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There is limited research available on safe medication management practices in emergency medical services (EMS) practice, with most evidence-based medication safety guidelines based on research in nursing, operating theater and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment.The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality; however, this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and "qualitized" quantitative data.Fifty-six articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified.The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication error occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.

A range of studies have shown that prenatal maternal stress (PNMS) exposure is associated with offspring autistic-like behaviors, however the potential pathways remain unexplored. This study aimed to evaluate the mediating role of parent-child interactions in early life in the association between PNMS exposure and preschoolers' autistic-like behaviors. Data from 65,928 child-parent dyads were obtained via a primary caregiver-reported questionnaire administered as part of the Longhua Child Cohort Study. To strengthen confidence in the reliability of the results, the analyses were initially conducted on a random selection of 70% of the total sample, and then validated on the remaining 30% of the sample. Analysis of covariance and multiple linear models were employed to estimate the associations between PNMS exposure, parent-child interactions in early life, and children's autistic-like behaviors. The results showed that PNMS exposure was positively associated with the presence of autistic-like behaviors at preschool age. The total indirect effect of the frequency of positive parent-child interactions in early life accounted for 9.69% or 8.99% of the variance of the association. Our findings indicate that parent-child interactions in early life might function as potential mediators of the association between PNMS and the increased risk of offspring autistic-like behaviors.

To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples’ cancer care experiences in the Australian healthcare system from the patient’s point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.

There is growing evidence that cooking oil fumes (COFs) are harmful indoor air pollutants. However, there is a dearth of research investigating whether maternal COFs exposure during pregnancy may affect children’s autistic-like behaviors in China. This study aimed to explore this association, and examine the effects of different cooking fuels and ventilation methods used by mothers on the presence of autistic-like behaviors. This study analyzed the survey data of the Longhua Child Cohort Study in 2017 with a total of 62372 child-caregiver dyads enrolled in this study. A self-administrative questionnaire was used to collect information on socio-demographic characteristics, cooking habits during pregnancy, and autistic-like behaviors (measured using the Autism Behavior Checklist). After adjusting for potential confounders, the results showed that compared with children whose mothers never cooked during pregnancy, children whose mothers cooked sometimes, often, always during pregnancy had the higher risk of autistic-like behaviors. As the amounts of COFs exposed to and the frequency of cooking during pregnancy increased, the risk of a child’s autistic-like behaviors also increased. Mothers using natural gas as cooking fuels had a lower risk of their child having autistic-like behaviors, compared with mothers using coal or other cooking fuels. Furthermore, pregnant women using ventilation measures during cooking significantly decreased likelihood of the presence of autistic-like behaviors in their children. These results suggest that maternal exposure to COFs during pregnancy may increase the likelihood of the presence of autistic-like behaviors in offspring. These findings support a recommendation that pregnant women should avoid exposure to COFs and use clean fuels and ventilation equipment in kitchens to reduce the risk of autistic-like behaviors in children.

Background Overseas study trips can enhance healthcare students’ intercultural communication competence. An opportunity to immerse in the new culture enables them to develop their ability to offer services to people from different countries. However, the role that open-mindedness (i.e., a personality trait) can play in this process has not been explored. Methods The present study adopted a mixed-method design to identify how open-mindedness trait affected this overseas learning process. Thirty-two undergraduate healthcare students in Australia took part in the study. Questionnaires, which measured socio-demographic information, intercultural communication competence and open-mindedness trait were administered to the participants before and after their overseas trip. Half of the participants (n = 16) were interviewed after the overseas trip. Results The correlational analysis showed that the open-mindedness trait was correlated with cultural skills, a component of intercultural communication competence, but not significant with the other three components. Three themes emerging from the qualitative data indicated that the open-mindedness trait affected students’ cultural exposure. This trait enabled participants to be actively involved in the immersion in the local culture. They were willing to learn from peer fellows, and keen to embrace novel challenges. Conclusion It is concluded that open-mindedness trait is vital for increasing cultural immersion, and hence promote intercultural communication skills.

This study aimed to explore the association of visual, hearing, or dual sensory impairment with healthcare use and costs.This is a cohort study.These research data were from the China Health and Retirement Longitudinal Study spanning 2011-2018 and included 8982 community-dwelling middle-aged and older adults (aged ≥45 years at baseline). Sensory impairment was measured according to self-reported assessment of visual and hearing functions, and healthcare use and costs were ascertained via self-report. The associations of sensory impairment with healthcare use and costs were estimated using the mixed-effects regression models.Of the 8982 respondents, 4346 (48.39%) were females and their mean (standard deviation) age at baseline was 57.03 (8.26) years. Individuals with hearing impairment (HI) only, visual impairment (VI) only, and dual sensory impairment (DSI) were all at significantly higher risks of healthcare use and catastrophic health expenditure than those without sensory impairment (all P 0.05), except that VI only non-significantly prolonged inpatient days. Compared with no impairment, DSI was associated with increases in outpatient (β = 50.67, 95% confidence interval [CI] = 17.47-83.86) and inpatient out-of-pocket costs (β = 40.35, 95% CI = 5.94-74.76), while VI only or HI only did not show significant effects. Further stratification analyses indicated that the associations between sensory impairment and outpatient use were more pronounced among males than among females but that age group did not moderate the associations with any healthcare outcomes.HI and VI were independently and together associated with higher risks of healthcare use and catastrophic health expenditure. Dual sensory impairment was the only category consistently associated with increased outpatient and inpatient costs.

