The COVID-19 pandemic has revealed significant disparities in disease severity and mortality across various population groups and regions. These disparities cannot be attributed solely to healthcare systems, socioeconomic factors, living conditions, or individual immune landscapes; environmental factors also play a crucial role. This work explores how variations in nasal morphology related to age, gender, and race can affect the respiratory system's ability to filter, warm, and humidify inhaled air. These variations may contribute to differences in how cold, dry, polluted, and infected air impact the respiratory system, thus influencing the observed patterns of disparities in COVID-19 outcomes. The analysis suggests that individuals with genetically determined wider nasal cavities, often found in populations originating from warmer climates, have decreased filtration and air conditioning efficiency, leading to increased susceptibility to respiratory infections and disproportionately high mortality rates from COVID-19. Moreover, age-related changes in nasal morphology, such as increased nasal volume and involution atrophy of the mucosa, contribute to impaired air conditioning and filtration, thereby increasing the risk of severe outcomes in the elderly. Gender differences in nasal morphology, with men typically having larger nasal passages compared to women, are linked to poorer air conditioning and filtration, potentially contributing to the higher risk of severe COVID-19 in men. Preliminary statistical analyses of the U.S. population suggest that men with favorable nasal structures may have a longer life expectancy than those with less optimal nasal anatomy; however, this should be regarded as a hypothesis. The findings underscore significant gaps in our understanding and highlight the urgent need for further research to unravel the complex interplay between nasal morphology, respiratory system dynamics, and environmental factors in shaping disease susceptibility and outcomes.

Background: The loss of a co-worker always evokes complex emotions. Such a loss is particularly challenging for those who spend many hours at work and develop close interpersonal relationships with their colleagues. While many studies have examined how losing colleagues affects employees in various organizations, no research has specifically examined this topic in the school environment. Methods: This qualitative study explored the experiences of school counsellors facing the loss of colleagues from their school educational team. Twenty-one school counselors ranging in age from 28 to 61 who had lost a colleague within the past five years were examined by semi-structured in-depth interviews. The interviews were transcribed and analyzed using thematic content analysis. Results: Three main themes emerged from the data: (1) “From Shock to Action”: School Counsellors’ Reactions to Colleague Loss; (2) “From Friendship to Conflict”: School Counsellors' Diverse Experiences with Colleague Loss; and (3) “The Burden of Care”: Coping Mechanisms for School Counsellors Facing Colleague Loss. Conclusion: This study highlights the complex experiences of school counsellors in dealing with the death of colleagues. It underscores the importance of providing long-term emotional support for counsellors throughout their careers, particularly when coping with crises and emergencies.

A diet with low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) are established treatment for irritable bowel syndrome (IBS), with well-documented efficiency. A starch- and sucrose-reduced diet (SSRD) has shown similar promising effects. This randomized, non-inferiority study aimed to test SSRD against low FODMAP and compare the responder rates to a 4-week dietary intervention of either diet. 155 IBS patients were randomized to SSRD (n=77) or low FODMAP (n=78) for 4 weeks, with a follow-up 5 months later without food restrictions. The questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) were completed at baseline and after 2 and 4 weeks and 6 months. Weight, height, waist circumference, and blood pressures were measured. Comparisons were made within the groups and between changes in the two groups. There were no differences between groups at baseline. The responding rate (RR=∆Total IBS-SSS ≥−50) of SSRD was non-inferior compared with low FODMAPs at week 2 (79.2% vs. 73.1%;p=0.661;95% confidence interval (CI)=-20-7.2) and week 4 (79.2% vs. 78.2%;p=1.000;95%CI=-14-12), with borderline-significance at follow-up (36.4% vs. 42.3%;p=0.252;95%CI=-9.4-21). All gastrointestinal and extraintestinal symptoms were equally improved (p<0.001 in most variables). SSRD rendered greater reductions in weight (p=0.006), body mass index (BMI) (p=0.005), and sugar craving (p=0.05), whereas waist circumference and blood pressure were equally decreased. Weight and BMI were regained at follow-up. In the SSRD group, responders at 6 months still had lowered weight (-0.7 (-2.5-0.1) vs. 0.2 (-0.7-2.2) kg; p=0.005) and BMI (-0.25 (-0.85-0.03) vs. 0.07 (-0.35-0.77) kg/m²; p=0.009) compared with baseline in contrast to non-responders. Those who had tested both diets preferred SSRD (p=0.032). A 4-week SSRD intervention was non-inferior to low FODMAP regarding effects on gastrointestinal and extraintestinal IBS symptoms. Reductions of weight, BMI, and sugar craving were most pronounced following SSRD.

Background: The study investigates patients' use of eHealth services, awareness of the availability of these services, and their intention to use them in primary care. It also examines patient characteristics and factors that influence their use. Methods: A cross-sectional design using questionnaire were conducted. Based on the unified theory of acceptance and use of technology (UTAUT), participants rated the two most common services. Descriptive analyses and linear correlation analyses were performed. Simple linear regression was conducted identify factors influencing participants' intention to use eHealth services. Results: 1203 participants were surveyed and their’ ages averaged 43.7 years. Participants usage rates varied, with the lowest at 2.4% for measuring vital signs and the highest at 47.4% for booking appointments. Intentions to use services ranged from 22.5% for video consultations to 46.6% for prescription refill requests. Approximately 20% of respondents were unaware of each service's availability. Positive associations were found between all constructs and the intention to use online services, with younger age being the most significant factor. Conclusions: Use of and intentions to use eHealth services varied greatly. Participants were often unaware of the availability of services. Promoting the availability and benefits of eHealth services could enhance patient engagement in primary care settings.

Histological evidence of active prosthetic valve endocarditis (PVE) in cardiac valve tissue is widely regarded as a criterion established by Duke to confirm the presence of this condition, although the histological characteristics of mechanical prosthetic valve endocarditis have not yet been definitively established. The primary objective of this study was to determine the histologic differences in mechanical PVE in individuals with either early- or late-onset PVE, with the aim of distinguishing the unique aspects of this rare condition. Histological analysis of mechanical cardiac valve tissue was conducted in 27 patients who underwent surgical valve removal, comprising individuals with early onset and late-onset PVE. The findings were compared between the two groups. Histopathologically, PVE in individuals with mechanical heart valves is typically associated with the formation of vegetation and considerable neutrophil-rich infiltrates. In cases of early onset PVE, the affected valve tissue displays intense inflammation predominantly consisting of lymphocytes. In contrast, valve tissue samples from patients with late-onset PVE exhibit extensive fibrosis and inflammation, comprising macrophages, which are specialized immune cells and calcifications.

With an aging population, the prevalence of geriatric diseases is increasing, especially among older individuals who live alone. This study investigates the potential of using TV viewing patterns to detect these diseases by analyzing variables such as daily average viewing time, peak viewing hours, and channel-switching behaviors. Significant correlations between TV viewing patterns and early indicators of geriatric diseases (depression, activities of daily living (ADL) performance, and cognitive function) were found. The correlations between the Korean form of the Geriatric Depression Scale (KGDS) and daily average viewing time and excessive channel switching were 0.320 and 0.308, respectively. The Korean version of the Modified Barthel Index (KMBI) showed correlations of -0.313 with daily average viewing time and -0.352 with excessive channel switching. Participants were divided into groups based on scores, and significant differences in peak viewing hours were observed among the different groups. The Korean version of the Mini-Mental State Examination (MMSE-K) groups showed significant differences at 3, 4, and 5 PM. The KGDS and KMBI groups showed significant differences at 8 PM and midnight and 1 AM and 2 AM, respectively. These findings suggest that TV viewing patterns can serve as effective early diagnostic indicators for geriatric diseases.

Asbestos, also known by its commercial name of amianthus, has been a widely used material in various industries due to its unique properties. However, its extensive use has led to serious consequences for human health, most notably asbestosis, an irreversible chronic lung disease. Asbestosis increases the risk of lung cancer and malignant meso-thelioma both fatal diseases. To understand the role of asbestos in human health, applied sciences such as microscopy (optical and scanning electron microscopy) and geochemistry are fundamental to characterize the mineral fibers. In previous work we used these technics to characterize the fibers and, in this paper, we explore their issues associated with asbestos and asbestosis, as well as the challenges of science communication strategies to effectively inform society and workers about these risks. The lack of scientific culture, in general, leads to the lack of public awareness of risks, and to address these challenges, it is essential to implement effective communication and outreach plans and strategies, including the visualization of the fibers to understand why there may be a problem if inhaled. Educational campaigns, guidelines and plans that are informative and action-able, targeting workers, communities and the public about asbestos risks are very im-portant. General knowledge of mineralogy and geochemistry is needed and providing proper scientific communication and dissemination may help to cover the knowledge gap. We use examples and experience in Spain and Italy to illustrate this subject.

