Leisure activities (LAs) have a positive effect on well-being, healthy aging, cognitive functions, physical function, and mental health.

To determine the prevalence of chronic musculoskeletal pain (CMSP) in schoolteachers and evaluate the relationship between different types of LAs and CMSP.

A total of 433 in-service schoolteachers (303 female, 130 male) participated in this cross-sectional study between January 2023 and March 2023 using an online survey. Common LAs in Turkey, including reading books/magazines/newspapers or writing stories/letters, leisure physical activities (PAs), computer-based LAs, television viewing, LAs on smartphones, music listening, going to the cinema/theatre/opera/ballet/concert, gardening, cooking meal/pastry, meeting with friends, and painting/marbling/ceramic/knitting, and their durations were recorded.

The median age of the participants was 38.0 (IQR, 35.0-45.0) years. The prevalence of CMSP was 44.8%. Multiple logistic regression analysis including age, sex, body mass index, comorbidities, weekly standing duration at work, and LAs showed that there was an inverse relationship between CMSP and PAs (OR = 0.564, 95% CI: 0.357-0.890) and listening to music (OR = 0.555, 95% CI: 0.317-0.973). Moreover, LAs on smartphones (OR = 4.318, 95% CI: 2.004-9.308), gardening (OR = 1.827, 95% CI: 1.097-3.043), and having a thyroid disorder (OR = 2.212, 95% CI: 1.045-4.684) were predictive variables for CMSP.

Considering that PAs and music listening are inversely associated with CMSP, it may be beneficial to make them a part of the lifestyle of both healthy individuals and individuals with CMSP. Physicians should also be aware that LAs on smartphones carry a greater risk for CMSP.

Understanding factors that contribute to the quality of life (QoL) of primary caregivers of young autistic children can help researchers and clinicians provide high-quality support to caregivers and families. This study examined whether family demographic factors, parenting stress, and caregivers' perceptions of family-centered healthcare experiences uniquely predict caregivers' QoL. Participants were caregivers of toddlers with: features of autism (n = 119), other developmental delays (n = 101), and no developmental concerns (n = 264). We hypothesized that higher levels of perceived family-centered care would moderate (ameliorate) the relation between parenting stress and QoL. Higher levels of perceived family-centered care were associated with higher QoL for all groups but did not moderate the negative relation between parenting stress and QoL. Negative effects of parenting stress on QoL were stronger for caregivers of children with autism features compared to other groups. Future research is needed to determine how to provide additional support to caregivers with lower QoL, particularly caregivers who are experiencing income- or parenting-related stress and lower levels of family-centered care. Caregiver QoL is especially important to support across service settings (e.g., primary care, early intervention) during the birth-to-three period, when the process of accessing autism services can be challenging for caregivers.

There is a critical need to identify proximal factors associated with help-seeking following a suicide attempt (SA; i.e., attempt to kill oneself). Many individuals receive emergency department care following a SA; however, little is known about factors distinguishing individuals who present to the emergency department voluntarily (i.e., played an active role in presentation through their own action to obtain help or through requesting help) and those who do not (i.e., brought to the emergency department due to no action of their own) following a SA, which could improve suicide prevention efforts. It was hypothesized that using a poisoning SA method and experiencing social support would increase the likelihood of help-seeking following SA. This study utilized electronic health record data for 553 emergency department patients (Mage = 37.94 [SD = 15.67], 53.30 % female, 94.40 % white) presenting within 24-hours after SA during a two and a half year period across six hospitals within a rural healthcare system. Within 24-hours of SA, 34.4 % engaged in help-seeking. The use of a poisoning SA method and a diagnosis of borderline personality disorder increased the likelihood of help-seeking, whereas a diagnosis of bipolar disorder and being in a romantic relationship decreased the likelihood. Results can inform suicide prevention initiatives to promote help-seeking immediately following SA, a critical period that may represent the last opportunity for self-intervention prior to the occurrence of lasting serious injury or death by suicide.

This study aimed to identify predictive factors for femoral bone mineral density (BMD) in adult patients with spinal deformity and to establish cutoff values for detecting osteoporosis using preoperative computed tomography (CT) scans.

A retrospective analysis was conducted on 90 patients with adult spinal deformity (ASD) who underwent preoperative bone density testing. Key parameters such as age, body mass index (BMI), and Hounsfield unit (HU) values from various vertebral levels were analyzed. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD T-score, and HU values were measured at C2, C7, T8, T9, L1, L2, and L3.

Multivariate regression analyses identified BMI and HU at C2 as independent predictors of femoral T-score. The following predictive equation was developed: femoral T-score = - 5.178 + 0.053 × BMI + 0.006 × C2 HU (R2 = 0.50). The formula derived from these variables explained 50% of the variance in femoral T-score. Receiver operating characteristic analysis identified cutoff values for predicting osteoporosis as 281 for C2 HU and 22.9 for BMI. The areas under the curve were 0.751 and 0.638, respectively.

These findings suggest that HU values from preoperative CT scans can serve as reliable indicators of femoral T-score, offering an alternative to DXA in cases where DXA is unavailable or inaccurate due to factors like severe spinal degeneration. This approach could enhance the preoperative assessment of osteoporosis in ASD patients by facilitating more targeted use of DXA and improving overall clinical decision-making.

IV.

This study aimed to examine the association between immigration status and women's contraceptive practices based on population data from government surveys.

A secondary data analysis was conducted on the Quebec Population Health Survey (2014-2015), which aimed to represent 98.8% of the population of Quebec aged 15 years and older through stratified sampling and data weighting (response rate of 61%). Univariate and multivariable analyses were used to compare contraceptive practices between immigrant and Canadian-born women. Two dependent variables were considered: (1) women who used contraception vs. no contraceptive method of any kind, and (2) among women who used contraception, those who used methods that required them to access health care (birth control pill, IUD, or tubal ligation) vs. women who used other methods (condom, coitus interruptus, other).

The logistic regression results revealed a strong association between immigration status and contraceptive practices, at two levels: (1) immigrant women had lower odds to use contraception than Canadian-born women; and (2) of the women who use contraception, immigrants had lower odds than those born in Canada to use feminine medical contraception. These findings held true for immigrant women regardless of the number of years they have spent in Canada. Women who lived in low-income households or who had not had a medical consultation for more than one year also had lower odds to use feminine medical contraception.

Barriers in access to contraceptive care interfere with women's reproductive health and autonomy. The lower odds for immigrant women to use contraception, and particularly the most effective methods, suggest that their contraceptive care needs are at least partially unmet or inadequately addressed. This is concerning given that other studies show no differences in fertility intention between immigrant and Canadian-born women, and high rates of abortion for immigrant women.

Shiga toxin-producing Escherichia coli (STEC) infection can cause potentially fatal hemolytic uremic syndrome (HUS). To determine epidemiologic and bacterial genomic factors associated with HUS, we conducted a retrospective case-control study with 108 HUS cases and 416 unmatched controls (non-HUS) selected among STEC notifications in Ireland during 2017-2020. We combined routinely collected epidemiologic data on STEC notifications with genomewide association study findings and used logistic regression to estimate adjusted odds ratios. Our findings reaffirmed known risk factors, such as young age (0-9 years) and presence of specific stx genes or gene combinations (stx2a; stx1a + stx2a; stx1a + stx2c), and additionally suggest that having outbreak-associated infection, residence within the East region of Ireland, and the combined presence of both ygiW and group_5720 or both pfkA and fieF genes are potentially associated with developing HUS. Our findings could improve early identification of high-risk STEC infections and help guide enhanced surveillance and public health management.

There are conflicting data regarding the association between epidural analgesia and obstetric anal sphincter injuries (OASIs). There are also few predictive models that document assessment for multicollinearity among risk factors or precisely identify effect modifiers and confounders.

The objective of this study was to evaluate the association between epidural analgesia and OASIs, using rigorous statistical methods to identify effect modifiers and confounders in a diverse, urban population.