Key Points Question Are spouses concordant in the development of functional limitation over time in middle and old age? Findings In this cohort study of 10 414 community-dwelling participants (5207 married, different-sex couples) 45 years or older in China, significant interdependent associations were observed within a couple in the development of major public health problems, including functional limitation, activities of daily living limitation, and instrumental activities of daily living limitation. Meaning In an unprecedentedly aging population accompanied by increasing burden from functional impairment, recognizing the spousal role in shaping health and prioritizing couple-oriented rather than individual-alone public health strategies is warranted for effective prevention and treatment of functional limitations., Importance Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate. Objectives To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations. Design, Setting, and Participants In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021. Exposures The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities‎ of daily ‎living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item. Main Outcomes and Measures The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time. Results A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P, This cohort study of middle-aged and older Chinese couples examines whether spouses are concordant in the development of functional limitation over time and whether sex differences exist in spousal health associations.

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors.Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect.Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14–1.52; frail: OR = 1.67, 95%CI = 1.13–2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance.Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

Background Cultural intelligence reflects the competence to adapt to new cultural settings. Universities offer students various opportunities to gain cultural learning and develop cultural intelligence. However, there has been little empirical research to compare the effects of cultural learning and other related psycho-social factors in this process. Objective This study explores the importance of cultural learning and identifies the unique contribution of cultural education in universities to health care students' cultural intelligence. Design Cross-sectional survey study. Methods 271 health care students completed a survey measuring social desirability, demographics, personality, prior cultural exposure, previous cultural learning and cultural intelligence. Results Hierarchical regressions showed that cultural learning could affect cultural intelligence and its three components (i.e., metacognition, cognition, motivation, and behaviour) under the control for related psycho-social factors. However, its effect on the behavioral component was not significant. Considering the different types of cultural learning, overseas study experiences were more related to cultural intelligence, compared to in-class cultural learning. Conclusion Cultural learning, especially overseas study experiences, plays a significant role in the development of health care students' cultural intelligence.

Objectives: To determine: (i) incidence and outcome of subarachnoid haemorrhage (SAH) in the general population; and (ii) proportions of SAH in both the general ED population and in ED patients presenting with headache. Methods: A population-based study in Queensland from January 2010 to December 2014 was conducted. Data were sourced from the Australian Bureau of Statistics, Queensland Hospital Admitted Patient Data Collection linked to the Queensland death registry and ED Information System. Admitted patients with SAH were identified from ICD-10-AM codes. Inter-hospital transfers and repeat admissions for previously diagnosed SAH were excluded. Pre-hospital deaths from SAH were included. ED patients with headache were identified from ICD-10-AM codes and finding ‘headache’ in the triage free-text entry. The incidence of SAH, inhospital mortality, proportions of SAH in the general ED population and ED patients with headache were calculated. Results: There were 1975 incident cases of SAH in admitted patients and 294 pre-hospital deaths from SAH. The incidence of SAH was 9.9 (95% confidence interval [CI] 9.5–10.4) per 100 000 person-years. The incidence standardised to the ‘World Standard Population’ was 7.0 per 100 000 person-years. The in-hospital mortality was 23.8% (95% CI 22.0–25.8%). SAH was found in 1407 (1.9%, 95% CI 1.8–2.0) of ED patients with headache. Overall, there were 2.4 (95% CI 2.3–2.5) SAH per 10 000 of all ED attendances. Conclusions: The incidence of SAH was similar to that previously reported for Australia. One in 50 ED patients with headache had SAH. Ten in 50 000 ED attendances had a SAH. These estimates can assist in the risk assessment for SAH.

Objective The aim of this study was to understand what factors influence patients’ choice between public and private hospital ED and the relative weight of those factors among adult patients with private health insurance in Australia. Methods A survey of 280 patients was conducted in four public and private hospitals’ EDs in Brisbane between May and August 2015. The survey included information about respondent's demographics, nature of illness, decision-making, attitudes and choice. Independent t-test and Pearson's χ²-test were used to identify binary associations, and logistic regression was used to determine what factors influence patients’ choice. Results Patients who agreed that ‘long waiting time is a barrier to access public hospital ED’ were twice as likely to choose private hospitals (odds ratio [OR] 2.172, P = 0.001). Alternatively patients who did not consider that ‘there were long waiting times in public hospital ED’ were less likely to access private hospitals (OR 0.200, P = 0.003). More public hospital patients (70.7%) than private hospital patients (56.4%) (P = 0.015) agreed that ‘out-of-pocket payment is a barrier to accessing private hospital ED’. Patients attending private hospitals rated the quality of service higher than those attending public hospitals (OR 1.26, P = 0.001). Conclusion Longer waiting times in public EDs is the principal issue considered by patients choosing private EDs and the out-of-pocket payment for accessing private EDs is the principal issue considered by public ED patients. The study suggests that addressing the out-of-pocket payments will attract more patients with private health insurance to access private EDs.