Background: Screening for postpartum depression can lower prevalence and ensure that mothers get adequate treatment and support. Yet, few practitioners screen.The present article is a brief review on barriers to screening and two screening scales that are validated for perinatal women. Findings: Despite recommendations from health organizations, most new mothers are not screened for depression. Providers cite lack of time, opening “Pandora’s box,” and lack of resources for mothers who screen positive as reasons for why they do not screen. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaires are brief screening scales that have been validated for new mothers and are widely available.Conclusions: Screening is the necessary first step to identifying new mothers who are depressed. Practitioners who screen need a clear plan, and to know how to access available community resources, so they will know what to do when a mother screens positive.

Substance use is a growing problem among young people in sub-Saharan Africa; tobacco use is the dominant one among these practices. The aim was to analyse prevalence rates and determinants for cigarette smoking of school-attending adolescents in the capital, Bissau, Guinea-Bissau. In June 2017, a survey questionnaire was implemented in 16 schools among adolescents aged 14–19 (52% girls). The Chi-square (p&lt;0.05) and odds ratios (OR) were calculated with 95% confidence intervals (CI). Potential explanatory variables for the dependent variables were introduced into a multinomial logistic regression model, and p-values were transformed to LogWorth values. The prevalence of lifetime smoking experience among 1,845 participants was 14.8%; 6.5% were current users, and 2.2% were daily smokers. The most significant determinants for cigarette smoking included having friends who smoke, being a boy, attending a private school, smoking initiation at a young age, other substance use and violent behaviour. It is imperative to initiate preventive actions against smoking and other use of tobacco in Guinea-Bissau. Considering the significant impact of the peer group, policymakers need to engage young people in developing primary prevention strategies to curb the use of tobacco and other substances.

Background: Research suggests that cognitive and behavioural factors, including lifestyle behaviours, contribute to the mitigation of perceived stress and stress-related health outcomes in later life. Given that stress management and lifestyle behaviour interventions for older adults are an important target for healthcare efforts, there is a need to comprehensively measure stress and coping resources in later adulthood. Additionally, researchers need a relatively short, standardized assessment tool that can robustly measure stress and coping for longitudinal and intervention-based studies to reduce burden on participants and for cross-comparison across research. Methods: The Stress Assessment Inventory (SAI), a valid and reliable 123-item measure designed to assess occupational stress and coping resources in younger adults was examined in 294 independent older adults. Results: A shortened and revised SAI is proposed for older adults, with good internal consistency and strong criterion validity. The revised SAI for older adults was found to have a 4-factor model that captures Adaptive Cognitive Resources, Maladaptive Behavioural and Cognitive Habits, Social Support and Adaptive Health Habits. Conclusion: The current study supports the use of the inventory in community-dwelling older adult populations as a comprehensive tool to assess stress and coping for use by researchers and healthcare professionals.

This study aimed to determine the COVID-19 recovery time and identify predictors among hospitalized patients in the Dhanusha District of Madhesh Province, Nepal. This hospital-based longitudinal study involved 507 COVID-19 patients admitted to three distinct medical facilities for therapeutic intervention between April to October 2021. Data were collected for patient demography, symptoms, vital signs, oxygen saturation levels, temperatures, heart rates, respiratory rates, and blood pressure measurements and other health-related conditions. Kaplan–Meier Survival Curve estimated the recovery time from, and Cox proportional hazard model was used to identify the predictors of recovery time. Of the total participants, mean age was 51.1 (SD=14.9) years, 68.0% were males, 49.5% recovered, and 16.8% died. The median for patient recovery was 26 days (95% CI: 25.1–26.7). Patients with severe or critical conditions were less likely to recover compared to those with milder conditions (Hazard Ratio (HR)=0.34, 95% CI: 0.15-0.79; p=0.012). In addition, an increase in oxygen saturation was associated with an elevated likelihood of recovery (HR=1.09, 95% CI=1.01-1.17, p=0.018). This study underscores the need for early admission in hospital and emphasizing the targeted interventions in severe cases. Additionally, the results highlight the importance of optimizing oxygen levels in COVID-19 patient care.

The rapid integration of Generative AI technologies in academic and research environments marks the beginning of a new digital era, characterized by enhanced efficiency and innovative capabilities. This technological advancement, however, brings forth significant challenges and ethical dilemmas. One of the primary concerns is the potential diminishment of authentic human intellect in scholarly works, fueled by the capabilities of AI to generate ambiguous, fabricated, or even biased and inappropriate content. These issues highlight the critical need for developing comprehensive frameworks and establishing a dedicated field of study to govern the use of AI-generated content in academic and professional contexts. This autoethnography explores the impact of generative AI on educational practices, detailing the development of the SPARRO framework in healthcare and nursing classes. Through personal reflections, interviews, and observations, it addresses specific challenges, offering insights into integrating GenAI ethically and effectively to enhance teaching and learning.

Several technologies have been introduced into neurorehabilitation programs to en-hance traditional treatment of individuals with Spinal Cord Injury (SCI). Their effec-tiveness has been widely investigated but their adoption has not been properly quanti-fied. The aim of this study is to assess the distribution of conventional (Treatment As Usual – TAU) and technology-aided (Treatment With Technologies – TWT) treatments, conveniently grouped based on different therapeutic goals, in a selected SCI unit. Data from 104 individuals collected in 29 months were collected in a custom database and categorized according to both the conventional American Impairment Scale classifica-tion and a newly developed multifactor (MF) clustering approach, that considers addi-tional sources of information (the lesion level, the level of independence in the activi-ties of daily living and the hospitalization duration). Results indicated an average technology adoption of about 30%. Moreover, the MF clusters were less overlapped and the differences in TWT adoption were more pronounced than in AIS-based clus-tering. MF clustering was capable of grouping individuals based both on neurological features and functional abilities. In particular, individuals with motor complete inju-ries were grouped together, whereas individuals with sensorimotor incomplete SCI were collected separately based on the lesion level. Analyzing TWT adoption, we found that in case of motor complete SCI, TWT for muscle tone control and modulation were mainly selected while the other types of TWT were seldom adopted. Even for in-dividuals with incomplete SCI the most frequent rehabilitation goal was muscle tone modulation, regardless of the AIS level, and technologies to improve walking ability and balance control were mainly used for individuals with thoracic or lumbar lesions. Analyzing TAU distribution, we found that the highest adoption of muscle tone mod-ulation strategies was reported in case of individuals with motor complete SCI, i.e. in cases when almost no gait training was pursued. In case of cervical motor incomplete SCI, compared to thoracic and lumbar incomplete SCI, there was a greater focus on muscle tone control and force recruitment in addition to walking, than on balance training.

Introduction: Adolescence is a critical period for the development of affectivity and sexual-ity. Adolescents begin to explore their sexual identity, form intimate relationships, and learn to manage their emotions in new and complex contexts. This study aims to analyze the prevalence of habits and behaviors related to the affective-sexual health of adolescents in the 4th year of ESO, identifying risk factors, comparing behaviors and risks, monitoring these behaviors, analyzing pornography consumption, and evaluating the use of the in-ternet as a source of sexual information. Method: Descriptive cross-sectional study using questionnaires. Participants are 4th-year ESO students from a school in the Baix Llobregat province (Catalonia) aged between 14 and 18 years. Descriptive and bivariate statistical analyses were conducted using the Chi-square test and p-value calculations with R Project software. Frequency and percentage analyses were also used to describe the health behav-iors of the participants. Results: The study reveals that girls have better knowledge of the contraceptive pill and male condom than boys. Sexual initiation and condom use man-agement vary between genders, with girls being more capable of persuading their partners to use them. Pornography consumption also shows significant differences in age of initia-tion and frequency between boys and girls. Conclusions: The study on adolescent affectiv-ity and sexuality reveals knowledge about contraceptives, early sexual initiation, and high pornography consumption, highlighting the need for early and diverse affective-sexual education, youth empowerment, and media misinformation management to promote safer and healthier behaviors in municipal public health. Keywords: Adolescents, Sexuality, Sexual Health, Pornography Consumption, Contracep-tive Knowledge, Gender Differences

Asthma is a chronic inflammatory disease for which the main anti-inflammatory drugs for better disease control are steroids or corticosteroids. The use of steroids in asthma patients, in particular in uncontrolled asthma patients, is associated with an increased risk of osteoporosis and fragility fractures. A single oral corticosteroids course increases the risk of osteoporosis and continual use of inhaled corticosteroids is correlated over time to an increased risk for both bone conditions. With the use of new, available biologic therapies for asthma, perhaps even anticipating the times of their use in what are the steps of therapeutic management, in the current guidelines and with targeted strategies of prevention it may be possible to improve asthma management, preventing some comorbidities, such as osteoporosis.

