To investigate the association of health literacy, illness perceptions, and beliefs about medications on medication-taking behavior among first- and second-generation Australians of Chinese heritage living with type 2 diabetes mellitus (T2DM).

A nationwide cross-sectional online survey of (N = 455) of whom 196 responded, was conducted among adults (≥18 years) with T2DM of Chinese heritage residing in Australia. Participants were recruited via direct invitation (national registry and specialist clinic). Data collection utilized four validated questionnaires: The Brief Medication Questionnaire, Beliefs about Medicines Questionnaire Specific (BMQ-Specific), Brief Illness Perception 9 Questionnaire (BIPQ), and a 12-item short-form health literacy (HL) questionnaire (HLS-SF12). Bivariate and multivariate analyses were conducted to explore the factors associated with medication-taking.

Overall, 27 % of participants reported missing diabetes medication(s) in the past week, with access barriers most cited (38 %), followed by belief (27 %) and recall (24 %) barriers. Median scores for health literacy, illness perception and beliefs about medications showed problems with health literacy (General Health Literacy Index, median [IQR] =31.94 [26.39ꟷ38.89], a moderate threat to illness perception (BIPQ:= 38.56 ± 10.52) and higher perceived necessity of taking diabetes medications relative to concern (BMQ-Specific Necessity: = 3.80 [3.20-4.20]; BMQ-Specific Concern: = 3.00 [2.50-3.67]). Better medication-taking was seen in people with high necessity beliefs and with low concerns in the use of medications. Health literacy and illness perceptions were not significantly associated with medication-taking behavior.

Medication beliefs play a role in sub-optimal medication-taking behavior among Chinese adults with T2DM. Increased attention needs to be placed on examining and enhancing understanding of diabetes medications while addressing concerns among individuals of Chinese backgrounds to better understand the complexities of medication-taking behavior. Culturally relevant clinical discussion and structured diabetes education may support the development of health promoting medication beliefs potentially supporting optimal medication-taking behavior.

Young People Living with HIV (YPLHIV, 15-24 years) are an important demographic of Persons Living with HIV (PLHIV) globally and in Southern Africa. However, YPLHIV experience poor outcomes across the HIV diagnostic and treatment cascade due to multiple factors. We estimated the prevalence and determinants of HIV viral suppression in YPLHIV on antiretroviral therapy (ART) in selected Southern African countries. We used publicly available data from Malawi, Zimbabwe, Mozambique, Lesotho, and Eswatini collected during the Population-based HIV Impact Assessments (PHIAs) of 2020 to 2021. Weighted proportions, and 95% confidence intervals (CI) were computed to estimate the prevalence of viral suppression (< 1000c/ml) and bivariate and multivariate analyses were conducted to identify determinants of viral suppression. A total of 855 records of YPLHIV on ART were included in the analysis. The prevalence of viral suppression in YPLHIV on ART was 82.4% (95% CI: 76.7, 86.9). Residing in Mozambique and duration on ART were inversely associated with viral suppression; adjusted odds ratios (AORs) of 0.37 (95% CI: 0.14, 0.95), and 0.87 (95% CI: 0.80, 0.94), respectively. A negative result in the depression screen, being married/cohabitating, and ever switching an ART regimen were positively associated with viral suppression: AORs of 5.78 (95% CI: 2.21, 15.11), 3.72 (95% CI: 1.44, 9.63), and 3.44 (95% CI: 1.69, 7), respectively. YPLHIV had suboptimal viral suppression lower than the UNAIDS 95% targets and may benefit from further research and tailored interventions addressing modifiable factors associated with viral suppression such as depression.

Knee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain.

A two-year longitudinal cohort study including 251 individuals aged 30-60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon's, McNemar's and Friedman's tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up.

Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain.

During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further.

Players in the National Basketball Association (NBA) are at high risk for ACL tears which are detrimental to their career due to the months of rehabilitation. The authors hypothesize that after anterior crucial ligament (ACL) injury, older players will be less likely to return to the NBA, players that do return will have a lower performance efficiency rating (PER), and the decrease in PER will be associated with a lower salary.

This case-control study utilized the publicly available database maintained by the NBA, professional basketball players from 2002 to 2022 who suffered an ACL tear were identified. Controls, without ACL tears, were matched by age, BMI, position, race, and average minutes played before the injury date to uninjured controls. Return to NBA, pre-injury and post-return player efficiency ratings (PER), and salary change after injury were analyzed by multivariate analyses.

A total of 67 players suffered an ACL tear. Fifty-six (83.6%) players returned to the NBA at some point after their injury, while 11 (16.4%) did not. Multivariate logistic regression showed that older age and the presence of multi-ligament injury predicted retiring from the NBA (ß = 1.4 and 10.7). Older age and greater minutes played before surgery to be the only significant predictors of decreased PER after return to the NBA (ß = -0.5 and -0.2). Players with a multiyear contract and with improvements in PER after injury tended to have greater salary increases (ß = 6.5 and 0.7). All p < 0.05. PER in players with ACL tears decreased by about 3 points (13.1 to 9.9) compared to controls without ACL tears (13.2 to 12.9).

Older age and multiligament injuries are associated with retiring for the NBA; older and increased minutes played are associated with a decreased PER upon return; and, PER decreases are associated with decreased salary. Players with ACL tears, even when case-control matched, showed decreased PER upon return. These results can be attributed to age-related changes in athleticism and health.

African swine fever (ASF) has severely disrupted the Philippine pig industry, necessitating a thorough understanding of its local epidemiology to develop effective mitigation strategies. The outbreak has particularly impacted smallholder farmers, who face substantial economic losses, livelihood threats, and psychological distress due to ASF. This study examined the ASF outbreak in Davao Region, Southern Philippines, by analyzing its spatiotemporal patterns and identifying risk factors. The investigation involved three parts: determining spatiotemporal patterns using spatial autocorrelation and hotspot analysis, conducting Key Informant Interviews (KIIs) with government veterinarians to identify local risk factors, and fitting a conditional logistic regression model to estimate the effects of biosecurity and farming practices on the likelihood of ASF occurrence. A sharp decline in incidence rates and non-recurring hotspots of ASF-affected barangays (villages) were observed, which may have been influenced by community quarantines and 1-7-10 zoning protocols. However, ASF hotspots continuously shifted towards the northeast provinces of the region. Thematic analysis of collected data from KIIs highlighted six general areas of ASF management and control that have posed challenges: farm biosecurity, traders' roles, farmers' capabilities, slaughterhouse practices, veterinary services, and response gaps. Regression analysis revealed that biosecurity measures for trade vehicles and cleaning practices were associated with a decreased likelihood of ASF risk, while swill feeding, inadequate waste management, and improper disposal of diseased pigs were associated with an increased likelihood of ASF risk. These findings provide critical insights for managing ASF spread while supporting smallholder farmers, strengthening the livestock industry's resilience against similar diseases.

Adolescents and young adults (AYA, 14-24 years old) have the highest rates of drug use in most low- and middle-income countries. Little is known about the drivers of drug use among AYA in Nigeria and harm reduction services are limited.