Two-dimensional surface-enhanced Raman scattering (SERS) substrates have drawn intense attention due to their excellent spectral reproducibility, high uniformity and perfect anti-interference ability. However, the inferior detection sensitivity and low enhancement have limited the practical application of two-dimensional SERS substrates. To address this issue, we propose that the interaction between the MoTe2 substrate and the analyte rhodamine 6G molecules could be remarkably enhanced by the introduced p-doping effect and lattice distortion of MoTe2 via hydrogen plasma treatment. After the treatment, the SERS is greatly improved, the enhancement factor of probe molecules reaches 1.83 × 106 as well as the limit of detection concentration reaches 10−13 M. This method is anticipated to afford new enhancement probability for other 2D materials, even non-metal oxide semiconductor SERS substrates.

In Australia there is limited access to acute care support for residents living within the residential aged care sector. Competing demands from families, residents, government agencies and the acute care sector has meant that staff with the sector struggle often to meet the acute care needs of residents, leading sometimes to transfer of residents to emergency departments with major hospitals. Hospital in the nursing home is a care delivery model designed to reduce transfers, facilitate appropriate care intervention, effectively utilize existing health resources, and extend support to the residential care sector. This research project used an interpretive qualitative framework to explore through focus group method, hospital in the home experiences of 20 residential care Directors of Nursing in South East Queensland. Research outcomes emphasize hospital in the nursing home as a mutually beneficial support strategy that can improve residential based management of acute and chronic illness, can positively assist family support, and assists with decision making and ongoing communication. Hospital in the home emphasises a move from hospital destination based acute care services to community based delivery supported by a multidisciplinary team.

This study examined the associations of interpersonal conflict and school connectedness with depressive symptoms in Chinese adolescents. A cross-sectional study was conducted among 6576 adolescents in Shenzhen, China. Participants completed a battery of questionnaires that assessed adolescents&rsquo, depressive symptoms, conflict with parents, teachers, and peers, school connectedness, and demographics. Multiple linear regression analysis was used to explore the association of interpersonal conflict and school connectedness with depressive symptoms in adolescents. Results showed that conflicts with their mother, father, teachers, and peers were associated with higher levels of depressive symptoms in adolescents, while greater school connectedness was related to lower levels of depressive symptoms in adolescents. Gender proved to be a moderator of these relationships in that the associations of quarreling with mothers, mothers&rsquo, use of emotional punishments, teachers&rsquo, use of emotional punishments, and school connectedness with depressive symptoms were stronger in females than males. Moreover, grade level proved to be another moderator, with the associations of teachers&rsquo, use of physical punishment and fighting with peers with depressive symptoms being stronger in primary school students than in secondary school students. Our findings suggest that gender and grade level moderated the association of interpersonal conflict and school connectedness with depressive symptoms in Chinese adolescents.

Objective The aim of this study was to gather patients' perceptions regarding their choice between public and private hospital EDs for those who hold private health insurance. The findings of this study will contribute to knowledge regarding patients' decision-making processes and therefore may contribute to the development of evidence based public policies. Methods An in-depth semi-structured guide was used to interview participants at public and private hospital EDs. Questions sought to identify the issues that were considered by the participants to decide to attend that hospital ED, previous ED experience, expectations of ED services and perceived benefits and barriers to accessing services. Interviews were audio recorded, transcribed verbatim and analysed using content and thematic approaches. Results Four core themes emerged: prior good experience with the hospital, perceived quality of care, perceived waiting times and perceived costs that may explain patients' choice. Patients' choice between public and private EDs can be explained by the interaction of these core themes. The principal issues appear to be concern for gap payments at private hospital ED and waiting times at public hospital ED. Conclusions Patients who choose to attend public EDs appear to value financial concern over waiting time; those who choose to attend private EDs appear to value waiting time ahead of financial concerns.

A new coordination polymer with formula of [Cd(TMA)(4-CNPy)(H2O)]n (named as CdL, H2TMA = 3-thiophenemalonic acid, 4-CNPy = 4-cyanopyridine) has been obtained through a facile precipitation method at room temperature. It contains two dimensional (2D) planar grid networks with the Schlafli symbol (44) stacked in a stagger-peaked fashion. This CdL was fabricated into humidity sensor and the corresponding humidity sensing properties have been investigated as well. According to the results, the CdL based sensor enjoys the advantages of high sensitivity, fast response and recovery, as well as narrow hysteresis loop. It is worth mentioning that the response time of the sensor is as short as 7 s. Finally, the humidity sensing mechanism has been discussed through complex impedance analysis, and the interaction between water molecules and the CdL active layer under different relative humidity is further visualized by a schematic diagram.