In surgically treated individuals with surgical stomas, the return to sports activity is an indicator of quality of life that reflects their well-being. With the aim of synthesizing the available evidence regarding the return to physical activity and sports practice in individuals with surgical stomas, a scoping review was developed following the methodological approach of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews criteria. Searches were conducted in Medline (PubMed), Scopus, Web of Science, Cinahl, and Lilacs, as well as the meta-search engines TripDatabase and Epistemonikos, using the MeSH terms "exercise", "return to sports", and "surgical stomas"; including studies in Spanish, English, Portuguese, and German, without any limitation on the year of publication. A total of n = 15 studies with different designs were included (n = 2 qualitative; n = 1 cohort; n = 8 cross-sectional; n = 2 case reports; n = 1 case series; and n = 1 Randomized Clinical Trial), which showed variability in the quality of the designs. The studies revealed the complex relationship between physical activity and having surgical stomas, associated with the individuals' characteristics. There is a need to increase the number and rigor of research to understand the phenomenon of return to physical activity and sport, thus providing evidence-based clinical recommendations for sports practice in people with stomas.

Choline and essential fatty acids (EFA) are vital for fetal brain development, supporting pregnancy, and maintaining hormonal balance. They also promote overall health. The childbearing years present a window of opportunity to increase the intake of these key nutrients and develop healthy dietary habits. Survey data were collected for the Estudio Latinoamericano de Nutrición y Salud (ELANS), including participants from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela (n=9,218; 15-65 years old). Women of childbearing age were extracted from the largest database (n=3,704). The aims of this study were to evaluate the intake of choline and essential fatty acids in women of childbearing age, identify their food sources, and determine if supplements containing choline and EFA were available across the ELANS countries. In general, choline intake was inadequate in all countries, while essential fatty acids intake was normal or above requirements. Chile had the lowest intake of choline and Colombia the highest. The results showed that some countries had more inadequate choline intake than others. Consuming a larger quantity of eggs helped reduce choline inadequacy, as did including eggs and fish in the diet. The intake of essential fatty acids, including ALA, EPA, and DHA, showed variability. The contributions of EPA and DHA were lower than that of ALA, and the results differed by age group. In conclusion, choline intake is inadequate and EFA intake is variable among women of childbearing age in the ELANS study. More awareness and education are needed to achieve better intake of these nutrients.

We were tasked by Canada’s COVID-19 Immunity Task Force to describe severe adverse events (SAE) associated with emergency department (ED) visits and/or hospitalizations in immune-mediated inflammatory diseases (IMID). At 8 Canadian centres, data were collected from adults with rheumatoid arthritis (RA), axial spondyloarthritis (AxS), systemic lupus (SLE), psoriatic arthritis (PsA) and inflammatory bowel disease (IBD). We administered questionnaires, analyzing SAEs experienced within 31 days following SARS-CoV-2 vaccination. About two-thirds (63%) of 1556 participants were female; mean age was 52.5 years. BNT162b2 (Pfizer) vaccine was the most common, with mRNA-1273 (Moderna) being second. Forty-nine percent of participants had IBD, 27.4% RA, 14.3% PsA, 5.3% SpA, and 4% SLE. Twelve SAEs leading to ED visit or hospitalization were self-reported, occurring in 11 participants. SAEs included 6 ED visits (including one Bell’s Palsy 31 days after first vaccination) and 6 hospitalizations (including one Guillain-Barré syndrome 15 days after the first vaccination). Two SAEs involved pericarditis, one in SLE (considered a serious disease flare) and one in RA. Thus, in the 31 days after SARS-CoV-2 vaccination in IMID, though several serious AEs occurred, these were relatively few. As SARS-CoV2 continues to be a common cause of death, our findings may help optimize vaccination acceptance.

Children and adolescents (C&A) with congenital heart defects (CHD) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased oxygen saturation. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify current evidence describing the impact of physical activity (PA) interventions on EF in C&A with CHD. The following databases were searched from 2014-present: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. Article inclusion criteria consisted of participants from birth to 18 years with CHD, interventions related to PA, and EF as an outcome. Articles were excluded if: adults were included, translation to English was impossible, and full access was unavailable. As a result of the review, 431 studies were screened. Three articles underwent full analyzation and only one met all criteria and this study found that with exercise there were significant improvements on self-reported cognitive functioning and parent-reported social functioning. Despite theoretical benefits, only one published study has investigated the role that PA interventions have on EF in C&A with CHD. Further investigation of the effect PA interventions have on EF in C&A with CHD is needed.

Health literacy is a growing research area with specific aspects and different instruments to measure health literacy. This article uses natural language processing model to analyze the academic corpora regarding seven health literacy instruments - Health Literacy Questionnaire, Mental Health Literacy Scale, Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults, Health Literacy Survey, The Newest Vital Sign and eHealth Literacy Scale. We apply Structural Topic Modeling to all the abstracts of the selected academic corpora, label the topics based on their focus, and use the topic distribution with metadata to train a Random Forest algorithm for predicting yearly citations. We estimate Regression models based on the ranking of the most relevant features, which serves as a robustness check and to infer their impact on citation dynamics. We have found that Digital Health Literacy is positively associated with yearly citations, while other topics such as Functional Health Literacy and Women's Health reduce citation likelihood. Other article characteristics also have shown a significant role in the citation likelihood, such as the publication year, amount of articles and certain keywords. These findings portray the current landscape of health literacy research, highlighting literature gaps and popular topics.

Emotional intelligence may help nurses to cope with demanding work environments. Although it is well known that emotional intelligence is positively related to work performance literature on nurses is limited. The aim of our study was to examine the impact of emotional intelligence on work performance in a sample of nurses in Greece. We conducted a cross-sectional study in Greece. We collected data from a convenience sample of nurses during January 2024. We measured emotional intelligence with the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and work performance with the Individual Work Performance Questionnaire (IWPQ). We created multivariable linear regression models adjusted for sex, age, educational level, and work experience. We found that the four streams of emotional intelligence (i.e. well-being, self-control, emotionality, sociability) increases nurses’ work performance. In particular, we found a positive relationship between well-being and task performance and contextual performance. Similarly, there was a positive relationship between self-control and task performance. Additionally, sociability increased task performance and contextual performance. Moreover, emotionality and sociability reduced counterproductive work behavior. Our multivariable models identified a positive impact of emotional intelligence on nurses’ work performance. Nurses managers and healthcare organizations should adopt appropriate interventions to improve nurses’ emotional intelligence.

Type 2 diabetes mellitus (T2DM) is a global health concern driven by factors such as obesity, sedentary behavior, and poor diet. This study uses data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS) to analyze regional and individual predictors of diabetes and predi-abetes. Employing a Bayesian multinomial mixed-effects model, we account for regional varia-bility and individual factors like age, gender, BMI, residence, wealth, education, employment, and hypertension. Our results indicate significant regional differences and associations between de-mographic and health-related factors with diabetes risk. Younger individuals and those with higher BMI are more likely to be diabetic, while hypertension significantly increases diabetes risk. We applied machine learning (ML) models, including logistic regression, decision trees, k-nearest neighbor, linear discriminant analysis, and random forest, to classify diabetic status using these predictors, assessing their accuracy through 10-fold cross-validation. Logistic regression and linear discriminant analysis demonstrated robust performance across various response distributions. Simulation studies further examined the impact of different response distributions on model performance, revealing significant differences in classification accuracies. This approach of esti-mating parameters with a Bayesian model, applying ML for prediction, and conducting simulation studies to explore various scenarios highlights the importance of integrating these methodologies for effective diabetes prediction, providing insights for public health strategies to mitigate T2DM's impact.

This paper presents a co-designed solution aimed at improving community healthcare assistance management. To enhance patients’ self-awareness of their health status, encouraging active participation in care process, and to support nurses in delivering patient-centered care, we have developed an innovative platform with a highly customized app. This platform was designed using a multi-disciplinary bottom-up approach. Patient data collection and processing facilitate the automation of care timeline planning, based on real time patients’ needs and the available resources. To achieve this goal different components have been considered: real-time health data collection and processing, patient care planning, decision support for nurses, secure communication for data transmission, and user-friendly interfaces to ensure easy access to platform functionalities.

Several years now, the global scientific community has accepted and recognized the importance of Evidence-based practice (EBP) for Nursing science. The main factor for the implementation of EBP is the competence of undergraduate Nursing students towards EBP, so that they as active nurses be ready for its application in their clinical practice, in order to provide better care for their patients. The aim of the present study is to examine the level of evidence-based practice competency evaluated with the self-reported EBP-COQ questionnaire. A quantitative study based on cross-sectional design was conducted from February to June 2022 in a convenience sample of Greek undergraduate nursing students. The Evidence-Based Practice Competence Questionnaire (EBP-COQ) and a questionnaire on undergraduate students’ gender, age, academic year, and training in the field of research were used. The SPSS 26.0 program was used to perform descriptive, bivariate and multivariate analyses. A total of 175 undergraduate students participated at the Hellenic University Nursing (Greece), specifically from the 2nd and 3rd academic year. The mean score of EBP-COQ for nursing undergraduate students was 3.03 ± 0.26, indicating moderate EBP. Among the EBP-COQ dimensions, the mean scores were obtained 3.03 ± 0.32 for Attitude toward EBP, 3.01 ± 0.49 for Skills in EBP, and 3.03 ± 0.49 for Knowledge in EBP. They were not found significant differences among participants’ mean EBP-COQ scores regarding gender (p = 0.766), age (p = 0.400), academic year (p = 0.153), and training in the field of Research Methodology (p = 0.538). It appears that the level of readiness towards EBP is mediocre between undergraduate nursing students at a university in Greece. Therefore, it is necessary to carry out new studies in the future, so that there is a correct approach of all the elements that contribute to the readiness of Nursing undergraduate students regarding EBP.

