COVID-19 pandemic in even high-income countries within the World Health Organization (WHO) European Region. The objective of this study was to compare trends in the quality of maternal and neonatal care (QMNC) in Sweden and Norway to 12 other countries from the WHO European Region during the COVID-19 pandemic, and to identify domains for improvement., Material and Methods: This cross-sectional study included women giving birth in Europe from March 1, 2020 to December 31, 2022. Women answered an online, anonymous questionnaire which included 40 WHO Standard-based Quality Measures collectively scored as the total QMNC index (0-400) and separately in four subdomains (0-100): provision of care, experience of care, availability of human and physical resources, and reorganizational changes due to COVID-19. To assess reported QMNC changes over time, we used adjusted quantile regression models., Clinicaltrials: gov Identifier: NCT04847336., Results: Of the 45151 women included in the study, 13 117 (29.1%) were from Sweden and Norway and 32034 (70.9%) from the 12 WHO European countries. The total QMNC index for Sweden and Norway (median: 325, IQR: 285-355) was higher than the 12 WHO European countries (median: 315, IQR: 265-350, p < 0.001) as were trends in QMNC index over time (Sweden and Norway median: 310-345; 12 WHO European countries median: 305-340). Sweden and Norway also had higher scores in three-of-four QMNC subdomains, with the 12 WHO European countries scoring higher only for reorganizational changes due to COVID-19. In adjusted quantile models of the total QMNC index, Sweden and Norway had higher scores, with largest differences in the lower quantiles (p < 0.001 in all percentiles)., Conclusions: Across Europe, there are significant gaps in the quality of maternal-neonatal healthcare services. Although women giving birth in Sweden and Norway reported higher QMNC scores in all subdomains except for "reorganizational changes due to COVID-19," there is room for improvement and shared learning across Europe. Policymakers should prioritize long-term investments in maternal and neonatal healthcare, ensuring that facilities are adequately equipped during public health crises and that all women have access to high-quality, evidence-based, equitable, and respectful care., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Background: Early support for children and families in need can improve children's health and development. In a Swedish region, a new working model called Safe Environment for Every Kid (SEEK) was introduced in the Child Health Services to facilitate the early identification of psychosocial risk factors., Objective: The aim of this study was to describe the adoption and introduction of the SEEK model in the Child Health Services of Region Jönköping County., Methods: Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed separately by a thematic approach. The results were then interpreted together with documents (including CHS management meeting notes and documents describing planning and training sessions) using an exploratory mixed-methods approach to give a comprehensive description of the adoption and introduction of the SEEK model., Results: The results show that the SEEK model improved coordination and collaboration, which led to better integrated care for children and families. The structure was regarded as supportive when introducing the SEEK model in Child Health Services. The questionnaire, as part of the SEEK model, was used in 88% of possible health visits. The most reported reason for not using it was a lack of time., Conclusions: The desire to make a difference and thereby promote better health and development for children was a crucial factor for the nurses in adopting the SEEK model in their clinical practice. The design using coaches was also appreciated and supported the adoption and introduction of the SEEK model., Patient or Public Contribution: Parents and healthcare professionals did not contribute to the research process. The results are based on dialogues between CHS nurses and parents after the parents filled in the SEEK questionnaire, providing an understanding of professional relationships when dealing with challenging issues., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Introduction: There is considerable variation in the types of symptoms experienced by people living with endometriosis, and it is unclear which symptoms impact people the most. This study aimed to identify the specific symptoms that are "most impactful" to people living with the condition., Material and Methods: Two sequential online surveys were conducted. Women aged over 18 years with a diagnosis of endometriosis were eligible to participate. Participants first provided a free-text list of all the endometriosis symptoms they experienced (Survey 1, Australian only). Responses were condensed into a shorter list by grouping symptom types and selecting the top 20 most common and most impactful. Survey 2 (international) participants reviewed the list and selected all that they had experienced in the last 3 months, nominated one as their single "most impactful symptom", and rated its impact on one of five randomized scale types., Results: Survey 1 and Survey 2 had 195 and 983 responses, respectively. The mean age of respondents was 30.8 ± 7.9 years. There were 275 separate symptom descriptions from Survey 1, which were condensed into 104 groups, of which 25 met criteria for inclusion in Survey 2. The most commonly experienced symptoms were abdominal pain (93% of respondents), bloating (92%), and fatigue (90%), and the symptoms nominated as causing the most impact were pelvic pain (20%), abdominal pain (15%), and cramps (7%). Nearly everyone (99.7%) in Survey 2 reported experiencing at least one pain symptom. The symptoms that generated the highest impact scores were infertility (99.8/100), irregular menstrual cycles (95.3/100), and constipation (92/100). The average impact score was 87.5/100., Conclusions: There was substantial variation in the symptom selected as causing the most impact, and the level of impact was high. A focus on measuring the "most impactful symptom" in future research may enable us to better capture and measure the true symptom experience., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Abstract Background Patient participation is considered central for good healthcare. Yet, the concept is not fully understood when it comes to patients' experiences of participation in conjunction with their preferences, particularly in long‐term healthcare. The aim of this study was to investigate the extent and variation of preference‐based patient participation in patients with end‐stage kidney disease (ESKD). Methods A cross‐sectional study was conducted with 346 patients in renal care. The main variables were patients' preferences for and experiences of patient participation, determined using the Patient Preferences for Patient Participation tool, the 4Ps. Analyses identified the degree of match between preferences and experiences, that is, the preference‐based patient participation measure. Results Overall, 57%–84% of the patients reached a sufficient level of preference‐based patient participation on the items, while 2%–12% reached an insufficient level. A mismatch indicated either less or more participation than preferred; for example, 40% had less experience than preferred for taking part in planning, and 40% had more than preferred for managing treatment. Conclusion This study shows that, although many patients reach a sufficient level of preference‐based patient participation, this is not the case for all patients and/or attributes. Further opportunities for a mutual understanding of patients' preferences are needed for healthcare professionals to support person‐centred patient participation. Patient or Public Contribution The 4Ps is manufactured in collaboration with people with experience of the patient role, and persons living with ESKD were engaged in identifying their preferences and experiences of participation in renal care.

Abstract Background Zoonoses among household pets are recognized as disease and infections transmitted between animals and humans. World Health Organization‐estimated zoonotic diseases have contributed about one billion cases of illness and millions of mortalities every year. Despite the emerging and re‐emerging zoonotic disease, most pet owners are unaware of the risks posed by their pets. As there are a lack of studies assessing infections at home, this study aimed to develop and validate a cognitive, affective and behaviour questionnaire (CAB‐ZDQ) to assess household pets’ zoonotic diseases. Methods This paper covers detailed explanation on the various developmental and validation process stages of the CAB zoonotic disease questionnaire development. The development phase comprised thorough literature search, focus group discussion, expert panel assessment and review. The validation process included pre‐test and pilot testing, data analysis of results, analysis of internal consistency and the development of the final version of the questionnaire. Participants selected represented main ethnicities, gender, levels of education and population type (urban/rural) in the Klang Valley area. Results The items in the questionnaire has undergone various changes in structurally and linguistically. The final refined CAB questionnaire consists of 14 items cognitive (no items removed at pilot phase), nine items affective (one item removed at pilot phase) and five items behaviour (no items removed from pre‐test phase), respectively. Reliability analysis revealed Cronbach's alpha values were 0.700 (cognitive) and 0.606 (affective) which indicated good internal consistency after item reduction. Conclusions The developed questionnaire has proved its feasibility in assessing the Malaysian general population cognitive, affective and behavior regarding the household pets’ zoonotic diseases.

Abstract Objectives Both positive and negative including psychotic‐like cannabis intoxication effects are well‐established. Yet, consequences for consumption patterns, addictive behavior or psychotic developments are poorly researched in general, in Germany not at all. Thus, objective was to develop the first German‐language questionnaire operationalizing acute cannabis intoxication effects, based on the original “Cannabis Experience Questionnaire” (CEQ). Methods After expert translation of the CEQ, items related to acute intoxication effects were presented to a sample of 537 cannabis users. Four‐ and five‐factorial solutions of explorative factor analysis with a randomly split sub‐sample 1 were cross‐validated by confirmatory factor analysis on sub‐sample 2. Results After content review of factors and analysis of external validity, a 17 item four‐factorial model was approved. Factors are (1) “paranoia/dysphoria”, (2) “confusion/disorientation”, (3) “euphoria/creativity”, (4) “psychosis‐like/loss of reality”. Model fit is satisfactory (RMSEA = 0.058, SRMR = 0.065, CFI = 0.929, TLI = 0.914). Correlations with corresponding external measures support construct validity. Conclusions The present questionnaire is a time‐efficient, valid and reliable instrument. Thus, predictors of different cannabis intoxication effects can be analysed for the first time in German‐speaking area, as well as their significance for substance use or psychosis risk.