This study aimed to examine the association between prenatal environmental tobacco smoke (ETS) exposure and hyperactivity behaviors in young children. A cross-sectional study was undertaken among 21,243 participants from all of the kindergartens in Longhua District of Shenzhen, China. Multivariate logistic regression models and hierarchical linear models were employed to assess the associations. After adjusting for potential confounders of gender, preterm birth, birth asphyxiation, etc., prenatal ETS exposure was significantly associated with an increased risk of hyperactivity behaviors in young children (OR (95% CI) = 1.51 (1.28–1.77); β (95% CI) = 0.017 (0.013–0.020)). Along with increases in children’s prenatal ETS exposure dose (measured by daily ETS exposure duration, daily cigarette consumption by household members, and overall score of prenatal ETS exposure), the children were also increasingly more likely to exhibit hyperactivity behaviors. Furthermore, children whose mothers had prenatal ETS exposure in any one or more of the pregnancy trimesters were more likely to exhibit hyperactivity behaviors as compared with those born to non-exposure mothers (all p < 0.05). Overall, prenatal ETS exposure could be associated with a detrimental impact on offspring’s hyperactivity behaviors, and public health efforts are needed to reduce prenatal ETS exposure.

Nuclear factor erythroid 2-related factor 2 (Nrf2) is an important redox-sensitive transcription factor that regulates the expression of several cytoprotective genes. More recently, genetic analyses of human tumors have indicated that Nrf2 may cause resistance to chemotherapy. In this study, we found that the expression levels of Nrf2 and its target genes GCLC, HO-1, NQO1 were significantly higher in cisplatin-resistant A549 (A549/CDDP) cells than those in A549 cells, and this resistance was partially reversed by Nrf2 siRNA. 3′,4′,5′,5,7-Pentamethoxyflavone (PMF), a natural flavonoid extracted from Rutaceae plants, sensitized A549/CDDP to CDDP and substantially induced apoptosis compared with that of CDDP alone treated group, and this reversal effect decreased when Nrf2 was downregulated by siRNA. Mechanistically, PMF reduced Nrf2 expression leading to a reduction of Nrf2 downstream genes, and in contrast, this effect was decreased by blocking Nrf2 with siRNA. Taken together, these results demonstrated that PMF could be used as an effective adjuvant sensitizer to increase the efficacy of chemotherapeutic drugs by downregulating Nrf2 signaling pathway.

Medical and dental students experience poor psychological well-being relative to their peers. This study aimed to assess the psychological well-being among medical and dental students in Saudi Arabia, identify the high-risk groups and assess the association between the psychological well-being and the academic performance.In this cross-sectional study, 422 preclinical medical and dental students at Umm Al-Qura University, Saudi Arabia, were recruited to assess their depression, anxiety, stress, self-efficacy and satisfaction with life levels using 21-items Depression Anxiety Stress Scale (DASS-21), General Self-Efficacy (GSE) scale and Satisfaction With Life Scale (SWLS). Students' academic weighted grades were obtained later. Descriptive statistics and univariate general linear model were used to analyse data.High levels of depression (69.9%), anxiety (66.4%) and stress (70.9%) were indicated, whereas self-efficacy (mean = 27.22, sd = 4.85) and life satisfaction (mean = 23.60, sd = 6.37) were within the normal range. Female medical students had higher psychological distress in contrast to dental students. In general, third-year students were more depressed and stressed in comparison with second-year students, except for stress among dental students. Moreover, all females had higher self-efficacy than males. Life satisfaction was higher within the second-year and high family income students. Depression was the only psychological variable correlated with the academic performance.High levels of psychological distress were found. Female medical students had higher psychological distress than males, whereas male dental students had higher distress than female. Medical students at third year were more depressed and stressed. Dental students were more depressed in the third year, but more stressed in the second year. Attention should be directed towards reducing the alarming levels of depression, anxiety and stress among medical and dental students.