The COVID-19 pandemic has triggered seismic shifts in how we work, and organizations behave. It has caused many organizations to transition from an office-centric culture to more flexible ways of working. This shift is necessitated by health conditions and the need for controls. It is also driven by the assumption that remote work or working from home offer a certain assurance of safety for employees against the threat of infection in highly vulnerable office conditions. The shift to remote work has so far been mainly experimental as most businesses continue to learn about what works and what doesn’t. There is also the assumption that all that matters for the efficient operability of a remote work regime is the availability and effectiveness of computing technologies and internet connectivity. Thus, once those supplies are in place remote work is expected to be fully functional and without problems. As learning continues about what works and what doesn’t, it has also become increasingly clear that beyond the threat of covid-19 and the relative safety that individual homes may offer, there are other vulnerabilities which are ignored or underestimated in the process. In most instances, the home environment of the employee, the conditions under which employees operate from home and the health and safety such environments provide (or not) are either ignored or underestimated in discussions around remote work practices. This paper highlights remote work as an emergent practice while exploring associated, but ignored, health and safety issues in employee homes.

Ferritin is an indirect marker for total body iron stores. Comparison of the ferritin concentrations in the meconium with the concentrations of proteins regulating iron metabolism could aid better understanding of principles behind the adjustment between the fetal iron pool and newborn body size. Ferritin, transferrin, haptoglobin, ceruloplasmin, lactoferrin, myeloperoxidase, neutrophil gelatinase-associated lipocalin (NGAL) and calprotectin concentrations were measured by ELISA in meconium samples from 122 neonates. The neonates were classified according to the meconium ferritin tertiles and the values were collated with the meconium concentrations of other proteins and newborn body weight and length measurements. Increasing ferritin concentrations in meconium in consecutive tertiles (p < 0.05) were parallel to increased NGAL concentrations (p < 0.05). The interrelationships between the meconium concentrations of transferrin, haptoglobin and NGAL as well as between myeloperoxidase, calprotectin and lactoferrin are maintained in all subsequent tertiles of ferritin concentrations, (p < 0.05). In contrast to ferritin, increasing meconium NGAL concentrations in consecutive tertiles were linked to increased concentrations of transferrin, haptoglobin, lactoferrin and myeloperoxidase (p < 0.05) and of calprotectin, ferritin and ceruloplasmin (p < 0.1). Meconium ceruloplasmin concentrations correlate exclusively with neutrophil granule proteins, i.e. myeloperoxidase, NGAL, lactoferrin and calprotectin (p < 0.05). Meconium ferritin concentrations negatively correlates with birth weight (r= -0.20) and length (r= -0.31) of neonates, whereas NGAL concentrations just with birth length (r= -0.26). The remaining proteins did not show such relationships with the size of the newborn. High meconium concentrations of both ferritin and NGAL may specifically characterize neonates of smaller size. High meconium concentrations of both ferritin and NGAL may specifically characterize neonates with lower body measurements. Correlations between meconium transferrin, haptoglobin and NGAL may confirm the interrelationships of these proteins for proper iron control and transport in the intrauterine environment. Meconium ceruloplasmin concentrations may reflect the control of neutrophil activity in utero.

Introduction; to the best of the authors knowledge no past research has established how illness narrative master plots are expressed initially, and then if, and how they change longitudinally following musculoskeletal trauma. The aim of the current research was able to consider how specific master plots were expressed, interact and change across time following musculoskeletal trauma. Methods; a narrative analysis was undertaken that included individuals who had experienced a musculoskeletal traumatic injury. Individuals were included if they were an inpatient within 4 weeks of the first interview had mental capacity to participate and were able to communicate in English. Three interviews were undertaken (within 4 weeks of injury, 6 and 12 months). A 5-stage categorical form type narrative analysis was performed. Results; Twelve individuals (49.9±17.5 years; 7 male, 5 female) completed interviews at three time points following the trauma event (&lt;4 weeks months, 6 months and 12 months). Three main narratives that appeared to work together to facilitate a positive accommodation of the trauma event into the individual’s life were presented. These included the resumption narrative, the activity narrative and quest narrative. Finally, less often regressive narratives were identified although these narratives were, at times, actively avoided. Discussion; The current results provide important consideration for how narratives are used within clinical practice, in particular the value of how these three narratives could be access and promoted.

Previous studies have examined the impact of Internet use on health in China, but they have not adequately addressed the issue of reverse causality or conducted a detailed analysis of health status. This study uses three waves of longitudinal data from the China Family Panel Studies conducted in 2014, 2016, and 2018 to investigate the association between Internet use and health status in China, aiming to address these gaps. The results indicate that Internet use may improve health status, including self-rated health, mental health, and outpatient visits. These effects vary by gender and age group: the positive effect of Internet use on health outcomes is more pronounced for women, and for middle-aged and older generations, compared to men and younger generations. These findings provide new evidence of the beneficial impact of Internet use on health outcomes in China, suggesting that policies promoting Internet utilization could enhance individuals’ health status, particularly among women and middle-aged and older populations.

Antimicrobial resistance (AMR) is a global threat associated with high morbidity and mortality, particularly in low- and middle-income countries. Inappropriate use of antimicrobials is one of the major drivers of the AMR pandemic. This study aims to evaluate the rate and quality of antimicrobial prescription and use at the University Teaching Hospital of Kigali, a tertiary referral and teaching hospital. A point prevalence survey (PPS) of antimicrobial prescription was conducted using the Global PPS tool, including the healthcare-acquired infections (HAI)-module. On the day of PPS, 39.3% (145/369) of the patients were prescribed at least one antimicrobial. Out of 259 prescribed antimicrobials, 232 (89.6%) were antibacterials of which 151 (65.1%) belonged to the Watch-group of the WHO AWaRe classification. Top three antibiotics prescribed were cefotaxime (87; 37.5%), parenteral metronidazole (31; 13.4%); and meropenem (23; 9.9%). Stop/review of the prescribed antimicrobials was documented in 27/259 prescriptions (10.4%). Surgical prophylaxis (SP) was prescribed for more than one day in 83.3% of 61. Samples for culture were sent for 27.1% (63/232) of all prescribed antibiotics. This PPS showed a high usage of Watch antibiotics, prolonged surgical prophylaxis and other poor-quality indicators. Therefore, there is an urgent need for antimicrobial stewardship interventions.

(1) Background: Youths with multiple risks and severe disadvantages experience poorer health and educational outcomes than less disadvantaged peers. To address problems with coping and self-regulation in this group, mental skills training (MST) approaches more commonly used in sport are an emerging intervention approach. (2) Methods and Results: This narrative review synthesizes literature to explain the need for MST, how it works, and evidence to support it works by focusing on two well evaluated programmes: LifeMatters and My Strengths Training for Life™. (3) Conclusions: To support positive youth development, MST is a strengths-based, flexible and adaptable approach to help fill the shortage of available evidence-based programs for those youths facing multiple disadvantages. The findings of this review may facilitate policy makers, commissioners, program planners, and researchers in the uptake of MST or similar psychoeducational approaches in future.

Breakthrough COVID-19 (occurring in fully vaccinated people) has been described. Data on its characteristics among immune mediated rheumatic disesases (IMRD) patients are scarce. This study describes breakthrough COVID-19 among IMRD patients participating of SAFER-study, a Brazilian multicentric cohort evaluating safety, effectiveness and immunogenicity of SARS-Cov-2 vaccines in autoimmune diseases. Descriptive analysis and a binary logistic regression model, to evaluate predictors of COVID-19-related hospitalization, were performed. P-value < 0.05 was significant. The included 160 patients were predominantly females (83.1%), with mean (SD) age 40.23 (13.19) years. Patients received 2 (19%), 3 (70%) or 4 (11%) vaccine doses. The initial two-dose series was mainly with ChAdOx1 (Oxford/AstraZeneca) (58%) or BBIBP-CorV (Sinopharm-Beijing) (34%). The first booster (n=150) was with BNT162b2 (BioNtech/Fosun Pharma/Pfizer) (63%) or ChAdOx1 (29%). The second booster (n=112) was with BNT162b2 (40%) or ChAdOx1 (26%). COVID-19 hospitalization rate was 17.5%. IMRD moderate/high activity (OR: 5.84, CI: 1.9-18.5, p=0.002) and treatment with corticosteroids (OR: 2.94, CI: 1.02-8.49, p=0.0043) associated with higher odds of hospitalization, while the increasing number of vaccine doses was protective (OR: 0.37, CI: 0.15-0.9, p=0.032). These findings, along with previous reassuring results about the safety of the COVID-19 vaccines, argue in favour of booster vaccination in IMRD patients.