This was a secondary analysis of a retrospective case-control study of women with singleton vaginal deliveries. Our primary analysis was to assess the association between epidural analgesia and OASIs, adjusting for modifiable and nonmodifiable risk factors. These risk factors were additionally assessed for effect modification and confounding effect.

Our sample consisted of 1,326 women who had a vaginal delivery. Among the women with OASIs, 218 women (75.4%) had an epidural, and among those without OASIs, 620 women (59.8%) had an epidural (P < 0.001). Epidural analgesia increased the odds of OASIs by 107% (odds ratio 2.07, 95% confidence interval [1.54 to 2.77]). Through further examination of the relationship between OASIs and epidurals, while considering multiple risk factors and addressing multicollinearity, effect modification, and confounding, we identified operative delivery and labor induction as confounding variables. Accounting for these factors mitigated the association between epidural use and OASIs (adjusted odds ratio 1.38, 95% confidence interval [1.00 to 1.91]).

Initially, we found epidural analgesia to be associated with OASIs; however, after performing additional statistical analysis and accounting for additional risk factors, this association was no longer statistically significant.

Nurses' moral courage (NMC) enhances care quality and patient safety. Nurses' professional values promote ethical adherence, moral obligation fulfillment, and compliance to prevent ethical violations. It is necessary to explore the current status and influencing factors of moral courage from the perspective of professional values.

To investigate the current situation of nurses' moral courage, analyze the latent profiles of nurses' moral courage, and explore the influencing factors from the perspective of professional values.

A cross-sectional design was employed.

Data were collected through convenient sampling at a tertiary hospital during May 2023 in Wuhan, Hubei province, China. A self-designed web-based questionnaire consisting of demographic characteristics, the Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV) and the Nurses' Moral Courage Scale (NMCS) were used for the cross-sectional survey. Latent profile analysis was conducted using the results of 3 explicit indexes of NMCS, and multivariate logistic regression was used to analyze the influencing factors of NMC.

Research ethics approval (with the code of TJ- IRB 20220543) was obtained from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.

This study included 966 nurses, predominantly female and under 30 years old, with 91.10% holding a bachelor's degree. Latent profile analysis identified three moral courage profiles: low-level (31.5%), medium-level (47.2%), and high-level (21.3%). Multivariate logistic regression analysis showed significant positive correlations between professional values and moral courage, with head nurses being significantly more likely to exhibit high moral courage (OR = 3.586, p = 0.013).

The moral courage of nurses can be classified into 3 subgroups. Nurses' professional values positively correlate with moral courage, with head nurses showing significantly higher levels of moral courage. Strengthening professional values through training can enhance ethical behavior in nursing, potentially improving patient care and safety.

Adult spinal deformity (ASD) has a significant impact on trunk balance and quality of life in the elderly. Postoperative rod fractures pose significant challenges, but the mechanisms of their occurrence are underexplored compared to other complications such as proximal junctional kyphosis. This study investigated factors associated with rod fracture in patients with ASD.

A retrospective single-center study analyzed 110 adult patients who underwent spinal deformity correction between 2012 and 2020. Comparative analysis and univariate and multivariate Cox regression analyses were employed to identify factors associated with rod fracture.

In this study, rod fracture occurred in 14.5% of patients. The rod fracture group exhibited a larger change in lumbar lordosis (LL), a higher proportion of patients with pre-operatively existing (pre-existing) vertebral fractures, and a greater percentage of patients with a rod diameter of 6 mm or less compared to the non-rod fracture group. Univariate Cox regression analysis revealed that rod fracture was associated with pre-existing vertebral fracture, LL change, preoperative sagittal vertical axis, and preoperative pelvic tilt. Multivariate Cox regression analysis identified pre-existing vertebral fractures and the amount of LL change as independent factors associated with rod fractures.

Pre-existing vertebral fractures and the magnitude of lumbar lordosis correction are independent risk factors for rod fracture following ASD surgery. Surgeons should consider these factors during preoperative planning to reduce the risk of postoperative rod fracture.

IV.

Sports-related (Sr-) sudden cardiac arrest (SCA) is widely recognized in young competitive athletes, yet occurs more frequently in middle-aged, recreational athletes. Our objective was to describe the epidemiology and characteristics of Sr-SCA in 5 Canadian Provinces (population: 10.9 million).

We conducted a retrospective cohort study using emergency medical services records from consecutive out of hospital SCAs, for patients aged 18-85 years, who were treated, and whose SCA was from a presumed cardiac cause, during or ≤ 1 hour after sports activity.

A total of 18,769 SCAs occurred between January 1, 2016 and December 31, 2020, of which 339 (1.8%) were sport-related. Most patients were male (93.8%; 318/339), with an average age of 58.1 ± 14.3 years old. The incidence of Sr-SCA was 1.2 per 100,000 person-years (95% confidence interval [CI], 1.1-1.4). Men had an almost 16-fold greater incidence than women (2.3 [95% CI, 2.1-2.6] vs 0.2 [95% CI, 0.1-0.2] per 100,000 person-years). Sr-SCAs occurred during 52 unique sports. Almost two-thirds occurred in recreational facilities (60.2%; 204/339), with high rates of bystander witnessed (75.6%; 256/339) and bystander cardiopulmonary resuscitation (73.6%; 248/337). Bystanders delivered automated external defibrillator shocks in 121 of 335 (36.1%) cases. Median emergency medical services response time was 6.2 (interquartile range, 4.8-8.9) minutes, with an initial shockable rhythm reported in 76.9% (249/324). More than half of those with known final vital status (52.0%; 167/321) survived to hospital discharge, which varied on the basis of sport.

Sr-SCA occurs infrequently, attracts high rates of bystander intervention, and has high survivability.

The prevalence of chronic kidney disease (CKD) is rising, increasing demand for renal replacement therapy (RRT). Community pharmacies, as accessible healthcare hubs, can play a pivotal role in CKD prevention. This study aimed to develop care models for community pharmacies to optimize medication use, encourage behavior modification, and promote self-management among at-risk individuals.

Conducted between June 2017 and July 2018, this study utilized an action research approach. Microalbuminuria was assessed using urine dipsticks, and pharmacists applied behavioral change and self-management support (SMS) strategies to slow CKD progression. Participants were categorized by albuminuria levels and enrolled in pharmacist-led care programs, with follow-up assessments at weeks 0 and 12.

Of 521 participants screened, 57% tested positive for albuminuria. For these individuals, serum creatinine testing and referrals to primary care were initiated. Self-management behavior assessment (S1) scores significantly improved (p = 0.024). Key factors associated with urine albumin levels included age < 60 years (OR = 0.44), diabetes (OR = 3.69), hypertension (OR = 2.01), BMI < 27.5 kg/m2 (OR = 0.42), eGFR ≥ 60 mL/min/1.73 m2 (OR = 3.34), lower systolic (OR = 0.55) and diastolic blood pressure (OR = 0.34), and fasting plasma glucose < 126 mg/dL (OR = 0.29).

Community pharmacist-led albuminuria screening effectively supports CKD prevention and enhances self-awareness within communities.

The impact of biomass fuel exposure on mental health, along with the associated gender disparities, remains largely unexplored. This study aimed to examine the association between biomass fuel use and depressive symptoms in the population of Oaxaca, Mexico, while also identifying gender differences in this relationship.

This study used data from the 2022 National Health and Nutrition Survey (ENSANUT). Depressive symptoms, the outcome variable, were assessed using the Center for Epidemiologic Studies Depression Scale (CESD). The primary predictor variable was biomass fuel use, with gender, age, and residency stratum included as covariates. First, a binary logistic regression model was developed to estimate the dichotomous variable "depression symptoms". Subsequently, a second binary logistic regression model was constructed to evaluate potential interactions between the covariates and the predictor variable.