Background/Aims: To explore whether Nrf2 was associated with drug-resistance in cisplatin resistant A549 (A549/DDP) cells, and if cryptotanshinone (CTS), one of the bioactive compounds isolated from the roots of Salvia miltiorrhiza Bunge (Danshen), could enhance the sensitivity in A549/DDP cells towards cisplatin. Methods: A549 and A549/DDP cells were subjected to various treatments, and then Sulforhodamine B (SRB) assay, flow cytometry analysis and western immunoblotting analysis were applied to determine IC50, apoptotic status and expressions of Nrf2 and its downstream genes. Results: The endogenous expression levels of Nrf2 as well as its target genes including GCLC, GCLM, HO-1, NQO1 and MRP1 were much higher in A549/DDP cells than those of A549 cells and the susceptibility of A549/DDP cells to cisplatin was partially restored by silencing Nrf2. The combination of CTS and cisplatin led to cell death and apoptosis through sensitizing A549/DDP cells towards cisplatin compared with cisplatin mono-treatment, however, this reversal role could be abolished by Nrf2 knockdown. Specifically, CTS obviously diminished Nrf2 expression, thus contributing to the decrease of Nrf2-target genes expression levels. Meanwhile, we also discovered that CTS triggered several other signals involving in chemoresistance such as MAPKs, Akt and STAT3 pathway. Conclusion: Our data indicated CTS may be developed as a potential sensitizer cooperating with anticancer drugs to combat chemoresistant carcinoma through the inhibition of the Nrf2 pathway.

Literature showed that sugar-sweetened beverages (SSBs) could increase the risk of developing hypertension in school students, but there is no reported evidence from China yet, so this study aims to investigate the association of the SSBs consumption and school students' hypertension in urban areas of Nanjing, China. A cross-sectional survey was conducted among primary and junior high school students selected from 32 primary schools and 16 junior high schools using a multi-stage random sampling method, with a total number of 10,091 participants involved. The mean age of Grade 4 is 9.04 ± 0.38, while the mean age of Grade 7 is 12.03 ± 0.41. Blood pressure was measured and SSBs consumption was reported using a validated questionnaire. The overall prevalence of hypertension was 4.5% among the participants. After adjustment for school, parental education, physical activity, diet intake including meat and snacks, participants who had an experience of SSBs intake were at a higher risk of developing hypertension (odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.15, 1.70) compared with those who had no experience of SSBs intake. A significant association between the consumption of SSBs and hypertension was observed among the students who were at a healthy weight (OR = 1.78, 95% CI = 1.20, 2.65), as well as who were overweight or obese (OR = 1.28, 95% CI = 1.01, 1.61). SSBs may play a contributing role in developing childhood hypertension in this population in China, which is of important implications for future population-based childhood hypertension intervention in China and other countries.

Introduction: Many studies have indicated the poor psychological health of medical and dental students. However, few studies have assessed the longitudinal trajectory of that psychological health at different times in an academic year. Aim: To evaluate the positive and negative aspects of psychological health among preclinical medical and dental students in Saudi Arabia prospectively. Methods: A total of 317 preclinical medical and dental students were recruited for a longitudinal study design from second and third-year students at Umm Al-Qura University in the 2012-2013 academic year. The students were assessed at the middle of the first term and followed up after 3-monthes at the beginning of the second term. Questionnaires included assessment of depression, anxiety, stress, self-efficacy, and satisfaction with life. Results: Depression, anxiety, stress, and satisfaction with life were improved significantly at the beginning of the second term, whereas self-efficacy did not change significantly. The medical, female, and third-year student subgroups had the most significant changes. Depression and stress were significantly changed at the beginning of the second term in most demographic subgroups. Conclusion: Preclinical medical and dental students have different psychological health levels at different times of the same academic year. It is recommended to consider time of data collection when analyzing the results of such studies.

Objective: The present study aims to investigate non-English-speaking background (NESB) patients' satisfaction with hospital ED service and compare it with that of English-speaking background (ESB) patients. Methods: A cross-sectional survey was conducted at the ED of an adult tertiary referral hospital in Queensland, Australia. Patients assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed in the ED, before and after their ED service. Pearson χ2-test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB groups in terms of patient-reported satisfaction. Results: In total, 828 patients participated in the present study. Although the overall satisfaction with the service was high - 95.1% (ESB) and 90.5% (NESB) - the NESB patients who did not use an interpreter were less satisfied with their ED service than the ESB patients (odds ratio 0.5, 95% confidence interval 0.3-0.8, P = 0.013). The promptness of service received the lowest satisfaction rates (ESB 85.4% [82.4-88.0], NESB 74.5% [68.5-79.7], P < 0.001), whereas courtesy and friendliness received the highest satisfaction rates (ESB 98.8 [97.6-99.4], NESB 97.0 [93.9-98.5], P = 0.063). All participants reported the promptness of service (33.5%), quality and professional care (18.5%) and communication (17.6%) as the most important elements of ED service. Conclusion: The NESB patients were significantly less satisfied than the ESB patients with the ED service. Use of an interpreter improved the NESB patients' level of satisfaction. Further research is required to examine what NESB patients' expectations of ED service are.