This study aims to evaluate the effectiveness of inactivating Salmonella enteritidis in fresh chicken breast by irradiation using a combination of short-wave UV (0, 3, 6, 9, 12 and 15 J / cm2) and a natural antimicrobial such as caffeine (0, 5, 10, 15 and 20 nM/g) as alternative proposals to conventional techniques to reduce pathogens in food. The temperatures used were from 2 to 22°C. The most suitable models were double Weibull in 60% of cases with an adjustment of R2 0.9903-0.9553 and Weibull + cola, in 46.67%, with an adjustment of R2 of 0.9998-0.9981. Noting that the most effective combination in the reduction of Salmonella was 12 J/cm2 of UV light and 15 nM/g of caffeine, with a reduction of 6 CFU/g and an inactivation rate of 0.72. The synergistic effect was observed by increasing caffeine and UV light. Furthermore, the physic-chemical characteristics of the food matrix were not affected by the combination of both technologies. Therefore, these results suggest that this combination can be used in the food industry to effectively inactivate Salmonella enteritidis, without deteriorating product quality.

The aim of present study was to assess the microbiological quality of eight traditional meat products (black pudding, white brown, baked pate, roasted pork, raw smoked ham, smoked steamed sausage, raw smoked bacon, raw smoked loin) manufactured by polish farmers in the Lodz region. A total of 37 samples were collected and analyzed twice: within 24 h after purchase from manufactures and after 7 days of storage. Mesophiles, lactic acid bacteria (LAB), Enterobacteriaceae, presence of Listeria monocytogenes and Salmonella spp. were determined. The counts of isolated microorganisms varied depending on the product type and manufacturer. Mesophiles and lactic acid bacteria constituted the main microflora in the tested meat products. Enterobacteriace value was below detection limit in the most samples. The highest mean bacteria counts (mesophiles, LAB and Enterobacteriace) during storage were estimated in black pudding, followed by smoked steamed sausage and white brown. In opposite, the lowest mean bacteria levels were in baked pate and roasted pork. The obtained results showed significant influence of storage time on the mean number of mesophiles and LAB in the meat samples. Negative results for Salmonella spp. and Listeria monocytogenes were observed during 7 days of storage, indicating the safety of the studied meat products.

Abstract: Epidemiological, experimental, and ecological data have indicated the controversial effect of in utero chronic low dose rate (100 mGy) dose radiation exposure. Our main goal of this study was to examine if different low dose rates of chronic pre- or/and post-natal radiation exposure with accumulative high doses could induce hippocampal cellular, mRNA, and miRNA changes leading to neuropsychiatric disorders. The comprehensive mouse phenotypic traits, organ weight pathological, blood mRNA and miRNA changes were also studied. Using different approaches including SmithKline, Harwell, Imperial College, Royal Hospital, Phenotype Assessment (SHIRPA), neurobehavioral tests, pathological examination, immunohistochemistry, mRNA and miRNA sequencing, and real-time quantitative polymerase chain reaction ( qRT-PCR) validation, we found that in prenatally irradiated (100 mGy/d for 18 days with an accumulative dose of 1.8 Gy) 1-year-old mice, no cellular changes including neurogenesis, mature neurons and glial cells in the hilus of the dentate gyrus and development of cognitive impairment, neuropsychiatric disorders occurred. However, a significant reduction in body weight and mass index (BMI) was indicated by the SHIRPA test. A reduced exploratory behavior was shown by an open field test. Organ weight measurement showed a significant reduction of the testes, kidneys, heart, liver, and epididymides although no abnormal changes from pathological examination. mRNA and miRNA sequencing and qRT-PCR validation revealed the upregulation of Rubcnl, Abhd14b and downregulation of Hspa1b, P4ha1, and Banp genes in both hippocampus and blood of mice prenatally irradiated with 100 mGy/d. Meanwhile, downregulation of miR-448-3p, miR1298-5p in the hippocampus, miR-320-3p, miR-423-5p, miR-486b-5p, miR-486b-3p, miR-423-3p, miR-652-3p, miR-324-3p, miR-181b-5p, miR-let-7b and miR-6904-5p in the blood was induced. The target scan revealed that Rubcnl is one of the miR-181b-5p targets in the blood. We, therefore, concluded that prenatal chronic irradiation with a low dose rate of 100 mGy/d and accumulative dose of 1.8Gy or below may not induce significant adverse health effects on the offspring. Further study of different low dose rate radiation exposure with accumulative high doses may provide threshold doses for authorities or regulators to set new radiation safety guidelines to replace those extrapolated from acute high dose/dose rate irradiation to reduce unnecessary emergency evacuation or expanding once a nuclear accident or leakage occurs.

Hemoglobin S (Hb S) is genetically inherited variant of hemoglobin affecting around 300 000 infants are born annually. Facilitates for universal population testing of carrier state are available only in developed countries. The screening tests for Hb S have their respective limitations and the confirmatory tests are costly and require experts for conduct and interpretation. The use of two tests will enhance the overall diagnostic accuracy at the level of screening. We have considered two scenarios for population screening for SCD – community based in health camp mode / house to house survey and facility-based mode at health center. The combination of lateral flow immunoassay based POCT with sickling test can be used in absence of HPLC for population screening. However, for antenatal women portable microelectrophoresis based test is recommended as it flags the presence other hemoglobin variants along with Hb S.

This study aimed to compare the levels of physical activity and quality of life reported by Chileans with and without osteoarthritis (OA). Educational level and monthly income data were collected from eighty-two participants (62 women and 20 men), of whom 41 had OA. Concerning the medical information of the persons suffering from OA, diseases, and date of diagnosis were indicated. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) and its Elderly version (IPAQ-E) estimated physical activity levels. The Short Form 36 Questionnaire (SF-36) assessed health-related quality of life. The findings indicate that non-OA subjects scored higher on all dimensions of the SF-36, including physical function, physical role, bodily pain, general health, vitality, social function, emotional role, and mental health. Individuals with OA reported better physical function and role, general health, vitality, social function, and mental health when they walked more. However, no associations were found between any physical activity levels and the degree of pain in people with OA. Our findings underscore the critical role of investigating physical activity in OA patients to enhance their quality of life, particularly in light of the increased sedentary behavior observed post-pandemic.

Abstract: Coal production in mining areas frequently results in a host of negative effects that spread to the neighboring populations, affecting their general well-being and health. This qualitative investigation, which sought to understand how communities living close to coal mines evaluated the effects of mining on their health and well-being, was motivated by the dearth of literature in the province of Limpopo. Eighty-one people in three villages close to the mine provided us with data. Results show that locals' opinions of the social, psychological, and bodily effects of coal mining are worrisome. There were themes that showed how several factors, such as noise pollution, land degradation, and pollution of the air and water, negatively affect physical well-being. Stress, anxiety, and terror were common as a result of safety worries and uncertain livelihoods that harmed mental health. Social wellbeing suffered as a result of the mining industry's negative effects on social cohesiveness, economic inequality, and stigma. Participants also noted that important environmental issues impacting community health and well-being include socioeconomic disparities, air and water pollution, occupational health and safety concerns, and social and cultural disturbances. This study emphasizes how urgently extensive research is needed to validate and

Adults’ with Intellectual Disabilities (ID) experiences on occupational participation were explored through the prism of Occupational Justice model (MOJ) aiming to shape and develop an occupation-centered model of Quality of Life (QoL). In this qualitative study participated thirteen adults with ID (N=13). A semi-structured interview based on MOJ was constructed and administered to explore perspectives on QoL, as well as injustices regarding occupational participation. The interviews were processed with QSR NVivo8 following content analysis research methodology. An Occupational – Quality of Life (O-QoL) model with an everyday occupations core component has been formed. This model includes three core O-QoL domains: (i) social well-being, (ii) emotional – physical well-being and (iii) material adequacy. Main indicators of O-QoL were the recreational occupations and social activities, while socio-environmental factors such as occupational deprivation have been identified as aggravating. In addition, specific occupations such as leisure activities, physical exercise / sports, art, video games and vocational training could also be beneficial for O-QoL. Moreover, the importance of promoting and supporting the rights of people with ID for employment, independent living and sexual expression was highlighted. The O-QoL could be a valuable conceptual framework in the field of ID, however further research for developing specialized assessment tools and Occupational Therapy interventions to promote O-QoL is needed.