The sample included 1.4 million adults from Oaxaca, with a prevalence of depressive symptoms of 15%. Biomass fuel was used by 15.4% of the population. The first logistic regression model showed that women (Odds Ratio (OR): 1.249; 95% CI: 1.235-1.263; p < 0.001), individuals aged 60 years and older compared to the younger population group (OR: 12.192; 95% CI: 12.064-12.321; p < 0.001), those residing in rural areas (OR: 1.245; 95% CI: 1.232-1.259; p < 0.001), and individuals using firewood or charcoal for cooking (OR: 1.674; 95% CI: 1.651-1.697; p < 0.001) had higher odds of depressive symptoms. In the second binary logistic regression model, all associations and OR coefficients retained their direction, although the coefficients underwent a slight adjustment following the introduction of the interaction term, indicating the presence of an interaction.

The study findings suggest a gendered association between biomass fuel exposure and depressive symptoms in the adult population of Oaxaca, with older women and women dwelling in rural areas being the most vulnerable. Interventions aimed at reducing biomass air pollution exposure and strengthening mental health support for women are strongly recommended.

Men's health behaviors influence health outcomes but remain understudied in high-risk occupational groups. This study examines determinants of health behaviors among public safety personnel using Andersen's Behavioral Model.

A cross-sectional study was conducted among 257 male public safety personnel in Kelantan, Malaysia. Participants were selected through simple random sampling. Data were collected using proforma and the validated Malay Health Behavior Inventory-Short Form (MHBI-SF). Multiple logistic regression identified factors associated with poor health behaviors.

Key risk factors for poor health behaviors included reliance on parental influence (AOR: 5.54; 95% CI: 1.74-17.64) and restricted healthcare access during leisure time (AOR: 4.70; 95% CI: 1.43-15.49). Protective factors included peer influence (AOR: 0.19; 95% CI: 0.05-0.71) and transportation support (AOR: 0.22; 95% CI: 0.06-0.79).

Addressing barriers to healthcare access and enhancing social support are critical to promoting healthy behaviors among men in high-risk occupations. Targeted interventions can reduce health disparities and improve outcomes.

Logistic regression is a useful statistical technique commonly used in many fields like healthcare, marketing, or finance to generate insights from binary outcomes (e.g., sick vs. not sick). However, when applying logistic regression to complex survey data, which includes complex sampling designs, specific methodological issues are often overlooked.

The systematic review extensively searched the PubMed and ScienceDirect databases from January 2015 to December 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, focusing primarily on the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). 810 articles met the inclusion criteria and were included in the analysis. When discussing logistic regression, the review considered multiple methodological problems such as the model adequacy assessment, handling dependence of observations, utilization of complex survey design, dealing with missing values, outliers, and more.

Among the selected articles, the DHS database was used the most (96%), with MICS accounting for only 3%, and both DHS and MICS accounting for 1%. Of these, it was found that only 19.7% of the studies employed multilevel mixed-effects logistic regression to account for data dependencies. Model validation techniques were not reported in 94.8% of the studies with limited uses of the bootstrap, jackknife, and other resampling methods. Moreover, sample weights, PSUs, and strata variables were used together in 40.4% of the articles, and 41.7% of the studies did not use any of these variables, which could have produced biased results. Goodness-of-fit assessments were not mentioned in 75.3% of the articles, and the Hosmer-Lemeshow and likelihood ratio test were the most common among those reported. Furthermore, 95.8% of studies did not mention outliers, and only 41.0% of studies corrected for missing information, while only 2.7% applied imputation techniques.

This systematic review highlights important gaps in the use of logistic regression with complex survey data, such as overlooking data dependencies, survey design, and proper validation techniques, along with neglecting outliers, missing data, and goodness-of-fit assessments, all of which point to the need for clearer methodological standards and more thorough reporting to improve the reliability of results. Future research should focus on consistently following these standards to ensure stronger and more dependable findings.

The UN General Assembly recognised the human right to water and sanitation through the sixth SDG in 2010. South Kordofan, a state in southern Sudan, faces WASH challenges due to conflict, geographical factors, and inadequate services, impacting over 600,000 residents. Such conflicts are well known for spreading diseases and disrupting WASH-related practices among displaced individuals.

The study aimed to evaluate the quality and availability of drinking water, as well as sanitation and hygiene practices in rural South Kordofan. It also sought to identify factors affecting community satisfaction with WASH services and to establish a data-driven basis for future interventions addressing these issues.

A cross-sectional study accompanied a medical mission to South Kordofan, selecting 33 villages from South Kordofan based on healthcare, population, and accessibility. Water samples, patient forms and questionnaires were collected using convenient sampling for targeted villages and for attendants of mobile clinics. Laboratory analyses were conducted on water samples. Descriptive statistics, univariate analysis and logistic regression were used to analyse the data. The used level of significance was 0.05.

Out of 784 participants, 60.2% were female. Tube wells/boreholes were the primary water source (68.1%), and most participants (70.9%) lived near their water source (less than 30 min). Dissatisfaction with water services was reported by 56.8%, and satisfaction associated with method of delivery (OR = 0.081, CI = 0.024-0.276)), appearance (OR = 0.299, CI = 0.182-0.489), distance (OR = 0.264, CI = 0.099-0.705), water unavailability (OR = 0.477, CI = 0.297-0.765), and obligation to pay (OR = 0.351, CI = 0.185-0.665). Samples showed high levels of contamination, both microbial and physicochemical. Regarding sanitation, over a third of the participants (41.5%) disposed of children's stool by leaving it outdoors. About 10% of the participants reported having diarrhea during the week before the study. However, about two-thirds of the participants (68.1%) showed good hygienic practices by using soap or detergents for hand washing.

The study revealed inadequate WASH services, high microbial contamination, and poor water treatment practices. Paradoxically, many participants expressed satisfaction with water services. Sanitation issues and open defecation persist, emphasizing the need for comprehensive interventions. All these negative consequences can be attributed to the armed conflict which resulted in poor awareness about the safety of drinking water, what safe water looks like and proper hygiene practices. Moreover, these conflicts led to disruption of the economical status leading to the absence of proper water purification infrastructure.

The postpartum period remains a very important period during which contraceptive needs can be met and a significant reduction of maternal and foetal morbi-mortality achieved. This study aimed to evaluate past contraceptive experience and identify factors associated with the desire for postpartum family planning among women in late pregnancy.

We conducted a cross-sectional survey from September 2020 to December 2021 in four major health facilities of the Nkongsamba Health District, Cameroon, and consecutively included all pregnant women in late pregnancy, who came for antenatal follow-up in these health facilities. Data were collected using a semi-structured interviewer-administered questionnaire. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) for the factors associated with desire for postpartum family planning. Two-tailed p-values < 0.05 were considered statistically significant.

Among the 1074 participants, 41.71% [95% CI: 38.78-44.70] reported a future desire for modern postpartum contraception. The self-reported prevalence of use of modern contraception in the past in the study population was 48.87% [95%CI: 45.86-51.88]. Only 17.64% [95%CI: 14.59-21.16] of women had adopted a modern contraceptive method other than the barrier methods in the past. Among pregnant women who had used modern contraception in the past, 11.50% [95%CI: 9.02-14.55] reported to have had their modern contraceptive experience with long-acting reversible contraceptives (LARCs). The prevalence of unintended pregnancy (current pregnancy) was 40.04% [37.15-43.00], with 11.55% being unwanted, and 28.49% mistimed. Compared to their respective counterparts, participants ≤ 30 years old (AOR = 0.71[0.52-0.99]), with monthly revenue below 100 thousand FCFA (AOR = 0.45[0.32-0.62]), who were single (AOR = 0.38[0.27-0.54]), had lower odds for desire of postpartum family planning. In contrast, women who were Christians (AOR = 2.13[1.27-3.58]), with a history of use of modern contraception before conception (AOR = 2.80[2.02-3.90]), and had a current unintended term pregnancy had higher odds of desiring postpartum contraception (AOR = 2.91[2.13-3.99]).

The desire for postpartum family planning is still low among pregnant women. This desire for postpartum family planning depends on sociodemographic factors and past contraceptive practices.