The aim of this study was to understand what factors influence patients' choice between public and private hospital ED and the relative weight of those factors among adult patients with private health insurance in Australia.A survey of 280 patients was conducted in four public and private hospitals' EDs in Brisbane between May and August 2015. The survey included information about respondent's demographics, nature of illness, decision-making, attitudes and choice. Independent t-test and Pearson's χ²-test were used to identify binary associations, and logistic regression was used to determine what factors influence patients' choice.Patients who agreed that 'long waiting time is a barrier to access public hospital ED' were twice as likely to choose private hospitals (odds ratio [OR] 2.172, P = 0.001). Alternatively patients who did not consider that 'there were long waiting times in public hospital ED' were less likely to access private hospitals (OR 0.200, P = 0.003). More public hospital patients (70.7%) than private hospital patients (56.4%) (P = 0.015) agreed that 'out-of-pocket payment is a barrier to accessing private hospital ED'. Patients attending private hospitals rated the quality of service higher than those attending public hospitals (OR 1.26, P = 0.001).Longer waiting times in public EDs is the principal issue considered by patients choosing private EDs and the out-of-pocket payment for accessing private EDs is the principal issue considered by public ED patients. The study suggests that addressing the out-of-pocket payments will attract more patients with private health insurance to access private EDs.

Aim: To show the validity and reliability of the translated Hill-Bone scale on 110 hypertensive participants from an Arabic speaking country. Background: With the wide spread availability of treatment, individuals with hypertension have reported various levels of adherence to their medications. Flexible and practical methods of measuring adherence are the use of surveys, scales and interviews. There is a scarcity in Arabic tools and scales that measure levels of adherence to antihypertensive treatments in the Arabic speaking context. Design and Methods: A cross-sectional study was conducted among 110 individuals diagnosed with hypertension and from an Arabic speaking country. The Hill-Bone scale includes three subscales that measure salt intake, medication adherence and appointment keeping. Given the focus on the pharmacological management of hypertensive patients, only items related to medication adherence and appointment keeping subscales were used. The scale was translated by following a comprehensive and accepted method of translation. Results: Instrument reliability was tested by identifying the Cronbach’s alpha coefficient. The subscale for medication adherence in the Hill-Bone scale reported an acceptable level of reliability (Cronbach’s alpha =0.76). Compared with other translated versions of the Hill-Bone scale, the scale also reported good reliability and validity. Conclusion: Results indicate that the Arabic translated version of the Hill-Bone scale has an acceptable level of reliability and validity and therefore can be used in Arabic speaking populations.

Educational stress is common among school children and adolescents, especially in Asian countries. This study aims to identify factors associated with perceived educational stress among students in China. A cross-sectional questionnaire survey was conducted with 1627 students (Grades 7–12) from six secondary schools in rural and urban areas of Shandong Province. A wide range of individual, family, school and peer factors were associated with stress measured using the Educational Stress Scale for Adolescents (ESSA). Rural school location, low school connectedness, perceived poor academic grades, female gender, older age and frequent emotional conflicts with teachers and peers were among the strongest correlates, and most of them are school- or study-related. Unexpectedly, family and parental factors were found to have little or no association with children's perceived educational stress. These findings may offer directions for interventions in secondary school settings.

Objective The 2010–2011 Queensland floods resulted in the most deaths from a single flood event in Australia since 1916. This article analyses the information on these deaths for comparison with those from previous floods in modern Australia in an attempt to identify factors that have contributed to those deaths. Haddon's Matrix, originally designed for prevention of road trauma, offers a framework for understanding the interplay between contributing factors and helps facilitate a clearer understanding of the varied strategies required to ensure people's safety for particular flood types. Methods Public reports and flood relevant literature were searched using key words ‘flood’, ‘fatality’, ‘mortality’, ‘death’, ‘injury’ and ‘victim’ through Google Scholar, PubMed, ProQuest and EBSCO. Data relating to reported deaths during the 2010–2011 Queensland floods, and relevant data of previous Australian flood fatality (1997–2009) were collected from these available sources. These sources were also used to identify contributing factors. Results There were 33 deaths directly attributed to the event, of which 54.5% were swept away in a flash flood on 10 January 2011. A further 15.1% of fatalities were caused by inappropriate behaviours. This is different to floods in modern Australia where over 90% of deaths are related to the choices made by individuals. There is no single reason why people drown in floods, but rather a complex interplay of factors. Conclusions The present study and its integration of research findings and conceptual frameworks might assist governments and communities to develop policies and strategies to prevent flood injury and fatalities.

Paramedic education has been undergoing major development in Australia in the past 20 years, with many different educational programmes being developed across all Australian jurisdictions. This paper aims to review the current paramedic education programmes in Australia to identify the similarities and differences between the programmes, and the strengths and challenges in these programmes. A literature search was performed using six scientific databases to identify any systematic reviews, literature reviews or relevant articles on the topic. Additional searches included journal articles and text references from 1995 to 2011. The search was conducted during December 2010 and November 2011. Included in this review are a total of 28 articles, which are focused around five major issues in paramedic education: (i) principle on paramedic programmes and the involvement of industry partners; (ii) clinical placements; (iii) contemporary methods of education; (iv) needs for specific programmes within paramedic education; and (v) articles related to the accreditation process for paramedic programmes. Paramedic programmes across Australian universities vary with many different practices, especially relating to clinical placements in the field. The further advances of the paramedic education programmes should aim to respond to population change and industry development, which would enhance the paramedic profession across Australia.