A secondary data analysis was performed of the baseline survey of the 'I-TEST' study involving AYA in Nigeria. The two primary outcomes of interest were lifetime measures of drug use and needle sharing. Logistic regression analyses were performed to obtain odds ratios for the associations between socio-demographic exposures and the two primary outcomes. Odds ratios were subsequently adjusted for age and sex.

1500 AYA survey responses were analysed. Respondents were mostly unemployed, students, and living in southern Nigeria. Drug use was reported by 301/1500(20.3 %) AYA. Among these, 213/301(71.5 %) reported needle sharing. Drug use did not vary by age (OR:0.94, 95 %CI:0.73-1.22) or sex (OR:1.00, 95 %CI:0.77-1.28). AYA in the North-Central zone had higher odds of drug use (OR:1.86, 95 %CI:1.28-2.69) and needle sharing (OR:2.51, 95 %CI:1.07-5.91) compared to AYA in the South-West zone of Nigeria. AYA aged 14-19 had higher odds of needle sharing compared to those aged 20-24 (OR:3.49, 95 %CI:1.94-6.26). Female AYA had higher odds of needle sharing compared to males (OR:5.05, 95 %CI:2.85-8.95).

Drug use and needle sharing are common among AYA in Nigeria. There is an urgent need for harm reduction services and research informed by AYA.

The use of physician-modified endografts (PMEGs) to treat juxtarenal aortic aneurysms has increased significantly over the past 10 years. However, there exists a paucity of data beyond 5 years. This study compares long-term outcomes and cause of death between patients who did and did not survive beyond 5 years after PMEG for juxtarenal aneurysm.

All patients with >5 years of follow-up data enrolled in a prospective, physician-sponsored investigational device exemption clinical trial treated with PMEG for juxtarenal aneurysm were included. Univariate analysis was used to compare demographics, anatomical and operative characteristics, late outcomes, and cause of death between patients who survived beyond 5 years and those who did not. Death on hospice, clinical follow-up status, and whether patients declined a secondary intervention were also evaluated. Survival was assessed with Kaplan-Meier analysis. Predictors of overall mortality and mortality before 5 years were determined using Cox regression analysis.

We included 98 patients with juxtarenal aneurysm wgo underwent PMEG from 2011 to 2018; 64 (65.3%) survived beyond 5 years and 34 (34.7%) did not. Patients who survived beyond 5 years were younger (73 years vs 78 years; P = .04) with a greater prevalence of preoperative antiplatelet use (81.3% vs 61.8%; P = .047). There were no differences in comorbidities, symptomatic presentation, or anatomical or operative characteristics. Patients who survived beyond 5 years were less likely to experience a perioperative adverse event (10.9% vs 38.2%; P < .01) and pulmonary complication (1.6% vs 17.7%; P = .01). There were no differences in late outcomes, including reintervention, aortic sac behavior, endoleak, or visceral patency. Patients who survived beyond 5 years more frequently died on hospice (58.6% vs 17.6%; P < .01), were lost to aortic-specific clinical follow-up (48.4% vs 5.9%; P < .01), and declined a secondary intervention (9.4% vs 2.9%; P = .04). For the entire study cohort, aortic-related mortality was 9.5%. Survival was 87% at 1 year, 65% at 5 years, and 10% at 10 years. Cardiac comorbidities (15.9%), systemic decline (15.9%), stroke (14.2%), and cancer (12.9%) accounted for the leading causes of death, with no differences between the two cohorts. On adjusted analysis, sac regression was associated with reduced mortality for the entire patient cohort (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.18-0.76) and those who died before 5 years (HR, 0.37; 95% CI, 0.16-0.92). Meanwhile, congestive heart failure (HR, 6.02; 95% CI, 1.60-22.65) was associated with increased mortality for patients who did not survive beyond 5 years.

Patients who undergo PMEG for juxtarenal aneurysm are more likely to die from underlying medical comorbidities; aortic-related mortality accounts for <10% of total deaths. Patients who do not survive beyond 5 years are older and experience more perioperative complications, whereas patients who survive beyond 5 years are more likely to die on hospice, be lost to clinical follow-up, and decline a secondary intervention. These findings reflect the high degree of chronic disease burden for this patient population, even after successful treatment of their aortic pathology.

The elderly are highly vulnerable to major burn injuries. Typically, 'elderly' is accepted as ≥ 65 years of age. This cut-off is arbitrary, lacks a robust evidence base and is potentially damaging from a clinical-decision-making perspective. The study objective was to utilise a large international dataset of major burns to stratify mortality risk by age and objectively define 'elderly' patients with significantly higher risk of poor outcome.

We performed a sub-analysis of the RE-ENERGIZE clinical trial dataset. RE-ENERGIZE included 1200 patients admitted to 54 burn centres worldwide with 2nd and/or 3rd degree burns, who were expected to require skin grafting. In a first-of-its-kind age stratification study, we stratified major burns patients by five-year age intervals. Logistic regression and Cox proportional hazards analyses were performed with three-month mortality and time-to-discharge-alive (TTDA) as the primary and secondary outcomes.

Three-month mortality was 15.41 %. Age was associated with three-month mortality upon multivariable logistic regression analysis (p = 0.000, OR=1.06, CI=1.05-1.08), independently of total burn surface area burned (TBSA%), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Charlson Comorbidity Index (CCI). Age 80 + was independently associated with increased mortality and TTDA, when compared to all referent 5-year age groups (p ≤ 0.000-0.043). The Lethal Dose 50 (LD50) for the 80 + group was 20.5 %.

We present a new threshold of risk stratification in patients with major burns; Patients ≥ 80 years have a significantly poorer outcome, irrespective of injury severity, resultant critical illness severity, and variables including comorbidities, which has implications for prognostication and management decisions.

Recovery after sport-related concussion is variable, and potential differences between team vs individual sport athletes are not fully understood. In a cohort of athletes with concussions, we sought to compare these groups across (1) symptom severity score, (2) individual symptom cluster scores, and (3) recovery metrics.

A retrospective, cohort study of 13 to 23-year-old athletes treated at a regional sport concussion center between November 2017 and April 2022 was conducted. Athletes were categorized into team vs individual sport athletes, with additional classification of individual sports based on strong vs minimal team elements (ie, the degree of interdependence displayed by athletes). The primary outcomes were symptom severity score, measured by either the Sport Concussion Assessment Tool-5th Edition or the Immediate Post-Concussion Assessment and Cognitive Testing, and physical, cognitive, emotional, and sleep symptom cluster scores. Secondary outcomes were recovery metrics, including time to return-to-learn, symptom resolution, and return-to-play.

Of the 1051 athletes, 954 (90.8%) were in team sports and 97 (9.2%) in individual sports. In multivariable linear regression, individual sport athletes had higher emotional symptom severity compared with team sport athletes (β = 0.09 [0.01, 0.17], P = .034) when adjusting for sex, attention-deficit/hyperactivity disorder, psychological disorders, time to clinic, on-field evaluation, and Immediate Post-Concussion Assessment and Cognitive Testing vs Sport Concussion Assessment Tool-5 th Edition scale. There were no significant differences in return-to-learn ( P = .104), symptom resolution ( P = .941), or return-to-play ( P = .279) on univariate regressions.