Intimate partner violence (IPV) is the most common form of violence, presenting a significant public health concern, especially for women and girls. Help-seeking can reduce future IPV and mitigate adverse health outcomes, including mental health issues.

This study is the first national assessment on IPV, mental health consequences, and associated help-seeking behaviors in Nepal.

A cross-sectional descriptive study.

Using secondary data from the 2022 Nepal Demographic and Health Survey, this study includes 5178 women aged 15-49 and employs multivariate regression analysis to explore the association between IPV and mental health problems, as well as factors influencing help-seeking behavior for both issues.

Among participants, 31.4% reported ever experiencing IPV, and most (29.4% of all women) in the past 12 months. Of those ever experiencing IPV, 72.0% had not sought help for IPV, and 92.2% of those who did, opted for informal support. A total of 27.6% (n = 1427) of female interviewees reported anxiety symptoms, 21.5% (n = 1110) depressive symptoms, and 7.1% (n = 368) suicidal ideation within the past 2 weeks. These rates were higher among women who had experienced IPV in the past 12 months, with 41.1% reporting anxiety, 33.2% depression symptoms, and 14.1% suicidal ideation. Of the 4194 respondents with symptoms of anxiety, depression, or suicidal ideation who were asked about help-seeking for mental health issues, 19.4% (n = 812) had sought help, primarily from informal sources (93.4%, n = 759). Emotional IPV in the past 12 months increased the odds of anxiety (adjusted odds ratio (aOR) 3.00, 95% confidence interval (CI) 2.08-4.31), depression (aOR 3.09, 95% CI 2.19-4.37), and suicidal ideation (aOR 1.91, 95% CI 1.20-3.04). Sexual IPV increased the odds of anxiety (aOR 2.88, 95% CI 1.67-4.95) and depression (aOR 2.12, 95% CI 1.32-3.41), while controlling behavior heightened the odds of depression (aOR 2.42, 95% CI 2.02-2.89) and suicidal ideation (aOR 2.24, 95% CI 1.25-4.02).

This nationwide study reveals a high prevalence of IPV and related mental health problems among women in Nepal and a low rate of help-seeking behavior, in particular to formal support structures. Stronger health system responses and empowering informal support are essential to improve referrals and raise awareness for violence survivors.

Schwannoma (SCH) and meningiomas (MEN) are the two most common primary spinal cord tumors. Differentiating between them preoperatively remains a clinical challenge due to the substantial overlap in their clinical presentation and imaging characteristics.

The objective of this study is to facilitate early diagnosis of patients and reduce clinician stress by constructing a deep learning-based classification model for automatic diagnosis of schwannoma and meningiomas using magnetic resonance images (MRI).

We retrospectively collected MRI images of 74 patients with pathologically confirmed schwannoma and meningiomas from 2015 to 2020 at a local hosipital, and constructed a CNN model based on the PyTorch's deep learning framework for the discrimination between the two. First, a modified feature fusion CNN model (ResNet34-SKConv) was trained by introducing a selective convolutional kernel module into the original CNN model. The introduction of the selective convolutional kernel module enhances the network's focus on tumor features and effectively improves the network's performance. Finally, the trained model was used to process all the MRI image slices to achieve the classification of SCH and MEN patients by the voting prediction method.

Using the 5-fold cross-validation method, this new ResNet34-SKConv model achieves a classification accuracy of 92.32%, a specificity of 95.87%, and a F1-score of 93.54, respectively.

This study demonstrated that a classification model using a deep learning network can be effective in achieving differential diagnosis of SCH and MEN. Thus, the new method has great potential for developing new computer-aided diagnosis and applications with future clinical practice.

We evaluated the efficacy of a booster dose of HBV in Italian medical students. We conducted a prospective observational study in students who had received a full course of anti-HBV vaccination for at least 15 y. Those with an anti-HBs titer <10 mIU/mL were offered a booster dose of the HBV vaccine and the antibody titer was reevaluated after 1 month. The participants were classified into three categories: with anti-HBs titer >100 mIU/mL, between 10 and 100 mIU/mL and <10 mIU/mL. The study population was n. 625 medical student and 355 (56.8%) with anti HBs titer <10 mIU/mL were offered a booster dose. A total of 166 of them received the booster dose and 92.77% (38 + 116/166) achieved an anti-HBs titer ≥10 mIU/mL. The post-booster anti-HBs titer response was higher, i.e. >100 mIU/mL, in subjects who had a pre-booster anti-HBs titer between 1.00 and 9.99 mIU/mL (84.38%, 81/96), compared to those with titer <1 mIU/mL (50.00%, 35/70). Subjects with a titer <1.00 mIU/mL at enrollment showed no anamnestic response (post-booster anti-HBs <10 mIU/mL, RRR 0.23, 95% CI 0.06-0.84) and to a low anamnestic response (post-booster anti-HBs 10-100 mIU/mL, RRR 0.16, 95% CI 0.07-0.38). Physical activity was linked to a better antibody response to vaccination (post-booster anti-HBs 10-100 mIU/mL: RRR 2.39, 95% CI 1.05-5.59). Immune protection following primary vaccination against HBV tends to wane over time. Booster dose induces anamnestic responses, especially in individuals who maintain titer HBsAg >1 mIU/mL and do physical activity.

Gestational Diabetes Mellitus (GDM) affects between 2 and 10% of pregnancies in the United States, with trends of increasing prevalence and a significant amount of variability across race and ethnicity, maternal age, and insurance status. Asian and Native Hawaiian or Other Pacific Islanders (NHOPI) have been documented to have a higher prevalence and risk of developing GDM compared to non-Hispanic white populations and have been under-studied in health disparities research.

Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2022 surveys, we conducted analyses for the overall PRAMS sample as well as within-group analyses among participants who identify as Asian and NHOPI to identify risk factors for GDM. Descriptive statistics were also collected in the Asian and NHOPI subsample, stratified by Asian and NHOPI ethnicity. Bivariate analyses were performed to explore the relationship between potential GDM risk factors among the overall analytic sample and within the Asian and NHOPI subsample, and multivariable logistic regression was used to investigate potential predictors of GDM.

Asian and NHOPI ethnicities differed by prevalence of GDM at 17.2%, 19.56%, 10.8%, 10.71%, and 18.49% for Chinese, Filipino, Japanese, Native Hawaiian/Other Pacific Islander, and Other Asian, respectively. Compared to White individuals (reference group), the odds of GDM were higher for Asian and Native Hawaiian/Other Pacific Islander individuals in the adjusted model (adjusted odds ratio (aOR) = 2.19, 95% CI: 2.62-2.9). Native mothers also demonstrated significantly elevated odds (aOR = 1.48, 95% CI: 1.4-1.6), while Mixed-race individuals exhibited slightly increased odds (OR = 1.22, 95% CI: 1.14-1.29). The findings revealed notable variability in GDM risk factors across ANHOPI subgroups. Obesity emerged as a consistent and strong predictor of GDM across all groups, while other factors such as interpersonal violence exposure and prenatal depression demonstrated limited or subgroup specific effects.

This analysis of 2016 to 2022 PRAMS data illustrated significant variations of GDM predictors between the general population and the Asian and NHOPI population, as well as differences between Asian and NHOPI ethnicities.

Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through rehabilitation or opioid substitution treatment (OST) in Lebanon. Furthermore, we investigated the effect of each treatment modality on the MS; Methods: This was a cross-sectional study, in which demographics and treatment-related, nutritional, and biochemical data of the participants were collected. MS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Descriptive statistics were presented, and bivariate and multivariate analyses were conducted; Results: A total of 155 male subjects with the following characteristics were included: OST: n = 80; rehabilitation: n = 75; mean age: 32.53 ± 8.39 years; mean body mass index (BMI): 27.41 ± 4.99 Kg/m2; mean duration of treatment: 18 months. More than half of the sample had low HDL-C (56.8%) and/or elevated blood pressure (51.6%), 42.9% had elevated WC, 21.9% had elevated TG, and 12.3% had elevated FBS. Furthermore, 7.2% of the sample had no components of the MS, 29.2% had one component, 40.9% had two components, 16.9% had three components, and 5.8% had four components. MS was identified in 22.7% of the sample. Higher age was associated with higher odds of being diagnosed with MS (OR = 1.072; 95% CI: 1.021-1.126), whereas higher duration of current treatment was associated with lower odds (OR = 0.969; 95% CI: 0.944-0.995); Conclusions: MS and its components are prevalent in PWUD undergoing treatment for recovery. Routine screening and preventive measures are essential to prevent metabolic syndrome, particularly among older people and treatment newcomers.

Physical therapists, because of their care work, are susceptible to work-related musculoskeletal disorders due to their caregiving duties. These disorders have a significant economic and social impact. Objectives: To analyze the prevalence of work-related musculoskeletal disorders among physical therapists and their associated factors. Methods: A cross-sectional design study was conducted among physical therapists who were working in the Community of Madrid. An online questionnaire was used and distributed through the professional association. This questionnaire included sociodemographic and occupational variables as well as the Standardized Nordic Questionnaire, specifically designed for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context. Data were analyzed using multivariate logistic regression models. Results: 212 questionnaires were analyzed. 98.1% reported a musculoskeletal problem in the past 12 months. The most affected regions were the neck (85.4%), upper back (59.4%), lower back (73.1%), shoulder (53.8%), and wrist and hand (63.2%). Neck disorders were associated with women (AOR = 2.41; 95%CI = 1.20-4.82); shoulder disorders with women (AOR = 7.79; 95%CI = 1.02-56.64) and older age (AOR = 1.06; 95%CI = 1.01-1.11); lower back disorders with women (AOR = 3.86; 95%CI = 1.11-13.49), a four-year bachelor's degree (AOR = 3.56; 95%CI = 1.09-11.62), treating trauma patients (AOR = 0.13; 95%CI = 0.02-0.62), and using manual therapy (AOR = 0.34; 95%CI = 0.15-0.78). Conclusions: 98.1% of the physical therapists reported musculoskeletal symptoms in the past 12 months. Several variables were associated with musculoskeletal disorders: gender, level of education, age, and type of patient and treatment. Further research is needed to identify preventive measures that can reduce the high prevalence of musculoskeletal problems among physical therapists.

Retrospective observational study.

This study analyzes the epidemiology of pediatric Le Fort fractures and assesses the incidence of concomitant injuries and acute-level hospital course using the largest, national pediatric trauma database to date.

Pediatric midface and Le Fort fractures from 2016-2019 were identified in the National Trauma Data Bank. Descriptive analyses of Le Fort compared to non-Le Fort midface fractures were performed. Multivariable regression assessed whether Le Fort fractures were risk factors for ICU admission, intracranial injury, cervical spine (C-spine) fracture, tracheostomy, and mortality.

A total of 1489 patients with Le Fort fractures were identified. There were 520 Le Fort I, 632 Le Fort II, and 609 Le Fort III fractures. Fracture incidence increased with age. Le Fort fractures showed higher rates of concomitant intracranial injury (P < 0.001), ICU admission (P < 0.001), C-spine fracture (P < 0.001), and tracheostomy (P < 0.001). Incidence of all the above increased with higher-grade Le Fort fractures. Le Fort III fractures had higher rates of mortality than non-Le Fort midface fractures (7.6% vs 3.2%). Multivariable regression showed that all Le Fort patterns were independent risk factors for tracheostomy and ICU admission, but only Le Fort I for C-spine fractures.

The incidence of Le Fort fractures appears to increase with age. Higher category Le Fort fractures are associated with greater morbidity.

In the United States, suicide is a leading cause of death in prisons and jails, with incarcerated individuals being nine times more likely to die by suicide than the general population. Identifying vulnerabilities at each stage of custody (prebooking, jail, prison) and factors that increase suicide risk can improve prevention efforts. A hierarchical binary logistic regression was conducted on data from the Texas Justice Initiative's Deaths in Custody Report. Variables included race/ethnicity, sex, age at death, days in custody, classification of crime as violent or nonviolent, and custody type of prebooking, jail, or prison. Among main effects, when compared to suicide rates in prison, jail suicide deaths were over three and a half times more likely (OR = 3.61), and the period of prebooking emerged as a period of staggering risk of suicide death, with suicides being over 5,000% more likely than at other stages of custody (OR = 50.86). When interactions were entered, Latinx individuals were at a particularly increased risk of suicide death (OR = 10.46), likelihood of suicide death decreased with each year of age (OR = .89), nonviolent offenders were just under three and a half times more likely to die by suicide when compared to violent offenders (OR = 3.45), and each stage of custody was shown to affect the relationship between age-related rates of suicide in different ways. Results call for further investigation into suicide among understudied populations in corrections, such as Latinx individuals, juveniles in the prison system, and nonviolent offenders, to identify the groups at the highest risk of premature death in correctional systems.

Whilst the dominant temporal lobe has a well-established role in memory, the functions of its nondominant counterpart remain enigmatic. We compared the lateralizing ability of a promising spatial memory task (Brown Location Test, BLT) to other commonly used verbal and visual memory tasks in a sample of patients with unilateral temporal lobe epilepsy (TLE).

Neuropsychological data from 48 TLE patients (right n = 28 and left n = 20) were compared on several verbal and nonverbal memory tasks. Univariate logistic regression analyses were used to examine the relationship between test scores and the odds of being categorised as right or left TLE, while multivariable logistic regression and decision tree analyses were used to establish the optimal combination of cognitive measures for lateralizing the epileptogenic zone (EZ).

Relative to normative expectations, the right TLE group was specifically impaired on BLT measures, whereas the left TLE group was impaired on verbal and nonverbal memory tasks. The combination of BLT Delayed Recall and Delayed Recall on the Rey Auditory Verbal Learning Task (RAVLT) was identified as optimal for correctly predicting EZ laterality (AUC = 0.79). These two variables were also optimal predictors in the decision tree analysis, correctly predicting 79% of the overall sample (AUC = 0.83).

Our findings support the BLT as a measure of right temporal lobe function. They demonstrate its superior sensitivity compared to another commonly used nonverbal memory test (i.e., Visual Reproduction; VR) and highlight the added lateralizing value of combining both verbal and nonverbal memory measures in the neuropsychological evaluation of epilepsy surgery candidates.

Unintentional injuries are a leading cause of hospitalisation for children. This study investigated the incidence and associated risk factors for unintentional injury hospitalisation (UIH) among Aboriginal and non-Aboriginal children aged under 5 years in Australia's Northern Territory.

This was a retrospective cohort study using linked data from a perinatal register, hospital admissions, school enrolment and child protection services. The outcome variable was a first UIH. Potential risk factors included gender, pregnancy and birth outcomes, maternal education level, child protection service contact and geographic remoteness. Modified Poisson regression was used for multivariate modelling.

A cohort of 21,189 children (54.0% Aboriginal) born between 2000 and 2010 were followed to the age of 5 years. The overall incidence of first UIH was 25.8 per 1,000 person-years, which was 28.6% higher among Aboriginal than non-Aboriginal children (28.8 and 22.4 per 1000 person-years, respectively). Risk factors identified in the full model included: being male (incidence rate ratio (IRR) 1.26, 95%CI: 1.17-1.36); living in a remote (IRR 1.26, 95%CI: 1.14-1.40) or very remote area (IRR 1.44, 95%CI: 1.29-1.59); having a notification or substantiated notification for abuse (IRR 1.42, 95%CI: 1.27-1.58 and IRR 1.60, 95%CI: 1.41-1.82, respectively); or neglect (IRR 1.32, 95%CI: 1.17-1.48 and IRR 1.28, 95%CI: 1.11-1.47, respectively). After adjustment, there was no difference in UIH rates between Aboriginal and non-Aboriginal children. In both stratified models, being male, living in remote or very remote areas and having a notification or substantiated notification for child maltreatment were identified as risk factors.