Hypertension is a global health issue among the adult population. Adherence to antihypertensive medications is an effective step for better control of blood pressure and preventing the risk of complications. Several factors support or hinder hypertensive patients’ adherence. Objectives: This article reviews the factors affecting adherence to antihypertensive treatments, and reflects on these factors from a Saudi Arabian perspective. Methods: Papers and studies about antihypertensive medication adherence were reviewed from different databases including MEDLINE, PubMed, ScienceDirect and Google scholar. Results: Factors affecting antihypertensive treatments adherence are classified into three domains: Patient (e.g. sociodemographic, individual knowledge and skills), Health System, and Provider related factors.

Objective: To compare access and utilisation of EDs in Queensland public hospitals between people who speak only English at home and those who speak another language at home. Methods: A retrospective analysis of a Queensland statewide hospital ED dataset (ED Information System) from 1 January 2008 to 31 December 2010 was conducted. Access to ED care was measured by the proportion of the state's population attending EDs. Logistic regression analyses were performed to determine the relationships between ambulance use and language, and between hospital admission and language, both after adjusting for age, sex and triage category. Results: The ED utilisation rate was highest in English only speakers (290 per 1000 population), followed by Arabic speakers (105), and lowest among German speakers (30). Compared with English speakers, there were lower rates of ambulance use in Chinese (odds ratio 0.50, 95% confidence interval, 0.47-0.54), Vietnamese (0.87, 0.79-0.95), Arabic (0.87, 0.78-0.97), Spanish (0.56, 0.50-0.62), Italian (0.88, 0.80-0.96), Hindi (0.61, 0.53-0.70) and German (0.87, 0.79-0.90) speakers. Compared with English speakers, German speakers had higher admission rates (odds ratio 1.17, 95% confidence interval, 1.02-1.34), whereas there were lower admission rates in Chinese (0.90, 0.86-0.99), Arabic (0.76, 0.67-0.85) and Spanish (0.83, 0.75-0.93) speakers. Conclusion: This study showed that there was a significant association between lower utilisation of emergency care and speaking languages other than English at home. Further researches are needed using in-depth methodology to investigate if there are language barriers in accessing emergency care in Queensland.

Objective This study investigated the characteristics of the patient–practitioner relationship desired by overweight/obese individuals in weight management. The aim was to identify characteristics of the relationship which empower patients to make lifestyle changes. Methods Grounded theory was used inductively to build a model of the patient–practitioner relationship based on the perspectives of 21 overweight/obese adults. Results Emerging from the match between patient and practitioner characteristics, collaboration was the key process explicitly occurring in the patient–practitioner relationship, and was characterised by two subcategories; perceived power dimensions and openness. Trust emerged implicitly from the collaborative process, being fostered by relational, informational, and credible aspects of the interaction. Patient trust in their practitioner consequently led to empowering outcomes including goal ownership and perceiving the utility of changes. Conclusion An appropriate match between patient and practitioner characteristics facilitates collaboration which leads to trust, both of which appear to precede empowering outcomes for patients such as goal ownership and perceiving the utility of changes. Collaboration is an explicit process and precedes the patient trusting their practitioner. Practice implications Practitioners should be sensitive to patient preferences for collaboration and the opportunity to develop trust with patients relationally, through information provision, and modelling a healthy lifestyle.

BACKGROUND: Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10- AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P

Highlights - This is the first review and meta-analysis on the modification of pollutants' effects on mortality by temperature. - We found temperature extremes modify the effects of PM10 and O3 on both non-accidental and cardiovascular mortality. - There may be value in promoting use of early warning systems on extremely hot or cold days that are also heavily polluted. Abstract Temperature extremes and air pollution both pose significant threats to human health, but it remains uncertain whether pollutants' effects on mortality are modified by temperature levels. In this review, we summarized epidemiologic evidence on the modification by temperature of the acute effects of air pollutants on non-accidental and cardiovascular mortality. The EMBASE, PubMed, ProQuest Dissertations and Theses, and Elsevier Science Direct databases were used to identify papers published up to 2nd December 2014. Studies with appropriate design, exposures and outcome indicators, quantitative estimates and high/intermediate quality were included. Twenty-one studies met the inclusion criteria, of which 12 reported the effects of PM10 on mortality modified by temperature, 10 studied O3, and the rest examined NO2, SO2, PM2.5, PM10-2.5, CO and black smoke. We divided temperature into low, medium, and high categories as defined in each study. In high temperature days, a 10μg/m3 increment in PM10 concentration corresponded to pooled estimates of 0.78% (95% CI: 0.44%, 1.11%) and 1.28% (0.66%, 1.91%) increase in non-accidental and cardiovascular mortality, both statistically significantly higher than the estimates in medium temperature stratum. Pooled effects of O3 on non-accidental mortality on low and high temperature days were increases of 0.48% (0.28%, 0.69%) and 0.47% (0.32%, 0.63%) respectively, for 10μg/m3 increase in exposure, both significantly higher than the increase of 0.20% (0.07%, 0.34%) on medium temperature days. The effect of O3 on cardiovascular mortality was strongest on high temperature days with pooled estimate of 1.63% (1.14%, 2.13%). No significant interactions between SO2/NO2 and temperature were detected by meta-analysis. Other pollutants were not analyzed due to the lack of suitable studies. In summary, we observed interactions between high temperature and PM10 and O3 in the effects on non-accidental and cardiovascular mortality. Low temperature modified the effects of air pollutants but not in a consistent fashion: the effect of PM10 oncardiovascular mortality was diminished but the association between O3 and non-accidental mortality was strengthened.