In the current single-center, pilot study of athletes with a sport-related concussion, individual sport athletes exhibited more emotional symptoms than team sport athletes. These preliminary data lend early support that individual sport athletes may be more at risk of emotional symptoms than team sport athletes after a sport-related concussion. Clinicians may use these findings to identify athletes who may be particularly vulnerable to emotional symptoms.

Childhood vaccination is a fundamental public health intervention, playing an essential role in improving health outcomes and preventing serious infections. Despite proven benefits of vaccination programs, its coverage in Indonesia remains inadequate over the years. Therefore, this study aims to develop a prediction rule using intrapersonal, interpersonal, organizational, community, and policy-related factors to distinguish between Indonesian children < 2 years at high and low risk of incomplete vaccination.

The prediction rule was developed using cross-sectional data from the 2017 Indonesia Demographic Health Survey. Data on vaccination status was obtained from a vaccination card, which was filled out by health care providers during vaccination. Multivariable logistic regression was applied to develop a prognostic score based on the regression coefficients of associated parental intrapersonal, interpersonal, organizational, community, and policy-related factors. Discrimination of the model was assessed with Receiver Operating Characteristic (ROC) curve.

The sample population in this study comprised 3,790 respondents, and 2,414 (63·7%) were incompletely vaccinated. Several factors such as a mother at young age, absence of a mobile telephone, limited antenatal care attendance, absence of postnatal checks within two months after birth, had not received tetanus vaccination during pregnancy, and low socio-economic status were independently associated with incomplete vaccination. The area under curve (AUC) of the model was 0·67, which showed moderate discrimination, but was acceptable. Using a cut-off score of > 20 points, only half of the parents with a high probability of incompletely vaccinated children are selected with a sensitivity of 60% and specificity of 64%, and only 41% of parents with incompletely vaccinated children are missed.

This novel, easy-to-use prediction rule could be a useful tool to complement current strategies and further encourage tailored vaccine uptake interventions, particularly to parents with a high chance of incompletely vaccinated children in Indonesia.

Our study aims to assess the moderating effect of self-esteem in the association between generalized anxiety disorder and disordered eating symptoms among a sample of Lebanese adults. The study engaged a cohort of 629 participants, who were recruited in May 2023, utilizing a snowball sampling technique. Data were collected via a questionnaire that included socio-demographic variables and the following scales: the Generalized Anxiety Disorder Scale (GAD-5), the Eating Attitudes Test (EAT-7), and the Single Item Self-Esteem Scale (SISE). Higher GAD-5 scores (Beta = 0.01; p = .004) were significantly associated with higher EAT-7 scores. The interaction generalized anxiety disorder by self-esteem was also significantly associated with EAT-7 scores (Beta = - 0.003; p = .019), indicating that self-esteem moderates the relationship between GAD and disordered eating symptoms. At low (Beta = 0.006; p = .001) and moderate (Beta = 0.003; p = .007) levels of self-esteem, higher GAD-5 scores were significantly associated with higher EAT-7 scores (more severe disordered eating symptoms). In contrast, at high levels of self-esteem, the association was not significant (Beta = 0.001; p = .812), indicating that higher self-esteem may act as a protective factor, reducing the impact of GAD on disordered eating symptoms. While an association between anxiety and disordered eating symptomatology has been reported, this study adds to the body of literature by indicating that the strength of this association may vary with an individual's level of self-esteem, which underscores the importance of integrating self-esteem-building strategies into therapeutic interventions aimed at reducing disordered eating in individuals facing anxiety. Future studies would allow for a more dynamic and nuanced understanding of the causal pathways between anxiety, self-esteem, and eating behaviors.

The use of seatbelts in motor vehicles among pregnant women can reduce morbidity and mortality due to road traffic crashes; however, to date, there are no published studies on seatbelt usage among pregnant women in Indonesia. This research aims to promote the safety of pregnant women when using a motor vehicle. Its objective was to investigate the practices of seatbelt usage among pregnant front passengers and the associated factors.

A cross-sectional study was conducted in Samarinda, Indonesia. Pregnant women were asked to complete a self-administered validated and published questionnaire, the SaPeIH-Q, which included sociodemographic information, and an assessment of knowledge, attitudes, and practices related to seatbelt usage among pregnant women. Multiple logistic regression (MLogR) was performed via SPSS version 27 to identify independent factors associated with seatbelt usage.

Among the 326 pregnant front passengers, only 34.7% used seatbelts, and only 39.3% correctly identified the placement of the three-point seatbelt. The practice of using seatbelts before pregnancy and knowledge of seatbelt usage were significantly associated with using seatbelts during pregnancy (p = 0.001 and 0.004, respectively).

The seatbelt usage rate among pregnant front passengers was low. Pregnant front passengers who used seatbelts before pregnancy were more likely to use them during pregnancy, and pregnant women with good knowledge were more likely to use seatbelts during pregnancy. The rate of seatbelt use during pregnancy may improve with increasing knowledge of seatbelt usage and the use of seatbelts before pregnancy.

Traumatic brain injuries (TBI) significantly contribute to hospital admissions in Europe. Acute symptomatic seizures (ASz), occurring within seven days post-TBI, increase morbidity and mortality. This study analyzes the frequency, risk factors, and short-term outcomes of ASz in patients with acute TBI.

This retrospective study included 212 patients with acute TBI admitted to the University Hospital Frankfurt/Germany between 2018 and 2021. Data were collected on demographics, injury characteristics, clinical course, and outcomes. ASz were defined as clinically or electroencephalographically detected seizures within seven days post-TBI. Logistic regression was used to identify predictors of ASz and non-convulsive status epilepticus (NCSE).

ASz occurred in 17.9 % (n = 38) of patients, with a mean latency of 2.4 ± 1.9 days post-TBI. Status epilepticus developed in 47.4 % (n = 18) of these patients, predominantly as NCSE (n = 15). Predictors of ASz included older age (OR = 1.034, p = 0.012), higher Glasgow Coma Scale (GCS) at 24 h (OR = 1.133, p = 0.021), severe TBI (OR = 5.085, p = 0.018), and pneumonia (OR = 5.828, p = 0.007). For NCSE, significant predictors were older age (OR = 1.059, p = 0.021), pneumonia (OR = 6.766, p = 0.012), and urinary tract infection (OR = 7.38, p = 0.012). Patients with ASz had a significantly worse modified Rankin Scale (mRS) score at discharge (OR = 5.01, CI: 1.93-13.0, p < 0.001)).

ASz are a frequent and serious complication of TBI, particularly in severe cases and older patients. Early identification of high-risk patients using predictive factors such as age, GCS, and pneumonia may result in earlier treatment and improved outcomes. The findings highlight the importance of dedicated epilepsy monitoring in acute TBI care.

This study aimed to examine menopausal symptoms and their associated factors among premenopausal, perimenopausal and postmenopausal groups of middle-aged Chinese women.