This research evaluates the feasibility of addressing computer vision problems with limited resources, particularly in the context of medical data where patient privacy concerns restrict data availability. (1) Background: The study focuses on diagnosing skin diseases using five distinct transfer learning models based on convolutional neural networks. Two versions of the dataset were created, one imbalanced (4092 samples) and the other balanced (5182 samples), using simple data augmentation techniques. Preprocessing techniques were employed to enhance the quality and utility of the data, including image resizing, noise removal, and blur techniques. The performance of each model was assessed using fresh data after preprocessing. According to the research findings, (2) Methods: the VGG-19 model achieved an accuracy of 95.00% on the imbalanced dataset. After applying augmentation on the balanced data, the best-performing model was VGG-16-Aug with an accuracy of 97.07%. (3) Results: These results suggest that low-resource approaches, coupled with preprocessing techniques, can effectively identify skin diseases, particularly when utilizing the VGG-16-Aug model with a balanced dataset. (4) Conclusions: The study addresses rare skin disorders that have received limited attention in past research, including acne, vitiligo, hyperpigmentation, nail psoriasis, and SJS-TEN. The findings highlight the potential of simple data augmentation techniques moreover, explainable AI: Grad-CAM interpreted the model outcome by showing image contours visually as well as identifying uncommon skin conditions and overcoming the data scarcity challenge. The implications of these research findings are significant for the development of machine learning-based diagnostic systems in the medical field. Further investigation is necessary to explore the generalizability of these findings to other medical datasets.

Background/Objectives: Nail technicians frequently have musculoskeletal pain, which impairs their job performance. A high-risk profession linked to back discomfort that causes morbidity is nail technician. QEC is a tool used for observing and assessing risks in a work environment. The goal of this research is to assess the ergonomic risks, pain, and their relationship with posture among manicurists. Methods: The 35 nail technicians filled the assessment form which consists of occupational information, pain, European Community Respiratory Health Survey, Nordic Musculoskeletal Questionnaire and QEC worker part. Physicians assessed nail technicians’ workspace and QEC outcomes. Results: It was stated that they worked an average of 61.92±11.09 hours per week, served an average of 11±5 customers per day, and their condition lasted 53.96±36.51 months. There is a strong significant correlation between discomforts, time spent in occupation (p=0,000) and working hours. Manicure, pedicure, unwanted hair removal, correction of eyebrow were considered for ergonomic risk evaluation. Each occupation accompanied repeated bad postures. Most of them were scored in very high risk categorization for back static positions (more than 29 point). Conclusions: This study may be useful for nail technicians seeking ergonomic improvements in the areas of engineering, administration, behavior, or personal.

Background: This study aimed to analyze the psychometric properties of the Brief-COPE Inventory and to determine its concurrent validity by exploring its association with perceived stress in Peruvian nurses. Methods: Psychometric study carried out in 434 Peruvian nurses to determine the psychometric properties by confirmatory factor analysis. Three stepwise variable selection regression models were implemented. Results: The three-factor of the Brief-COPE Inventory reported adequate fit (root mean square error of approximation = 0.052, standardized root mean square = 0.068, and both the comparative fit index and the Tucker–Lewis index = 0.95). Likewise, we found that its factors are correlated (p &lt; 0.001) and that there is adequate reliability (ω= 0.90). Moreover, nurses showed a medium level of perceived stress and the following associated factors: sex, having received stress management training, fear of COVID-19, and problem-focused coping strategies (p &lt; 0.05). Conclusion: This study proved that Brief-COPE Inventory is a valid tool for measuring coping strategies in Peruvian nurses because it has a good fit to the model, excellent reliability, and concurrent validity with perceived stress. However, further studies are required to evaluate its validity according to the nursing professionals’ perceived areas of performance.

Mammarenavirus Wenzhouense (WENV) is broadly distributed in Asia, while the he dynamics process of WENV infection remains unclear. A field derived strain of WENV was used to inoculate Sprague-Dawley (SD) rats by intramuscular injection, the process of virus infection was de-tected by controlling time for 28 days. Viral RNA became detectable in the blood at 3 d pi, and remained detectable for about 12 d. In most organ tissues, viral RNA peaked at 7 d pi, then began to decline by 14 d, however remained detectable in intestine and brain tissues at 21 and 28 d pi. Virus shedding had been detected from fecal samples for 5 days from 6 to 11 d pi using qRT-PCR, and was recovered from feces collected at 8 d pi. Horizontal contact infection occurred among cage-mates at 14 and 21 d pi. Antibodies against the nucleocapsid were detected at 5 dpi, next increased and persisted until the end of experiment. The results enabled to discriminate the kinetic of viremic response, virus shedding in feces and horizontal transmission, as well as the potential sites for WENV replication or maintenance of the virus in nature.

Introduction: The COVID-19 pandemic challenged people with spinal cord injury (SCI) regarding a variety of mental and physical issues. New challenges may arise as the effects of the pandemic continue. The objective of the present study was to explore the social participation of Canadians with SCI during the second wave of COVID-19. Methods: Participants with SCI from two Canadian provinces (Quebec and British Columbia) were interviewed. Results: Eighteen participants completed interviews. Facilitators of social participation remain similar since the first wave of COVID-19, such as the use of technology, help received by relatives and the use of delivery services to obtain groceries and other essentials. Obstacles to mobility due to winter conditions and lack of considerations related to COVID-19 public health measures specific to wheelchair users were also discussed by participants. Conclusions: People with SCI perceived participation restrictions, little changes in life habits, and uncertainty about the future during the second wave of COVID-19. The unique living conditions of people with SCI, ability to adapt life habits, and the lived experiences of people with SCI may have contributed to an overall resilience during the pandemic. Adaptive families, social contacts and technology made a difference during the pandemic.

Brazil is the world leader in pesticide consumption, and its indiscriminate use puts farmers’ health at risk. The CYP2C9 gene stands out for encoding the CYP2C9 enzyme, which metabolizes several endogenous substrates and specific xenobiotics, especially pesticides. Our goal is to study the risk of pesticide use, espe-cially the herbicide glyphosate, in the development of diseases and the association with two CYP2C9 poly-morphisms, in farmers living in the southern region of Espírito Santo state, Brazil. The allelic frequency of CYP2C9*1, CYP2C9*2 and CYP2C9*3 was determined in blood samples from individuals exposed or not to pesticides using real-time PCR. 304 blood samples were analyzed, dividing CYP2C9 genotypes into three metabolization classes: normal, intermediate, and slow. Our results show that normal metabolizers are more vulnerable to diseases such as blood pressure changes and cardiovascular and kidney problems, while in-termediate metabolizers show an association with attention deficit disorder and miscarriages, suggesting that farmers in the studied region developed symptoms correlated to the CYP2C9 genotype they have. This work is pioneering in associating specific genetic variations and health risks with pesticide exposure, em-phasizing the importance of personalized medicine and stricter regulation of pesticide use for public health and occupational safety.

Childhood overweight/obesity (OV/OB) is a major public health problem, of greater concern when accompanied with comorbidities such as hypertension and insulin resistance leading to metabolically unhealthy obesity (MUO). Aetiologic associations between meal patterns, OV/OB risk and MUO are limited. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 - April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk; none on MUO risk. Regular consumption of breakfast and family meals and avoiding dining while watching TV may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and improved methodological approach (e.g. harmonised definitions) regarding the assessment of meal patterns are highly warranted.

Background: Shoulder pain is the third most common musculoskeletal issue in primary care, affecting up to 50% of patients six months post-consultation, leading to significant functional impairments and societal costs, especially due to sick leave. Shoulder injuries are particularly prevalent among 'overhead athletes' in sports like swimming, volleyball, and handball, with high injury rates reported annually. Screening tools like the Arm Care Screen (ACS) have been used to identify athletes at risk of shoulder injuries effectively. However, their applicability to the general population is less understood. This study aimed to assess the discriminant validity of a modified ACS (MACS) in detecting musculoskeletal risk factors among non-athletes. Methods: A prospective cross-sectional study was conducted with 30 asymptomatic subjects over 18, excluding those with a history of shoulder injuries or surgeries. The MACS, comprising four tests, was administered, and its diagnostic performance was evaluated through sensitivity, specificity, predictive values, and likelihood ratios. Results: Results indicated low sensitivity (0%-47.62%) and variable specificity (55.56%-100%), suggesting that MACS may not effectively identify risk factors in the general population. Positive and negative predictive values were inconsistent, highlighting the need for non-athlete-specific screening tools. Conclusion: While the MACS showed promise in athletes, its application in the general population requires further refinement. The study underscores the necessity for tailored screening methods to enhance early detection and prevention of musculoskeletal issues in diverse populations.