Chemoresistance is a disturbing barrier in cancer therapy, which always results in limited therapeutic options and unfavorable prognosis. Nuclear factor E2-related factor 2 (NRF2) controls the expression of genes encoding cytoprotective enzymes and transporters that protect against oxidative stress and electrophilic injury to maintain intrinsic redox homeostasis. However, recent studies have demonstrated that aberrant activation of NRF2 due to genetic and/or epigenetic mutations in tumor contributes to the high expression of phase I and phase II drug-metabolizing enzymes, phase III transporters, and other cytoprotective proteins, which leads to the decreased therapeutic efficacy of anticancer drugs through biotransformation or extrusion during chemotherapy. Therefore, a better understanding of the role of NRF2 in regulation of these enzymes and transporters in tumors is necessary to find new strategies that improve chemotherapeutic efficacy. In this review, we summarized the recent findings about the chemoresistance-promoting role of NRF2, NRF2-regulated phase I and phase II drug-metabolizing enzymes, phase III drug efflux transporters, and other cytoprotective genes. Most importantly, the potential of NRF2 was proposed to counteract drug resistance in cancer treatment.

Epidemiologic evidence supports the positive association of cardiopulmonary morbidity and mortality, and lung cancer risk with exposure to airborne particulate matter (PM). Oxidative stress and inflammation have been proposed to be the major causal factors involved in mediating PM effects on both cardiovascular and pulmonary health outcomes. However, the mechanism whereby PM causes the health effects is not fully elucidated. To evaluate and investigate human exposure to PM, it is essential to have a specific, sensitive and robust characterization of individual exposure to PM. Biomarkers may mark important intermediate steps leading to overt health effects after PM exposure. Thus biomarkers are promising indicators, which could serve as representative measures of the exposure to PM for assessing the health impacts and understanding the mechanism. Indeed, a number of biomarkers are already in use in the field of epidemiological studies and toxicological research. However, we are facing now the challenges to select robust, specific and sensitive biomarkers, which can be employed in large-scale of population to assess the health risk and to monitor the effectiveness of interventions. In this review, we describe a range of biomarkers that are associated with air pollution exposure, particularly markers of oxidative stress, inflammatory factors, and microRNAs, as well as markers of pollutants metabolites. Understanding the nature of the association of these biomarkers with PM exposure may shed some light on the process of selecting biomarkers for large-scale population studies, developing novel preventative and therapeutic strategies.

Medical students in Australia often participate in overseas electives as a part of their medical education. There are different views as to the value of these experiences, particularly in developing countries. The Chinese health care system has undergone repeated rapid transformations and presents unique learning opportunities for Australian medical students. Emergency Department cases observed first-hand at a Chinese tertiary hospital in December 2012 demonstrate some of the differences in health care systems including the privatization and change to hospitals becoming profit-driven, the tensions in the doctor-patient relationship and the differences in the use of analgesia. Thus, an overseas experience in a country such as China provides learning not only in clinical practice, but also in managing health care systems in a different environment.

In Australiathereislimitedaccesstoacutecaresupportforresidentslivingwithin the residentialagedcaresector.Competingdemandsfromfamilies,residents,government agencies andtheacutecaresectorhasmeantthatstaffwiththesectorstruggleoftento meet theacutecareneedsofresidents,leadingsometimestotransferofresidentsto emergency departmentswithmajorhospitals.Hospitalinthenursinghomeisacaredeliverymodel designed to reduce transfers, facilitate appropriate care intervention, effectively utilize existing healthresources,andextendsupporttotheresidentialcaresector.Thisresearchproject used aninterpretivequalitativeframeworktoexplorethroughfocusgroupmethod,hospital in thehomeexperiencesof20residentialcareDirectorsofNursinginSouthEastQueensland. Researchoutcomesemphasizehospitalinthenursinghomeasamutuallybeneficialsupport strategy thatcanimproveresidentialbasedmanagementofacuteandchronicillness,can positively assistfamilysupport,andassistswithdecisionmakingandongoingcommunication. Hospital inthehomeemphasisesamovefromhospitaldestinationbasedacutecareservicesto community based delivery supported by a multidisciplinary team.