The nationwide cross-sectional study involved 9740 middle-aged women from 115 medical centers across 27 provinces in China. Logistic regression analyses were performed to explore the associations between menopausal symptom severity and age, menopausal status, body mass index (BMI), smoking, employment status, income, education level, exercise and alcohol use.

Among the 9740 participants, 17.6% (n = 1711) were premenopausal, 38.3% (n = 3730) were perimenopausal and 44.1% (n = 4299) were postmenopausal. The likelihood of moderate to severe menopausal symptoms was positively associated with age (odds ratio [OR] 1.10; 95% confidence interval [CI] 1.09-1.11; p < 0.001), perimenopause (OR 2.15; 95% CI 1.90-2.45; p < 0.001) and postmenopausal stage (OR 5.96; 95% CI 5.25-6.77; p < 0.001), smoking (OR 1.96; 95% CI 1.39-2.77; p < 0.001) and unemployment (OR 1.47; 95% CI 1.31-1.65; p < 0.001). In contrast, higher income was inversely associated with symptom severity (OR 0.69; 95% CI 0.58-0.82; p < 0.001). BMI demonstrated a positive association with symptom severity in premenopausal women.

Age, menopausal status, smoking, unemployment and lower income were associated with more severe menopausal symptoms.

The coronavirus SARS-CoV-2 (COVID-19) experience has underscored the consequences of inequalities in health and access to health services across and within countries. Vulnerable population groups have been disproportionately exposed to certain diseases such as tuberculosis (TB) due to service interruptions. The current study aimed to assess TB related mortality and risk of drug resistance during the COVID-19 Pandemic in Burundi.

We conducted an incident case-control study on 362 TB patients, with 181 multidrug resistant TB (MDR-TB) patients and 181 drug susceptible TB (DS-TB) patients. These patients under TB treatment between July 11, 2018, and November 11,2022 (18 months before and 18 months during COVID-19). Baseline and drug susceptibility status data were captured at treatment initiation. Mortality during treatment follow-up TB mortality was compared between categories of drug susceptibility, period (before vs during COVID-19) and regimen phase. A multivariate logistic regression was used to show the predictive risk factors. K-Fold cross-validation was used to evaluate the final model.

A half of TB patients was under 40 years old, with majority of them being unemployed, malnourished and lacking food support during TB treatment. Most of them lived in precarious conditions with limited access to healthcare services. The overall TB-related mortality was 16.0% (95% CI: 12.5%- 20.3%) with 15.5% (95%CI: 10.7%-21.8%) in MDR-TB patients and 16.6% (95% CI: 11.6%-22.9%) in DS-TB patients. Stratified by the period, TB related mortality was 15.3% (95%CI: 11.7%-20.9%) before the COVID-19 pandemic and 17.1% (95%C 11.5%-24.6%) during the COVID-19 pandemic. More than a half of deaths in TB patients occurred during intensive phase of treatment. The risk of MDR-TB was significantly higher (p < 0.05) among patients undergoing treatment during the pandemic, those with a low education level, living in rural areas, unemployed, using public transportation, or living in overcrowded households (big family size,a small number of rooms). Additionally, patients with history of TB, previous treatment failure, and close contact with MDR-TB patients were more likely to have MDR-TB. The likelihood of MDR-TB further increased with the cumulative presence of these risk factors on the same TB patient.

TB mortality increased during the COVID-19 pandemic, particularly among MDR-TB patients. The odds of MDR-TB encompass a range of socio demographic and clinical factors particularly among economically disadvantaged patients. These findings underscore the need for targeted equity-driven interventions in high-risked populations, especially in the context of emerging outbreaks, in order accelerate TB elimination goals. Additional investigation on TB related mortality should focus on the intensive phase of treatment, which aligns with the 2025 World Health Organization consolidated guidelines on TB diagnosis and control.

There were only a few studies that assessed health-related quality of life (HRQoL) of patients with Alzheimer disease (AD) in Malaysia. This cross-sectional study was to investigate the HRQoL scores of patients with AD in Malaysia using 2 HRQoL instruments and to identify predictors of patients' HRQoL.

Informal caregivers of patients with AD were recruited in 4 tertiary hospitals during outpatient visits. Patients' HRQoL was assessed using proxy-rated generic (EQ-5D-5L and EQ-VAS), and disease-specific (Quality-of-life Alzheimer's Disease [QoL-AD]) assessment instruments were utilized to obtain proxy HRQoL scores of patients with AD from caregivers via structured interviews. The difference between HRQoL scores and other variables was tested using analysis of variance. Pearson correlation test was conducted between the 2 instruments, whereas a multivariable linear regression model was utilized to identify predictors of HRQoL in patients with AD.

The mean EQ-5D-5L index, EQ-VAS, and QoL-AD score of patients with AD were 0.63 ± 0.30, 61.05 ± 20.48, and 26.69 ± 6.83, respectively, via proxy ratings. In terms of correlation, EQ-5D was weakly correlated with QoL-AD (r = 0.36, P < .01). EQ-5D index and QoL-AD score reduced significantly as AD advanced (P < .05). Besides, cognitive decline, presence of behavioral symptoms, female caregiver gender, and nonmarried status were associated with lower patients' HRQoL in multivariable models with EQ-5D index (P < .05).

Low HRQoL of patients with AD requires attention from healthcare providers and stakeholders in optimal resource allocation and decision making. Such health utility values are useful in future economic evaluations in investigating the cost-effectiveness of new interventions or disease-modifying therapies.

Flooding exacerbates health challenges by spreading waterborne diseases like diarrhea through the destruction of sanitation infrastructure and contamination of drinking water sources. However, evidence on the prevalence and contributing factors of diarrheal diseases among under-five children in the Dasenech district is limited. This study aimed to assess the prevalence of acute diarrhea and its determinants among under-five children in flood-affected areas of the South Ethiopia region. A community-based cross-sectional study was conducted from July 1 to July 15, 2024, in flood-affected areas of the Dasenech district, involving 696 under-five children. Five kebeles were purposively selected, followed by the proportional allocation of households, after which a systematic sampling technique was applied to identify study participants. Data were collected using a pretested and structured questionnaire administered by trained interviewers. Multivariable logistic regression analysis was performed to identify factors associated with acute diarrhea, with statistical significance set at p < 0.05 and a 95% confidence interval (CI). The prevalence of acute diarrhea was 31.6% (95% CI: 28.7-34.3%). Significant predictors of acute diarrhea included non-adherence to exclusive breastfeeding (AOR: 2.14, 95% CI: 1.65-3.98), lack of latrines (AOR: 12.08, 95% CI: 9.77-13.13), unsafe disposal of child excreta (AOR: 3.86, 95% CI: 2.38-6.26), home delivery (AOR: 6.02, 95% CI: 5.53-8.82), and a recent history of diarrhea among mothers or caregivers (AOR: 3.14, 95% CI: 1.33-5.66). Acute diarrhea is highly prevalent among under-five children in the Dasenech district. The findings underscore the need for targeted public health measures, such as improving waste management, promoting exclusive breastfeeding, constructing and utilizing latrines, and addressing maternal and caregiver health, to mitigate the burden of diarrheal diseases in this vulnerable population.