Cytologic diagnosis of extra‐adrenal paraganglioma presenting as a peripancreatic mass is challenging with a high rate of diagnostic error. We present a case of a peripancreatic mass identified by radiology as a gastrointestinal stromal tumor. Endoscopic ultrasound‐guided fine needle aspiration (FNA) of the mass showed a moderately cellular tumor composed of small to medium sized neoplastic cells with round to oval nuclei arranged singly and in loose clusters. The cells were positive for neuroendocrine markers (synaptophysin and chromogranin) and negative for CD117. A diagnosis of a neoplasm with a neuroendocrine tumor (NET) was made on FNA cytology. The subsequent surgical resection of the tumor revealed peripancreatic paraganglioma with immunohistochemistry positive for synaptophysin, chromogranin, and S100. The latter delineates the sustentacular cells. Although paraganglioma is a well recognized tumor, a detailed comparison of peripancreatic paraganglioma versus pancreatic/gastrointestinal NET is still lacking.

Background: It has shown that meal timing, poor sleep quality and chronotype could play a relevant role in the development of type 2 diabetes mellitus (T2DM). However, the relationship with macronutrients by eating occasions has not been explored deeply. Objective: Our aim was to estimate the association between chrono-nutrition, sleep quality, chronotype and the prevalence of T2DM. Methods: This cross-sectional study included a subset of 3465 middle-aged adults (2068 women) from the European Prospective Investigation into Cancer and Nutrition (EPIC) Spain cohort study. In the 2017-18 follow-up, we assessed chronotype, sleep quality, diet, and sociodemographic data by validated questionnaires. Further, we used blood samples to determinate serum levels of glucose. We defined a case of T2DM when serum glucose concentration was ≥126 mg/dl or when participants self-reported diabetes. Results: Higher prevalence of T2DM was associated with poor sleep quality (ORpoorvsgood=2.90, 95%CI=1.30, 6.28). Carbohydrate intake at breakfast was inversely associated with the prevalence of T2DM (OR=0.75, 95%CI=0.66, 0.85). Finally, lipid intake at breakfast were associated with a 13% higher the prevalence of T2DM (OR=1.13, 95%CI=1.01, 1.26) for each 1 standard deviation (1-SD) increase. We observed no associations between macronutrient intake at lunch or dinner and T2DM. Conclusions: The study concludes that a breakfast with higher content in carbohydrate at breakfast is correlated with a reduced prevalence of T2DM. While higher lipids intake at breakfast was associated with higher prevalence of T2DM. Furthermore, poor sleep quality is as a potential factor associated with an elevated prevalence of T2DM. Our results emphasize the need for prospective studies to validate and strengthen these observed associations.

Sodium hypochlorite (NaOCl) is widely used in public healthcare facilities; this exposure can result in the development of bacterial tolerance to disinfectant, which has known links to antibiotic cross-resistance. However, the mechanism through which cross-resistance to antibiotics and disinfectants develops remains ambiguous. Therefore, this study aimed to examine the phenotypic, and transcriptomic changes caused by disinfectant exposure in gram-negative bacteria and determine the cause of cross-resistance to antibiotics. The results demonstrated that the misuse of disinfectants plays an important role in the emergence of disinfectant resistance and in the increase in antibiotic resistance. Antibiotic resistance may occur from exposure of gram-negative bacteria to subminimal inhibitory concentrations (MICs) of NaOCl. Ten passages of gram-negative bacteria in increasingly higher subMICs of NaOCl disinfectant was sufficient to increase the MIC to &gt;2,500 µg/ml NaOCl, particularly in K. pneumoniae and P. aeruginosa. To determine the development of cross-resistance to antibiotics due to NaOCl exposure, the MICs for each antibiotic before and after exposure of each strain to sublethal concentrations of NaOCl were compared. After overnight incubation with a sublethal concentration of NaOCl, a statistically significant increase in MIC was only observed for imipenem (P&lt;0.01). Investigation of the mechanism of cross-resistance by means of transcriptome analysis revealed that 1,250 µg/ml NaOCl-adapted K. pneumoniae and P. aeruginosa strains increased resistance to imipenem due to increased expression of the resistance-nodulation-cell division (RND) efflux pumps, such as AcrAB-TolC and MexAB/XY-OprM. Therefore, we suggest that exposure to NaOCl can influence the expression of RND efflux pump genes, contributing to imipenem cross-resistance.

The Chinese community is one of the main minorities in Colombia, and although China has made advances in public health, it faces a growing burden of cardiovascular diseases. This study focuses on evaluating cardiovascular risk factors in Chinese immigrants in Barranquilla, Colombia, due to the lack of specific data on this population. Methods: A cross-sectional study was conducted with 67 Chinese immigrants over 18 years of age residing in Barranquilla. Sociodemographic, anthropometric, clinical, and biochemical data were collected through structured interviews and medical record reviews. Cardiovascular risk was estimated using the 10-year ASCVD (Atherosclerotic Cardiovascular Disease) formula from the ACC/AHA. Statistical tests were employed to assess significant differences and relationships between variables. Results: The sample included 54% women with an average age of 53 years. 75% were over 45 years old, with the main occupations being trade (43%) and homemaking (40%). 54% had social security. Significant differences were observed in systolic blood pressure and the prevalence of smoking and alcoholism between men and women. Women had higher levels of HDL and lower creatinine, while men had higher levels of hemoglobin and creatinine. Cardiovascular risk was high in 9% of cases, moderate in 39%, and low in 52%. Conclusions: Chinese immigrants in Barranquilla present a significant prevalence of cardiovascular risk factors influenced by their socioeconomic situation and barriers to accessing healthcare. Interventions should focus on improving access to healthcare services and promoting healthy lifestyles for this vulnerable community.

A cross-sectional study was organised to investigate the range, prevalence, and associated factors for occupational health problems related to dental practice among Cambodian dentists; Participants underwent a face-to-face interview to explore dentists work-related health problems; 106 Cambodian dentists participated in this study, 68.9% were male. Ages ranged from 29 to 71 years, averaging 36.1 years, with the majority (77.4%) in the 29-40 age group. They had 5 to 18 years of practice experience, and worked an average of 52.2 hours per week. Commonly reported health issues included back pain (88.7%), headaches (81.1%), shoulder pain (78.3%), arm/hand pain (57.5%), and eye problems (48.1%). 38.7% of participants felt stressed and 19.8% depressed. Some reported suicidal thoughts and taking medication for depression. Despite these challenges, 91.5% enjoyed practicing dentistry; Findings highlight the need for interventions and strategies to address the physical and mental well-being of Cambodian dentists. By addressing these issues, steps can be taken to enhance the working conditions and professional satisfaction of dental professionals, ultimately benefiting both the practitioners and their patients.

Background: Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer and evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL). Methods: A prospective study using an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models analyzed total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression analyzed the association between daily symptom burden in the first month and HRQOL in the third month, adjusting covariates. Results: Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL, both in each week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95%CI: 4.10-9.02), depression (6.32; 95%CI: 3.18-9.47), fatigue (7.93; 95%CI: 5.11-10.80), sleep (6.07; 95%CI: 3.43-8.70), pain (5.16; 95%CI: 2.11-8.22), and cognitive function (-6.89; 95%CI: -10.00 to -3.79) in the third month. Conclusion: Daily assessment reveals fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability.

There is a lack of studies on the level of stress and health of families of workers in road transport. This study aimed to evaluate the perceived stress level and Family Effectiveness of family members of road transport workers. A quantitative study was carried out with family members of road transport workers in the southern region of Brazil. For the data collection, a sociodemographic form, the Perceived Stress Scale (PSS), and the Evaluation of Family Effectiveness Strategies were used. The data were analyzed by simple frequency, Spearman correlation coefficient (ρ) (p &lt; 0.05), and descriptive analysis from the perspective of the Systemic Organization. 49 family members of road transport workers were participants. Perceived stress was higher in family members who had more than nine years of schooling, the targets of Control and Growth were higher in the evaluation of Family Effectiveness. The Control target was also higher in families with more than three people. The Coherence dimension had higher levels in families with health problems and whose income was less than $792.00 US dollars per month. In the Individuation dimension, income over $792.00 had better results. The Maintenance dimension of the system was higher in families whose drivers’ activity was as an intercity driver, as well as in the Stability target. In conclusion, the social factors such as schooling, income, diseases, type of worker activity in road transport, and number of people in the family influenced perceived stress and Family Effectiveness, which demonstrates the need to increase the promotion of health care of the families of road transport workers.

Anthrax is a severe acute zoonotic disease of herbivores caused by Gram-positive, anaerobic, spore-forming bacteria. It is transmitted via direct contact with sick farm animals or those who have died of Anthrax. This study intends to present a cutaneous form of Anthrax in a 36-year-old woman suffered from a painless ulcer on her thumb five days after handling a head of sheep. The lesion started as a small papule that developed as a painless vesicular blister on the dorsal exterior surface of the right thumb. However, upon clinical investigation, the patient showed an absence of fever, lethargy, and pain. Swabs were collected and examined according to conventional microbiological tests. Direct smear revealed a Gram-positive bacilli that showed spore formation resembling B. anthracis. Nutrient agar, 5% sheep blood agar, and PLET agar were streaked by the swab. Other swabs were inoculated into the peptone water. All cultured media were inoculated at 37 oC for 24 hours. The morphology of growing colonies was examined, while the biochemical tests were done to identify the isolated bacteria, including a motility test and antibiotic sensitivity. The results of this study approved the existence of Bacillus anthracis by microbiological analyses. Accordingly, cutaneous form of anthrax was diagnosed, and specific systematic and local treatments were provided for the patient. In conclusion, this study confirmed the diagnosis of cutaneous Anthrax, a highly contagious disease that needed early detection and more attention and awareness should be taken when handling animal products.