Our study found high UIH incidence rates and evidence for an association between UIH and child maltreatment. This suggests child maltreatment and UIH have shared determinants and points to the need for clinicians to be aware of the overlap between these conditions and the importance of cross-agency collaboration in prevention and management.

To date, surveillance of vaping among Canadians (using vaping products with or without nicotine) has largely been examined with respect to age and smoking status. However, a nationally representative examination of a broad set of characteristics is lacking. This study characterized Canadians aged 15 years and older who vape, stratified by smoking status.

Data from the 2020 Canadian Community Health Survey (unweighted analytical sample size: 28 413 respondents) were used to examine past-30-day vaping stratified by smoking status (current smoking, former smoking, and never/nonsmoking). A Sexand Gender-Based Analysis Plus approach was used to select individual-level characteristics for analysis. Descriptive statistics were used to examine outcomes by each characteristic and multivariable logistic regression models were constructed to identify significant factors associated with each past-30-day vaping by smoking status category, using weighted data.

In 2020, 2.0% (605 000) of Canadians aged 15 years and older reported vaping and current smoking (dual use), 1.2% (372 000) reported vaping and former smoking and 1.1% (352 000) reported vaping and never/nonsmoking. Within each past-30-day vaping by smoking status category, certain subgroups presented higher risks: youth and young adults, men, and those having a mood and/or anxiety disorder had higher odds of dual use. Vaping and former smoking was associated with self-identification as a man, having a mood and/or anxiety disorder and provincial region. Youth and young adults, men and those identifying as not a visible minority had higher odds of vaping and never/nonsmoking.

This analysis of Canadians who vape, stratified by smoking status, identifies high-prevalence subpopulations and informs us of the composition of vaping populations by select characteristics, deepening our understanding of Canadians who engage in vaping behaviours.

This article describes the sociodemographic characteristics of internationally educated nurses since the change in the registration examination in 2015. It aims to investigate the association between internationally educated nurses' sociodemographic characteristics and their successful integration into the nursing workforce in Canada.

Cross-sectional and secondary data survey questions.

This study adopts a cross-sectional and secondary data analysis, utilising data from IENs who engaged with internationally educated nurse initiatives such as the Creating Access to Regulated Employment Centre for Internationally Educated Nurses (CARE) or initiated the registration process with the College of Nurses of Ontario (CNO) in 2015 and after.

There were 259 participants, with 155 participants from primary data collection and 104 participants from secondary data sources. Quantitative analysis reveals that most participants are females, under 40 years old, educated in English and hold at least a bachelor's degree in nursing, with 47.3% of internationally educated nurses migrated from India and the Philippines. Significant associations were identified between internationally educated nurses having CARE membership and the currency of nursing practice and their successful outcomes.

Recognising and addressing the unique needs of IENs is essential for their successful integration into the Canadian healthcare workforce, thereby ensuring resilience and cultural competence in nursing for the future.

This analysis highlights the impact of sociodemographic characteristics of internationally educated nurses on their successful outcomes and underscores the diversity and richness they bring to the healthcare landscape. Since internationally educated nurses continue to experience challenges while integrating into the Canadian nursing workforce, these findings have substantial implications for nursing policy, practice, professional development and research.

Dengue poses a significant global public health challenge, including in Nepal. Understanding community's knowledge, attitudes, and behaviors concerning dengue fever is imperative to developing effective prevention and control strategies. This study aimed to assess the knowledge, attitude, and practices related to dengue fever among residents of Lalitpur Metropolitan City.

A descriptive cross-sectional household study was conducted using a mixed-method approach, which included quantitatively studying 636 individuals and conducting 20 qualitative interviews. The data was collected between April 2023 and June 2023. The multistage cluster sampling method was applied for household selection during the quantitative study and a purposive judgmental sampling method was used to identify participants for the qualitative interviews. Face-to-face interviews were conducted using a structured questionnaire for the quantitative study and an interview guide for the qualitative study. Quantitative data were analysed using logistic regression in STATA version 13, and thematic analysis was applied to the qualitative data. The findings were validated through triangulation of results from both the qualitative and quantitative study.

Regarding knowledge, 64.94% (n = 413/636) reported being informed about dengue fever. In terms of attitude, a substantial majority, 91.51% (n = 582/636), expressed a positive attitudes toward dengue fever, indicating a favorable perception and knowledge of its significance. Concerning practice, 49.84% (n = 317/636) of respondents reported actively engaging in dengue fever prevention measures. The variables gender, previous history of dengue fever and residency were the determinants of dengue fever knowledge. Additionally, gender, residency, and attitude were predictors of preventive practices concerning dengue fever.

Our study revealed that while the community demonstrated good knowledge of dengue fever and positive attitudes toward prevention, their preventive practices were inconsistent, indicating a gap between knowledge and action. A positive attitude was linked to better adherence to preventive measures. To address this gap, it is crucial to promote a positive attitude toward dengue prevention through initiatives like education efforts and social mobilization programs. Implementing Social and Behavior Change Communication (SBCC) programs focused on dengue prevention and control measures can help bridge this knowledge-action gap.

To assess factors associated with the risk of severe disease in children aged 5 years or younger with laboratory-confirmed respiratory syncytial virus (RSV) infection.

We conducted a nationwide retrospective cohort study in Mexico.

Eligible participants included children aged 5 years or younger with laboratory-confirmed RSV infection January 1, 2023, and May 15, 2024. We collected relevant clinical and epidemiological data. Risk ratios (RR) and 95% confidence intervals (CI) were employed to identify factors associated with the risk of severe disease, characterized by clinical and radiographic evidence of bronchiolitis or pneumonia requiring hospital admission.

Data from 2022 children were analyzed and the overall risk of severe disease was 21.0% (n = 424/2022). In multiple generalized linear regression analysis, a personal history of immunosuppression (due to any cause) showed a protective effect (RR = 0.14, 95% CI 0.05-0.42, P = 0.001) against severe RSV disease, while an increased risk was documented for each additional day elapsed between the date of symptom onset and the date of seeking healthcare RR = 1.06, 95% CI 1.02-1.10, P = 0.004).

These findings provide insights into risk stratification and suggest specific directions for future research. This information informs the development of targeted intervention strategies to mitigate the impact of RSV infections in this vulnerable population.

Ambient air pollution exposure increases the incidence and severity of pediatric asthma. Despite this, we lack effective therapies to protect patients from the impact of ambient air pollution exposure. A roadblock is the inability to identify patients that are affected by air pollution.

To examine the association between AAP sensitivity determined by individual exposure prior to asthma exacerbations and the severity of asthma in pediatric patients.

We assess the association between spikes in ambient air pollution and asthma exacerbations. Patients were considered sensitive to a specific pollutant if they experienced an asthma exacerbation immediately following a spike in the concentration of that pollutant. Cut off values for these spikes were determined as two standard deviations above the mean concentration two weeks prior and two weeks post the days leading up to an asthma exacerbation.

We included 8129 pediatric patients with over 34,346 associated asthma exacerbations. In a multinomial log-linear logistic regression model comparing patients with mild asthma to patients with moderate or severe asthma, sensitivity to Ozone, SO2, PM2.5 and PM10 was significantly associated to severe as opposed to mild asthma (OR 1.39 with CI 1.08-1.78, 1.58 with CI 1.12-2.23, 1.37 with CI 1.07-1.76, and 1.63 with CI 1.12-2.37 respectively). Furthermore, moderate as opposed to mild asthma was significantly associated with sensitivity to SO2 and PM2.5 (OR 1.24 with CI 1.06-1.44 and 1.26 with CI 1.12-1.43, respectively).