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.

Pain is defined as an unpleasant sensory and emotional experience in response to a noxious stimulus. Nowadays, it is increasingly prevalent among adults and may be influenced by past experiences such as child abuse, trauma or psychiatric conditions like anxiety. Thus, this study aims to evaluate the mediating effect of anxiety between child abuse and pain among a sample of Lebanese adults. This cross-sectional study was conducted between March and April 2024. Participants were selected using a snowball sampling method from various Lebanese governorates, and completed a self-administered online questionnaire via Google Forms. All adults over the age of 18 were eligible to participate. The questionnaire included sociodemographic questions, the short form of McGill pain questionnaire, the generalized anxiety disorder-7 (GAD-7), and the child abuse self report scale (CASRS-12). A total of 507 Lebanese adults completed the questionnaire. The mean age was 26.80 ± 10.29 years and 73.2% were female. The results showed that anxiety partially mediated the association between child abuse and pain. Higher levels of child abuse were significantly associated with greater anxiety, which in turn was significantly associated with increased pain. Child abuse was directly associated with higher pain levels. The study highlights the relationship that child abuse has on pain in adults and its relationship with anxiety. Future research delving into the relationship between child abuse and chronic pain in adulthood is essential to better understand the underlying pathways and support effective prevention and intervention strategies.

The aim of this study was to develop a scoring tool to estimate the probability of survival following extracorporeal rewarming in patients suffering hypothermic cardiac arrest. This is a multicenter retrospective study based on registry data. We included adult patients with hypothermic cardiac arrest not associated with asphyxia, with a core temperature of ≤28°C, who underwent extracorporeal rewarming. A multivariable logistic regression model was developed to serve as the predictive tool. Internal validation with bootstrap resampling was performed to adjust model parameters and reduce model optimism. Our study population included 141 patients. The survival rate was 46% (65/141). A total of 88% of the survivors (57/65) had a favorable neurological outcome (Cerebral Performance Category 1-2). The predictive model includes four variables. Outdoor occurrence of hypothermia and a higher hemoglobin level raise survival odds while higher concentrations of potassium and lactate reduce survival odds. The area under the receiver operating characteristic (ROC) curve was 0.812 and p value of the Hosmer-Lemeshow test was 0.8. We developed a prognostic model to estimate the probability of survival in adult patients with non-asphyxia-related hypothermic cardiac arrest. This model may aid in identifying candidates suitable for extracorporeal rewarming, though it should not be used as the sole deciding factor.

Eating disorders significantly impact physical health and have negative psychosocial consequences. The global burden of anorexia nervosa and bulimia nervosa among young females is estimated to account for 1.9 million disability-adjusted life years. Early identification of disordered eating attitudes is critical for preventing the progression to more severe forms of eating disorders; however, there is limited evidence on this issue among university students in Ethiopia. Therefore, this study aimed to assess disordered eating attitudes and their associated factors among female students at Arba Minch University, Arba Minch, Southern Ethiopia, in 2023.

An institution-based cross-sectional study was conducted at Arba Minch University from January 1, 2023, to April 1, 2023. A total of 600 female students participated in the study, selected through simple random sampling. Data were collected using a self-administered questionnaire, entered into Epi-Info version 7, and exported to SPSS version 20 for analysis. Multivariable binary logistic regression was used to identify factors associated with disordered eating attitudes, with variables having p-values <0.05 considered statistically significant. The strength and presence of associations between the outcome variable and independent variables were measured using adjusted odds ratios with 95% confidence intervals. Model fitness was assessed using the Hosmer and Lemeshow goodness-of-fit test.

The study found that the prevalence of disordered eating attitudes among female students at Arba Minch University was 11.5% (95% CI: 9.0-14.3). Factors significantly associated with disordered eating attitudes included academic department (AOR=2.27, 95% CI: 1.06-4.86) and body mass index (AOR=5.83, 95% CI: 2.34-14.52).

The study indicated a notable prevalence of disordered eating attitudes among female students at Arba Minch University. Body mass index and academic department were found to be significantly associated with these attitudes. The link between disordered eating and body image concerns underscores the need for policies promoting self-confidence and positive body image. More specifically, university health services should implement routine screening using EAT-26, combined with psychological counseling services to support at-risk students.

A study on pornography is vital due to internet accessibility, widespread pornography usage, and a lack of data, especially in non-western countries.

This study estimates the occurrence of pornography use (PU), compares demographic, sexual, and psychological factors between users (PUs) and non-users, and identifies associated factors of PU based on gender. It examines problematic pornography use (PPU), comparing usage patterns between PPUs and non-PPUs, and identifies associated factors of PPU.

In 2021, an online cross-sectional nationwide survey was conducted among 1249 Iranians (865 women, 384 men) in all provinces except one, using a convenience sampling method through social media platforms.

Participants were categorized into PUs and non-users based on their pornography use over the past year. PUs were further divided into PPUs and non-PPUs, using the Problematic Pornography Consumption Scale cutoff (>20). The researcher-made questions assessed patterns of pornography use, demographic characteristics, and sexual information; sexual health variables and psychological factors were evaluated by standard scales.

PU was reported by 30.1% of participants (n = 376), including 27.5% of women and 35.9% of men. Logistic regression identified being male, shorter marriage duration, earlier age at first sex, lower religiosity, poorer sexual communication, masturbation, substance abuse, and depression as associated factors for PU. Among PUs, 13% (n = 49) were PPUs, including 10% of women and 17.1% of men. Linear regression identified the following risk factors for PPU: being male, longer marriage duration, masturbation, sexual distress, and pornography use. Conversely, having more children was a protective factor. Compared to non-PPUs, PPUs reported higher pornography consumption, the primary motivation being masturbation, greater usage among close friends, prioritizing pornography over sex with their spouse, negative effects on their sex life, and increased use during the COVID-19 pandemic.

Healthcare providers should address modifiable factors related to PU/PPU through early sex education and support. Objective measurements of PPU should be prioritized over subjective perceptions, as many infrequent users feel moral incongruence.

The study's applicability may be limited by imbalanced gender participation, recruitment of married individuals, and a small number of PPUs. However, strengths include standardized assessment tools, gender-based data collection, and anonymous sampling to enhance response accuracy in conservative contexts.

Accurate pornography occurrence measurement requires clear definitions, consideration of dropout rates, and consistent time units. Strong correlations with PPU included frequent masturbation, fewer children, lower education for women, poor sexual communication, and frequent PU for men.

The career decisions of medical students are pivotal in shaping the future healthcare workforce. In many countries, the number of medical students who choose general practice as their career is insufficient to meet the needs of the healthcare system.

To describe the factors influencing medical students' career intentions and their preference for a career in general practice.

A cross-sectional study involving medical students from Flanders (Belgium), Estonia, and Hungary.

An online questionnaire, which was sent to undergraduate medical students, was used to gather data. Multivariable logistic regression was conducted.

Altogether 1601 medical students participated in this study, which found that 18.5% of the participants were interested in general practice. Factors related to medical students and the curriculum that predicted the interest in general practice were being a woman, being a medical student from Flanders, being a sixth-year medical student, coming from a rural area, and having GP role models. Students preferring general practice named the following factors as important: short and low-intensity training programme; having long-term and close relationship with patients; continuity of care; regular and flexible working hours; and opportunities to achieve work-life balance.

This study adds further evidence of which characteristics and factors can predict medical students' interest in general practice; having GP role models being the most important predictor. Further research into which qualities medical students value in their role models could give us better understanding on how we can support GPs to be better advocates for their specialty and thereby help increase interest in general practice.

Cervical cancer is the leading cause of cancer-related mortality in low- and middle-income countries (LMICs). Prior studies associate high cervical cancer awareness with reductions in cervical cancer incidence. In this study, we utilize nationally representative Demographic and Health Surveys Program (DHS) to analyze correlates of cervical cancer awareness to inform global strategies. All DHS surveys between 2017-2023 were queried for questions on cervical cancer awareness. Socio-demographic variables (e.g., age, marital status), socioeconomic variables (e.g., education, wealth, literacy) and variables pertaining to healthcare decision making, distance traveled, intimate partner violence (IPV), and female genital mutilation/circumcision (FGC/M)) were extracted. Sample weights were applied, and logistic regressions were performed. Variables with p < 0.20 were included in multivariate analysis. Data was obtained from 30,214 women aged 30-49 years old living in Benin, Cameroon, Madagascar, Mauritania, and Mozambique, 19,403 of whom were asked questions on cervical cancer awareness. Cervical cancer awareness varied from 53% in Cameroon to 12% in Benin. Literacy, frequency of watching television, mobile telephone ownership, visiting a local healthcare facility and hormonal contraceptive use were associated with increased cervical cancer awareness, while lack of healthcare decision making independence was associated with decreased awareness after multivariate adjustment. Women who experienced emotional IPV were associated with increased awareness in Cameroon. Less than 4% of all women were screened for cervical cancer. Given the known association between awareness and screening, targeted efforts to increase awareness among women without communication modalities has the potential to reduce global cervical cancer disparities. Potential strategies include co-locating cervical cancer awareness programs with public health programs and implementing large-scale telecommunication outreach programs to improve awareness.

Endoscopic procedures are essential for diagnosing and managing gastrointestinal conditions, often requiring sedation for patient comfort. Propofol is a common choice for outpatient sedation due to its rapid onset and predictable recovery time. Although propofol has an established safety profile, adverse drug reactions (ADRs) can still occur. This study investigated the prevalence and risk factors associated with ADRs related to nurse-administered propofol sedation during outpatient endoscopic procedures at a private hospital in Peru.

We conducted a retrospective study. The clinical records of 919 Peruvian patients who underwent endoscopic interventions under propofol sedation were reviewed. This study included patients between the ages of 18 and 69 years who had American Society of Anesthesiologists (ASA) physical status classification scores of I-III and who were hemodynamically stable with an oxygen saturation (SO2) > 90% before the procedure. Sedation was nurse-administered using standardized protocols. ADR data, including severity and causality assessment data, were collected. Data were collected and analyzed by SPSS, Inc., and the statistical significance was calculated at the p < 0.05 level.

A total of 693 patients were included in the study, 30.9% of whom experienced at least one ADR, predominantly cardiovascular or respiratory events such as hypotension and hypoxia, with causality scores classified as probable or definitive. Among the ADRs, 35.8% (n = 87) were moderately severe, and 64.2% (n = 143) were mildly severe. There were no reports of any serious adverse events. An ASA class III status (p = 0.048, PR adjusted (PRa) = 1.73, 95% CI: 1.01-2.99) and a procedure time of more than 20 min (p < 0.0001, PRa = 2.05, 95% CI: 1.53-2.73) were significant risk factors for ADR occurrence. Patients with ADRs had longer recovery times than did those without ADRs (22 min ± 22.5 vs. 14 min ± 8, respectively; p < 0.001).

In our work, moderate propofol sedation administered by trained nursing staff to outpatients undergoing interventional endoscopic procedures was generally safe but not free from risks. Vital parameters should be monitored regularly during long-term interventions and when patients are classified as ASA III.

Outpatient psychotherapies are gold standard interventions for borderline personality disorder (BPD); however, in clinical reality, higher rates of psychiatric hospitalization and more severe symptoms, including suicidality and self-harm, occur for those with BPD compared to those with other psychiatric disorders in inpatient units.

This study aims to distinguish the clinical profile and outcomes of patients screening positive for a threshold of BPD traits in the inpatient psychiatric setting using the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), from those who do not.

Compared to those screening negative on the MSI-BPD (MSI-BPD-), those who screen positive (MSI-BPD +) are younger, more likely to be female, and more likely to report a range of health and psychosocial risk factors such as unstable housing, reduced educational attainment, physical health problems, past trauma, and problematic drug and alcohol use. MSI-BPD + patients report significantly higher severity of anxiety, depression, suicidality, self-harm, and global symptoms on admission than MSI-BPD- patients. In terms of response to inpatient care, they also self-report significantly greater improvements and higher proportions of reliable change on measures of anxiety, depression, and general psychiatric severity. At discharge, MSI-BPD + patients no longer report significantly higher suicidality but do report greater levels of thoughts of self-harm.

These findings suggest that patients with self-reported BPD symptoms experience acute symptom relief during short-term inpatient hospitalization, including for suicidality-related symptoms. Our study also demonstrates the feasibility of utilizing the MSI-BPD screening tool within a large adult inpatient psychiatric population to identify individuals likely to have BPD with distinct clinical profiles.

Cervical cancer is the second leading cause of cancer death among women in Addis Ababa and other parts of Ethiopia. Yet, there are limited age-eligible city-wide data on cervical cancer screening prevalence in Addis Ababa to inform public policy.

A population-based cross-sectional study was conducted among 1881 screening eligible women aged 30 to 49 years, who were selected from 63 enumeration areas in Addis Ababa based on multistage sampling and proportional sample size allocation. Logistic regression was used to identify barriers to screening. All statistical tests were two-sided, P < 0.05.

Overall, 30.8% [95% confidence interval (CI), 28.8%-33.0%] of study participants reported receipt of screening in the past 5 years. Less than half (45.7%) of women reported that they received healthcare provider recommendation for screening, and only 15% of married women reported that they had spousal support for it. In the multivariable adjusted model, the odd of being screened was considerably higher in women with healthcare provider recommendation, with spousal support, and with good cervical cancer screening awareness and knowledge of risk factors for the disease. Factors associated with not seeking screening service included feeling healthy and perception of low risk for cervical cancer.

Cervical cancer screening uptake is low in Addis Ababa, and less than half received healthcare provider recommendation. Future studies should identify barriers to provider recommendations.

The findings underscore the need for a coordinated effort to enhance healthcare provider recommendations for cervical cancer screening and to raise awareness about the benefits of screening in the general population.