There is a subpopulation of pediatric asthma patients that experience asthma exacerbations just following spikes in ambient air pollution. This subgroup of patients has more severe asthma despite correction for significant confounders. The presented work is the first to reveal the clinically significant impact of variation in ambient air pollution sensitivity in pediatric asthma, highlighting the importance of accounting for variable sensitivity in the study of the effects of ambient air pollution exposure on pediatric asthma.

Despite the importance of timing of nerve surgery after peripheral nerve injury, optimal timing of intervention has not been clearly delineated. The goal of this study is to explore factors that may have a significant impact on clinical outcomes of severe peripheral nerve injury that requires reconstruction with nerve transfer or graft.

Adult patients who underwent peripheral nerve transfer or grafting in Alberta were reviewed. Clustered multivariable logistic regression analysis was used to examine the association of time to surgery, type of nerve repair, and patient characteristics on strength outcomes. Cox proportional hazard regression analysis model was used to examine factors correlated with increased time to surgery.

Of the 163 patients identified, the median time to surgery was 212 days. For every week of delay, the adjusted odds of achieving Medical Research Council strength grade ≥ 3 decreases by 3%. An increase in preinjury comorbidities was associated with longer overall time to surgery (aHR 0.84, 95% CI 0.74-0.95). Referrals made by surgeons were associated with a shorter time to surgery compared to general practitioners (aHR 1.87, 95% CI 1.14-3.06). In patients treated with nerve transfer, the adjusted odds of achieving antigravity strength was 388% compared to nerve grafting; while the adjusted odds decreased by 65% if the injury sustained had a pre-ganglionic injury component.

Mitigating delays in surgical intervention is crucial to optimizing outcomes. The nature of initial nerve injury and surgical reconstructive techniques are additional important factors that impact postoperative outcomes.

Comfort-focused nutrition orders are recommended to manage eating changes among long-term care (LTC) residents nearing the end of life, though little is known about their current use. This investigation aims to describe current practices and identify resident-level and time-dependent factors associated with comfort-focused nutrition orders in this context.

Data were retrospectively extracted from resident charts of decedents (≥65 years at death, admitted ≥6 months) in 18 LTC homes from two sampling frames across southern Ontario, Canada. Observations occurred at 6 months (baseline), 3 months, 1 month and 2 weeks prior to death. Extracted data included functional measures (e.g. cognitive performance, health instability) at baseline, formalised restorative and comfort-focused nutrition care interventions at each timepoint and eating changes reported in the progress notes in 2 weeks following each timepoint. Logistic regression and time-varying logistic regression models determined resident-level (e.g. functional characteristics) and time-dependent factors (e.g. eating changes) associated with receiving a comfort-focused nutrition order.

Less than one-third (30.5%; n = 50) of 164 participants (61.0% female; mean age = 88.3 ± 7.5 years) received a comfort-focused nutrition order, whereas most (99%) received at least one restorative nutrition intervention to support oral food intake. Discontinuation of nutrition interventions was rare (8.5%). Comfort orders were more likely with health instability (OR [95% CI] = 4.35 [1.49, 13.76]), within 2 weeks of death (OR = 5.50 [1.70, 17.11]), when an end-of-life conversation had occurred since the previous timepoint (OR = 5.66 [2.83, 11.33]), with discontinued nutrition interventions (OR = 6.31 [1.75, 22.72]), with co-occurrence of other care plan modifications (OR = 1.48 [1.10, 1.98]) and with a greater number of eating changes (OR = 1.19 [1.02, 1.38]), especially dysphagia (OR = 2.59 [1.09, 6.17]), at the preceding timepoint.

Comfort-focused nutrition orders were initiated for less than one-third of decedents and most often in the end stages of life, possibly representing missed opportunities to support the quality of life for this vulnerable population. An increase in eating changes, including new dysphagia, may signal a need for proactive end-of-life conversations involving comfort nutrition care options.

Early and open conversations with residents and family about potential eating changes and comfort-focused nutrition care options should be encouraged and planned for among geriatric nursing teams working in LTC. These conversations may be beneficial even as early as resident admission to the home.

The aim of this study is to evaluate the ability of infrared wavenumber of calculus to predict postoperative infection in patients with upper urinary tract calculus (UUTC), and to establish a predictive model based on this. From March 2018 to March 2023, 480 UUTC patients from Fujian Provincial Hospital were included in this study. The infrared-wavenumbers related infection score (IR-infection score) was constructed by univariate analysis, multicollinearity screening, and Lasso analysis to predict postoperative infection. Continually, the Delong test was used to compare the predictive power between the IR-infection score and traditional indicators. Afterward, we performed urine metagene sequencing and stone culture to prove the correlation between calculus toxicity and IR-infection score. Finally, logistic regression was used to build a nomogram. IR-infection score composed of four independent wavenumbers could precisely predict postoperative infection (AUCvalidation cohort = 0.707) and sepsis (AUCvalidation cohort = 0.824). IR-infection score had better predictive ability than commonly used clinical indicators. Moreover, metagenomics sequencing and calculus culture confirmed the correlation between IR-infection score and calculus toxicity (all P < 0.05). The nomogram based on the IR-infection score had high predictive power (all AUCs > 0.803). Our study first developed a novel infrared spectroscopy marker and nomogram, which can help urologists better predict postoperative infection in UUTC patients.

HIV testing is an important component of HIV prevention and serves as a gateway to other HIV-related services. However, the uptake remains suboptimal among young people, particularly in highly prevalent settings such as Papua New Guinea (PNG). This study aimed to assess the prevalence and determine the predictors of HIV testing uptake among young men aged 15-24 years in PNG.

The 2016-2018 PNG Demographic and Health Survey (DHS) data was used. A total of 1,275 young men aged 15-24 years were included in the final analysis. Descriptive, bivariate, and multivariable logistic regression analyses were performed to determine independent predictors of HIV testing. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. All analyses were adjusted using survey weights to account for unequal sampling probabilities.

The overall prevalence of HIV testing among young men was 17.1% (95% CI: 15-19). Of those who were tested for HIV, about one-third (32.9%) had experienced a sexual debut at age <15 years, and 33.9% inconsistently used condoms during sex. In multivariable analysis, men aged 20-24 years (AOR 1.18, 95% CI: 1.00-2.31), who owned mobile phones (AOR 1.43, 95% CI: 1.00-2.55), who were aware that consistent condom use during sex can reduce HIV risk (AOR 2.18, 95% CI: 1.18-4.04), who had paid for sex (AOR 1.75, 95% CI: 1.01-5.83), and who had two or more sexual partners (AOR 1.37, 95% CI: 1.01-3.14) had increased odds of HIV testing. However, decreased odds of HIV testing were found among men who were never married (AOR 0.51, 95% CI: 0.29-0.88), lived in rural areas (AOR 0.54, 95% CI: 0.32-0.92), and consistently used condoms during sex (AOR 0.59, 95% CI: 0.34-1.01).

The findings show that HIV testing is low among young men in PNG. To increase HIV testing uptake among young men, it is crucial to implement comprehensive youth-friendly HIV/STI education and tailored sensitization programs and enable more accessible and affordable HIV testing services. Also, outreach and community-based testing programs for young men in rural and prioritized areas requiring urgent prevention interventions are feasible options in PNG.

Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services.

To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs.

A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables.

Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001).

Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.

We evaluated the association of hepatitis B virus (HBV) treatment with all-cause, and liver-related mortality among individuals with HBV and cirrhosis in British Columbia (BC), Canada.

This analysis included people diagnosed with HBV and had cirrhosis in the BC Hepatitis Testers Cohort, including data on all individuals diagnosed with HBV from 1990 to 2015 in BC and integrated with healthcare administrative data. We followed people with cirrhosis from the first cirrhosis diagnosis date until death or December 31, 2020. We compared all-cause and liver related mortality between those who received treatment and those who did not. HBV treatment was considered a time-varying variable. We performed multivariable Cox proportional hazards model and competing risk regression models to assess the association of HBV treatment with all causes, and liver-related mortality respectively using inverse probability of treatment weighted population.