Maternal mental health and other underlying factors might affect a child's nutritional status. This study assesses child undernutrition and its associated characteristics, including maternal mental health, in low-income settings in Dhaka, Bangladesh.

A community-based cross-sectional study was conducted among 397 lactating mothers with children aged 6-23 months from low-income settings in Dhaka. Anthropometric measurements were taken following standard protocols, and Z-scores for weight-for-age, height-for-age, and BMI-for-age were calculated. Maternal depression and anxiety were assessed using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-Item Scale, respectively. The child feeding index was developed based on breastfeeding, dietary diversity, and meal frequency. Multivariate logistic regression models explored the relationship between child undernutrition and maternal mental health and other risk factors.

In low-income regions of Dhaka, the prevalence was 31.9% for stunting, 14.0% for wasting, and 24.1% for underweight children. Approximately half of the mothers experienced depression (55%) and anxiety (50%). High maternal depression levels were associated with increased odds of stunted (AOR = 1.80, 95% CI = 1.10-2.94, p < 0.05) and wasted (AOR = 2.70, 95% CI = 1.38-5.28, p < 0.05) children. Similarly, anxiety was linked to a higher risk of underweight children (AOR = 1.77, 95% CI = 1.04-3.11, p < 0.05). Female children had approximately twice the risk of stunting than boys (AOR = 2.13, 95% CI = 1.32-3.44, p < 0.01). Younger maternal age also doubled the risk of stunting (AOR = 1.97, 95% CI = 1.20-3.22, p < 0.01). Low adherence to a feeding index increased the odds of stunting (AOR = 3.21, 95% CI = 1.99-5.16, p < 0.001) and underweight (AOR = 4.20, 95% CI = 2.50-7.07, p < 0.01). Children born to underweight mothers were almost twice as likely to become underweight (AOR = 2.01, 95% CI = 1.01-4.03, p < 0.05) compared to those born to normal/overweight mothers.

Maternal depression and anxiety adversely affect the nutrition of their children. Sociodemographic factors such as the child's sex, maternal age, maternal health, and child feeding practices significantly contribute to child undernutrition. Policy initiatives should prioritize maternal mental health and address child undernutrition in these settings.

One in two people with diabetes in sub-Saharan Africa remains undiagnosed, which has contributed to the region's high rates of diabetes-related morbidity and mortality. While the COVID-19 pandemic likely exacerbated diabetes prevalence, limited data from the region, including Uganda, hampers our understanding of this impact. To address this gap, we analysed the diabetes prevalence and correlates among adults from three rural districts of Uganda using data from a community-based screening programme conducted by community health workers (CHWs) during the pandemic.

We used anonymised data of 2587 records to analyse the prevalence and correlates of diagnosed and undiagnosed diabetes. Prevalence was presented as proportions with 95% CIs. Correlates of diabetes and undiagnosed diabetes prevalence were analysed using logistic regression and presented as ORs.

The overall prevalence of diabetes was 11.3% (95% CI 10.2 to 12.5%), with a 7.2% (95% CI 6.2 to 8.1%) prevalence for diagnosed diabetes. A high proportion (36.4%) of diabetes cases were undiagnosed. Older age, high body mass index and pre-existing hypertension were associated with high diabetes prevalence.

There was a high proportion of undiagnosed diabetes among rural adults during the pandemic. Engaging CHWs in routine diabetes screening and awareness programmes can reduce the burden of undiagnosed diabetes.

BackgroundAcute invasive fungal rhinosinusitis (AIFR) is a life-threatening disease mainly affecting immunocompromised patients. Early detection is therefore key to improving patient survival. To date, there are still no standard clinical criteria for AIFR diagnosis.ObjectiveThis study develops a predictive model that utilizes clinical presentation and computed tomography (CT) findings to diagnose AIFR.MethodsA retrospective cohort study was conducted on patients with high risk for AIFR at King Chulalongkorn Memorial Hospital over the past 15 years (2008-2022). We constructed several multivariate logistic regression models for AIFR diagnosis based on different subsets of variables from 3 categories: signs/symptoms, endoscopy, and CT imaging.ResultsThere were 67 AIFR-positive patients and 68 AIFR-negative patients. Combining variables from 3 categories, a 6-variable model (fever, visual loss, mucosal discoloration, crusting, mucosal loss of contrast, retroantral fat stranding) achieved the highest area under the receiver operating characteristic curve of 0.8900 (74.63% sensitivity, 89.71% specificity).ConclusionsWe proposed predictive models for AIFR diagnosis in high-risk patients using clinical variables. The models can be used to guide the decision for further management such as biopsy or surgical intervention.

The 'Life's Essential 8' (LE8), a recent framework introduced by the American Heart Association (AHA), refines and expands the concept of wellness, with a particular emphasis on promoting cardiovascular health. The fractional exhaled nitric oxide (FeNO) score, a non-invasive and easily obtainable biomarker, offers a convenient method for evaluating respiratory conditions such as asthma. While both LE8 and FeNO represent emerging and widely recognised indicators of health, research exploring their interrelationship remains limited. This study aims to examine the associations between LE8, FeNO, and all-cause mortality.

A total of 14,293 eligible participants, aged ≥18 years, were enrolled from the National Health and Nutrition Examination Survey (NHANES) database spanning 2007-2012. This observational cohort study integrated baseline NHANES data with mortality records from the U.S. National Death Index through 2021. To assess the association between LE8 and FeNO, we employed multiple linear regression models, both with and without adjustments for demographic factors and health-related practices. Additionally, these data were utilised to explore the relationships between various health determinants and all-cause mortality.

In this observational analysis, we found that an increase in the LE8 score was positively associated with elevated FeNO levels, a marker implicated in immune responses to respiratory diseases. Furthermore, higher LE8 scores were inversely associated with survival risk in the population, suggesting a potential protective effect on survival in the studied population.

Our findings suggest that primary and tertiary prevention efforts to promote cardiovascular health should be strengthened, especially those targeting unhealthy factors and behaviours to improve cardiorespiratory fitness and reduce survival risk.

Periprosthetic fractures (PPFs) are a significant complication in total hip arthroplasty (THA), with their incidence varying from 0.1% to 5.2% in registries. The use of a collared femoral stem may reduce the risk of PPF by enhancing the distribution of load and the stability of the implant. The aim of this study was to compare the effect of collared versus collarless stems on the incidence of PPFs in a large cohort of patients.

This retrospective study involved all primary THAs performed in a single centre between 1 January 2010 and 31 December 2020. Of the 2,182 THAs performed in 1,767 patients, 559 in 447 patients were excluded for the following reasons: having cemented stems, patients with a femoral neck fracture, dysplasia of the hip, or an oncological indication for surgery. A total of 1,623 THAs in 1,320 patients were included. The data which were collected included the patients' demographics, the surgical approach, the implant characteristics, and the incidence of PPF. Univariate and multivariate analyses were conducted using the Bursac's logistic regression model considering factors such as sex, age, BMI, surgical approach, and the presence of a collar.