Among 4962 individuals with HBV and cirrhosis, 48.1% received HBV treatment. Treated individuals had a median follow-up of 2.97 years, compared to 2.87 years for untreated individuals. The treated group was older (median age 57 vs 54 years), had higher proportion of treated of males [1802 (75.50%) vs 1766 (68.8%)], from urban area [2318 (97.2%) vs 2355 (91.8%)], and from East and South Asian ethnicity [1506 (63.1%) vs 709 (27.5%)] compared to untreated group. Untreated people experienced higher all-cause mortality (115.47 vs. 35.72 per 1000 person-years) and liver-related mortality (49.86 vs. 11.39 per 1000 person-years). Multivariable models showed that HBV treatment significantly lowered the risk of all-cause mortality (adjusted hazard ratio (aHR) 0.74; 95% CI: 0.65, 0.84) and liver-related mortality (adjusted subdistribution hazard ratio (asHR) 0.72; 95% CI: 0.58, 0.89) compared to untreated individuals. Among untreated individuals with HBV, those with HCV coinfection had a higher risk of both all-cause and liver-related mortality (aHR 1.57; 95% CI: 1.22, 2.04, and asHR 1.60; 95% CI: 1.25, 2.05, respectively).

HBV treatment was associated with a significant reduction in all-cause and liver-related mortality among individuals with cirrhosis. The findings highlight the need for treatment among individuals with HBV related cirrhosis especially those with coinfection with hepatitis C virus.

This work was supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research (CIHR) [Grant # NHC-142832, PJT-156066, and SC1 -178736]. JDM has received doctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). DJ has received Doctoral Research Award (#201910DF1-435705-64343) from the Canadian Institutes of Health Research (CIHR) and doctoral fellowship from the CanHepC. CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (CIHR) (NHC-142832) and the Public Health Agency of Canada (PHAC).

Metabolic syndrome increases the risk of heart disease and diabetes. Early identification and management are crucial, especially in economically challenged regions with limited healthcare access.

To develop nomograms for individualized risk estimation for metabolic syndrome in young people from low-income regions.

We assessed 496 college students from two Brazilian cities with Gini indices ≤0.56. Of these, 69.9% were female, 65.1% were younger than 20 years, 71.8% were non-white, and 64.3% were enrolled in health-related courses. For external validity, we assessed metabolic syndrome in a subset of 375 students.

We found 10 variables associated with abdominal obesity by logistic regression: age, biological sex, physical education facilities, enrollment in sports competitions during elementary school, grade retention, physical education as the preferred subject, physical education classes per week, and enrollment in sports training in secondary school (score A); adherence to 24 h movement behaviors (B score); and body weight (score C). We designed three nomograms (for scores A, B, and C), all of which showed acceptable performance according to the area under the receiver operating characteristic curve (≥0.70) and calibration (Hosmer-Lemeshow test, p > 0.05). In the external validation, we observed higher predictive capability for the A and B scores, while the C score had lower but still acceptable predictive ability.

User-friendly self-reported data accurately predict metabolic syndrome among youths from economically challenging areas.

Corona virus disease 2019 (COVID-19) is an extremely contagious viral infection caused by the severe acute respiratory syndrome coronavirus 2. Understanding the willingness of the community to receive the COVID-19 vaccine will help in the development and implementation of effective COVID-19 vaccination promotion programs. Therefore, we aimed to assess the level of COVID-19 vaccine acceptance and associated factors among residents of Dire Dawa Administration, Eastern Ethiopia.

A community-based cross-sectional study was conducted among 840 residents in Dire Dawa Administration from May 18th to June 18th, 2021. Multistage cluster sampling followed by systematic random sampling was used to select respondents. A pretested interviewer-administered structured questionnaire was used to collect the data from respondents. Bivariable and multivariable logistic regression were used to identify predictors of COVID-19 vaccine acceptance. The odds ratio (OR), along with a 95% confidence interval (CI), was used to estimate the strength of the association.

Out of 840 respondents recruited, the proportion of COVID-19 vaccine acceptance was found to be 54.4% (457/840); (95% CI: 51.0%, 57.7%) Being male [AOR = 1.85, 95% CI: (1.35, 2.54), P < 0.001], not having a current habit of substance use [AOR = 2.38, 95% CI: (1.73, 3.26), P < 0.001], having a monthly income of less than 51.31 USD [AOR = 0.19, 95% CI: (0.04, 0.88), P = 0.001]; and not having a prior history of vaccination experience [AOR = 0.40, 95% CI: (0.29, 0.54), P < 0.001] were significantly associated with COVID-19 vaccine acceptance.

This study reveals that the proportion of COVID-19 vaccine acceptance among residents of Dire Dawa Administration, Eastern Ethiopia, was 54.4%. Factors like being male and not having a current habit of substance use were positively associated, whereas having a monthly income of less than 51.31 USD and not having a prior history of vaccination experience were negatively associated with COVID-19 vaccine acceptance. Health information dissemination and economic empowerment are crucial to improving COVID-19 vaccine acceptance among the community. This study provides valuable data for policymakers to plan early vaccination programs and tackle the challenges identified in the study.

The pediatric craniofacial trauma literature is limited to single institutions or short study periods. Herein, this study analyzes a national database over 10 years to delineate the epidemiology of pediatric craniofacial fractures and to identify risk factors for acute-level hospital course in the largest series to date.

Utilizing the National Trauma Data Bank, pediatric craniofacial fractures admitted between 2010 and 2019 were identified. Descriptive analyses and multivariable regression were performed to identify risk factors for acute-level hospital course.

A total of 155,136 pediatric craniofacial fracture cases were reviewed, including cranial vault (49.0%), nasal (22.4%), midface (21.0%), mandibular (20.2%), and orbital floor fractures (13.7%). Midface and orbital floor fractures occurred commonly as multicraniofacial fractures. Cranial vault fractures were the most common among all age groups, but frequency declined with age. In contrast, facial fractures increased with age. Despite the inherent complexity of multicraniofacial trauma, isolated fractures remained a concern for acute-level hospital course.Cranial vault and midface fractures had an increased risk of intracranial injury and intensive care unit admission (P<0.001). Mandibular and midface fractures had an increased risk for cervical spine fracture and tracheostomy (P<0.001). Patient and injury-specific risk factors among the fractures with the strongest association for each outcome-cranial vault and mandible-were identified.

The inherent limitations of prior studies-geographical biases, small cohorts, and short-term study periods-were addressed. Describing the independent contribution of each craniofacial fracture to the risk of acute-level hospital course outcomes can be employed to better optimize risk stratification, counseling, and management.

Good sleep quality is crucial for dental students as they must have optimal cognitive function, memory, and decision-making to accomplish their learning requirements. This study aims to determine sleep quality, its associated factors, and the association between sleep quality and academic performance among dental students in Malaysia.

This cross-sectional study involved dental students at four public universities in Malaysia. A validated Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess their sleep quality. An additional self-administered questionnaire was employed to obtain the students' sociodemographic profile, lifestyle, and academic performance. The data were analysed using descriptive, chi-square, and multiple logistic regression.

Three hundred eighty-four dental students participated in this study. About half of the dental students (51.6%) have poor sleep quality. The mean of sleep hours per night was 5.72 (SD 1.06). The sleep quality was significantly poor among Malay students (P = 0.023), students who stayed at hostel (P = 0.002), and those who consumed caffeinated drinks (P = 0.028). Multiple logistic regression analysis revealed that the poor sleep quality was significantly associated with self-perceived poor academic performance (Adjusted Odds Ratio (AOR) 2.95, 95% CI [1.25-6.96], P-value = 0.013) and students skipping class (AOR 1.70, 95% CI [1.00-2.91], P-value = 0.046).

Most of the dental students in Malaysia have poor sleep quality. Ethnicity, accommodation, and caffeine consumption were significantly associated with sleep quality. Awareness to sleep quality among dental students is needed to ensure they are able to cope with the challenging dental school learning environment.