There were nine PPFs within 90 days of surgery: five in the collared stem group (0.4%) and four in the collarless stem group (1.6%). Multivariate analysis revealed that the presence of a collar was the only significant independent predictive factor of a reduced rate of PPFs (p = 0.048). Other factors such as sex, age, BMI, and surgical approach did not show significant correlations.

The collared stem was a protective factor against early femoral PPF when cementless stems were used in primary THA. These results support the preference for collared versus collarless cementless stems, particularly in patients who are at a high risk of PPF, to enhance the initial stabilty of the stem and reduce complications.

Individuals with First Episode Psychosis (FEP) have a higher risk of compulsory admission, but evidence on its prognostic role on outcomes and its baseline predictors is poor. The aims of this investigation were to calculate incidence rate of compulsory admission in FEP individuals treated within an Italian "Early Intervention in Psychosis" (EIP) service across 2 years of follow-up, and to compare clinical and sociodemographic characteristics between FEP patients with and without compulsory admission during the follow-up.

500 FEP patients were recruited within the "Parma-Early Psychosis" program and completed a socio-demographic chart, the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale. For inter-group comparisons, Mann-Whitney and Chi-square tests, Kaplan-Meier survival analysis, Cox and binary logistic regression, and mixed-design ANOVA were performed.

30 (6 %) FEP participants were compulsory admitted. At baseline, they were likely to be males and to have a diagnosis of schizophrenia and lower GAF scores. Longitudinally, they had higher risk of service disengagement, new attempted suicide, and functioning impairment, and showed significant group effects in terms of more severe positive symptoms, negative symptoms, uncooperativeness, and GAF scores (0.023 < ƞ2 < 0.100). At baseline, the most robust predictor for compulsory treatment was uncooperativeness (HR = 1.460), while the strongest protective factor was family history of psychosis in first-degree relatives (HR = 5.790).

A not negligible part of FEP participants were compulsory admitted across the follow-up. This was longitudinally associated with poor outcomes and worse treatment response. Implementing initiatives to improve the skills of professionals to increase treatment motivation from presentation is crucial to promote positive outcomes.

Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in patients with RA treated with contemporary treatment strategies are lacking. The objectives were (1) estimate age-specific and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age-matched and sex-matched general population controls, and (2) compare the risk of all-cause mortality in RA and general population controls after hip fracture.

A longitudinal study of a population-based incident cohort of patients with RA diagnosed between 1997 and 2009, followed until 2014, with age-matched and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 820.0 or 820.2; ICD-10-Canada code S72.0 to S72.2) and mortality at predefined intervals after fracture (in hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRRs), were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA versus controls; logistic regression compared in-hospital mortality risk.

Overall, 1,314 hip fractures over 360,521 person-years were identified in 37,616 individuals with RA and 2,083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95% confidence interval 1.20-1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 ± 10.8 vs 81.6 ± 9.3 years). Postfracture mortality risk at one-year and five-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only individuals with RA who received disease-modifying antirheumatic drugs.

People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.

The aim of this study was to identify predictors of NCLEX-RN® failure and guide nursing program support and resources for at-risk students.

Prelicensure nursing programs have adopted stringent admission and progression policies and often delay student testing based on known predictors of NCLEX-RN success. Students also delay scheduling the exam based on their perceived level of test readiness. There is a gap in the literature associated with predictors of NCLEX-RN failure.

A retrospective predictive analysis was conducted on 3,396 graduates for the period 2018 through 2022 using demographic characteristics and academic metrics as variables.

Students who were men and students with increased lag time to take the NCLEX-RN (>45 days between graduation and initial attempt) were significantly more likely to fail.

Nursing programs using only known predictors of success for admission and progression decisions exclude students who could be successful if given the opportunity.

Hydroxyurea is the primary disease-modifying therapy for sickle cell disease (SCD), yet adherence is low. Our objective was to identify patterns and predictors of hydroxyurea adherence among Medicaid enrollees with SCD. Children and adults with SCD who received Medicaid benefits between 2009 and 2018 in California were included. Monthly hydroxyurea possession ratios were calculated using filled hydroxyurea prescriptions. Group-based trajectory modeling was applied to identify hydroxyurea possession trajectories and multinomial logistic regression modeling to evaluate predictors of hydroxyurea possession group membership: prior acute care visits due to VOCs, prescriber specialty, and participant sex and age. 713 participants (48% in the 0 to 17 age group, 50% male) had 3 distinct hydroxyurea possession groups: persistently high (n=263, 37%), moderate to low (n=253, 35%), and low to no possession (n=197, 28%). The 18 to 24 and 25+ age groups had greater odds of being in the moderate to low (OR: 2.62, 1.70) and low to no (OR: 3.60, 2.45) than the persistently high possession group compared with the 0 to 17 age group when adjusted for prior VOCs. Children had greater odds of being in the persistently high hydroxyurea possession group compared with young adults and adults, suggesting there are protective factors at this age that promotes better hydroxyurea adherence.

Loneliness is common among nursing home residents, and it is also thought to be a problem in assisted living (AL). However, we lack research on loneliness in AL. Our objectives were to assess changes in risk-adjusted prevalence of loneliness in AL, and facility-level variations in loneliness before and during the COVID-19 pandemic, and facility-level factors associated with AL resident loneliness during the pandemic.

This population-based, repeated cross-sectional study used Resident Assessment Instrument-Home Care (RAI-HC) data (01/2017-12/2021) from Alberta, Canada. On a system-level, we estimated quarterly, risk-adjusted loneliness prevalence, and used segmented regressions to assess whether loneliness changed after the start of the pandemic. For risk adjustment, we used resident-covariates known to be associated with loneliness, but out the health system's or AL home's control (e.g., age or cognitive impairment) to enable fair comparisons over time. Linking AL home surveys, collected in COVID-19 waves 1 (March-June 2020) and 2 (October 2020-February 2021) to RAI-HC records, we used covariate-adjusted general estimating equations (GEE) to assess AL home factors (e.g., staffing shortages, social distancing measures) associated with resident-level loneliness during the pandemic.

Quarterly samples included 2026-2721 residents. Loneliness [95% confidence interval] fluctuated between 13.6% [11.5%-15.7%], and 16.8% [14.4%-19.2%], with no statistically significant increase during the pandemic. Facility-level median [inter-quartile range] loneliness prevalence varied considerably before (14.9% [8.3%-21.1%) and during the pandemic (13.5% [6.9%-21.3%]). GEEs included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Facility-factors associated with decreased odds of loneliness included: facilitating caregiver involvement (odds ratio = 0.531 [95% confidence interval: 0.286-0.986]), essential visitor policies (0.672 [0.454-0.994]), and video calls with volunteers or religious/spiritual leaders (0.603 [0.435-0.836]). Facilitating outdoor activities/visits (2.486 [1.561-3.961], and providing hallway-based activities (1.645 [1.183-2.288]) were associated with increased odds of loneliness.

Loneliness did not change during COVID-19 in AL on a health system level, but varied considerably between facilities before and during the pandemic. Modifiable facility-level factors explained variations in loneliness within facilities, suggesting important targets for policies and improvement interventions.