Understanding and addressing dehumanization in healthcare is crucial due to its pro-found impact on patient care, ethical implications on patient dignity and autonomy, and its potential to affect the psychological well-being of healthcare professionals. The primary aim of this study was to establish reliable and valid instruments measuring two different types of dehumanization, namely animalistic dehumanization (i.e., stripping one of their uniquely human characteristics) and mechanistic dehumanization (i.e., stripping one of their human nature characteristics) among healthcare professionals. In a cross-sectional validation study among healthcare professionals, we tested measures of both animalistic and mechanistic dehumanization, focusing on dehumanization of patients (hetero-dehumanization) and oneself (self-dehumanization), respectively. All measures were developed and validated based on a concept analysis, a literature review, and an appraisal of pre-existing scales. The research was conducted among 400 nurses and medical doctors employed in Greek public hospitals. Coefficient Validity Ratio re-sults showed that 100% of items were acceptable for both measures. The newly estab-lished and validated hetero-dehumanization scale encompassed two-factors (factor 1: animalistic dehumanization, factor 2: mechanistic dehumanization, Cronbach’s alpha was equal to 0.86 for each measure). The self-dehumanization scale was a mono-factorial measure mechanistic dehumanization (Cronbach’s alpha = 0.97). Two validated measures of (self and hetero-) animalistic and mechanistic dehumanization measures were developed for the assessment of dehumanization among health profes-sionals, which will form the basis for future research in this important scientific field.

Although numerous observational studies reported the association between alcohol consumption and cancer, insufficient studies have estimated the causality. Our study evaluated the causal relationship between various type of cancer according to the frequency of drinking and the amount of alcohol consumed. The research data were obtained from the publicly available MR-Base platform. The frequency and amount of drinking were selected as exposure, and 14 cancer types were selected as the outcome. Two-sample summary data Mendelian randomization (2SMR) was conducted to examine the causality between alcohol consumption and cancer type. Additionally, for cancers suspected of pleiotropy, outliers were removed and re-analyzed through radial MR. MR results by Inverse Variance Weighted (IVW) method were different before and after removing outliers. The biggest differences were found in esophageal cancer and biliary tract cancer. For esophageal cancer, after removing outliers (rs13102973, rs540606, rs650558), the OR (95% CI) was 3.44 (1.19-9.89), which was statistically significant (p=0.02172). Even in biliary tract cancer, after removing outliers (rs13231886, rs58905411), the OR (95% CI) was 3.86 (0.89-16.859), which was statistically significant at the borderline. (p=0.07223). The strongest association was shown in esophageal cancer. For other cancers, the evidence was not sufficient to draw conclusions. More research is needed to understand the causality between drinking and cancer.

The pervasive use of plastic for milk packaging has raised significant health concerns, despite its advantages in terms of cost-effectiveness, convenience, and durability. The potential correlation between cancer and plastic packaging is one of these concerns. This mini-review examines the health implications of plastic materials used in milk packaging, with a particular emphasis on their carcinogenic hazards. This work endeavors to summarize the current state of knowledge regarding the influence of plastic components on human health and underscore the importance of ongoing research in this field by utilizing insights from a comprehensive review article. Harmful chemicals have been observed to leach into milk from plastics used in milk packaging, including high-density polyethylene (HDPE), low-density polyethylene (LDPE), and polyethylene terephthalate (PET), particularly under conditions of protracted storage and heat. Bisphenol A (BPA), phthalates, and styrene are among the most prevalent leachates. These chemicals have been associated with a variety of health issues, such as an elevated risk of cancer, and are recognized for their endocrine-disrupting properties. BPA and phthalates, in particular, have the potential to disrupt hormone function, which may result in breast cancer, prostate cancer, and other hormone-related malignancies.This review emphasizes the significance of comprehending the precise components of plastics utilized in milk packaging and their potential health consequences. It advocates for more rigorous research to completely elucidate the long-term health impacts of these materials by emphasizing the current state of knowledge and regulatory initiatives. Additionally, it underscores the necessity of innovative packaging technologies to guarantee consumer protection and mitigate the risk of exposure to carcinogenic substances.

Objective: To verify knowledge about HPV, promote educational action and encourage vaccination among students from 6th to 9th grade in the public school system of Campo Grande - MS. Methods: Conducting a structured interview. Results: It was pointed out that 70.1% had heard about HPV, however, 38.1% stated that it is a virus that causes cancer and 11.3% related it to the virus that causes warts. The free availability of the vaccine was known to 57.7% of participants and 62.3% were vaccinated with at least one dose. 79 students were vaccinated during the actions. Conclusion: There is a lack of knowledge, as the majority did not know how to relate HPV to the development of cervical cancer. The interaction between primary health care and schools resulted in the dissemination of knowledge about HPV, an increase in vaccine doses administered, favoring an increase in vaccination coverage among students.

Pharmacist-prescribed hormonal contraception (HC) is supported by a majority of pharmacists and pharmacy students; however, few studies have evaluated perceptions of non-community pharmacists, or differences in geographic areas. The primary objective of this study is assess differences between community and non-community pharmacists in perceptions of pharmacist HC prescribing. Secondary objectives include assessment of community pharmacist interest in prescribing HC, and differences in perceptions between pharmacists in metropolitan and nonmetropolitan areas. A survey was emailed in early 2022 to 2592 Georgia pharmacists, with Likert questions assessing interest, perceptions, comfort, and perceived barriers regarding pharmacist prescribed HC. Completed survey response rate was 11.8%. Regardless of practice site, a majority agreed pharmacists are well-trained to prescribe HC (Community 61.8% vs. Non-community 68.1%, p=0.25) and provision of HC services is within the pharmacist’s scope (Community 73.6% vs. Non-community 74.2%, p=0.90). Overall metropolitan and non-metropolitan community pharmacists' perceptions were similar, however more metropolitan pharmacists believed pharmacists are well trained to prescribe HC (66.7% vs 48.7%, p=0.049) and that it is within their scope of practice (78.1% vs. 61.5%, p=0.045). In summary, the majority of pharmacists, regardless of practice type, believe that pharmacists are prepared to prescribe HC and it is a part of pharmacist’s professional scope of practice.

Background: Among the cognitive markers of Alzheimer’s disease (AD), semantic and phonemic verbal fluency tasks seem to be an early indicator of deterioration. The aims of this study are 1) to evaluate both types of Verbal Fluency in the early stages of AD in order to know which of them deteriorates earlier and, 2) to investigate if Verbal Fluency Tasks can help to differentiate between patients with Mild Cognitive Impairment (MCI) who will progress to AD two years later (progresses) and those who do not (non-progresses). Method: A Verbal Fluency Task was administered to 25 patients with MCI and their respective control subjects. All patients underwent a neuropsychological evaluation twice in order to follow up their global cognitive status. The second time, 8 of them converted to AD. Results: On the one hand, Phonemic Verbal Fluency deteriorates earlier than Semantic Verbal Fluency in MCI patients; on the second hand, although we found statistically significant differences between patients with MCI and AD in both type of fluency tasks, they were not found when comparing the performance of progresses and non-progresses. Conclusion: These results point to a greater impairment in Phonemic Verbal Fluency in MCI patients and its potential predictive capacity to predict conversion to AD.

A thorough understanding of the type and severity of cataracts is crucial for accurately estimating the optimal phacoemulsification energy. In preceding research efforts, an innovative clinical prototype known as the Eye Scan Ultrasound System (ESUS) was developed to facilitate the automated characterization of cataracts. To evaluate the effectiveness of the prototype as a medical tool, extensive data must be collected from several patients with and without cataracts. However, obtaining an adequate number of patients and data for training and testing machine learning models is challenging. To overcome this limitation, the authors implemented a simulated prototype model of the ESUS system, to augment the data. The proposed model encompasses the electric-to-acoustic signal conversion in the ultrasonic transducer, the wave propagation through the eye, and the subsequent acoustic-to-electric signal conversion. Electrical modelling of the transducer was done using a two-port network and the wave propagation was modelled by using the k-Wave MATLAB toolbox. This holistic modelling approach enabled the generation of synthetic data augmentation, presenting great similarity with real data. The synthetic data can then be employed together with real data for the purpose of cataract classification.

Brazilian garimpeiros are a highly hard-to-reach and mobile population, with little access to basic hygiene and health services, and have been crossing the border to work irregularly in gold mines in French Guiana since the 90s. This study aimed to characterize this population and identify their main health problems. A cross-sectional study was carried out in the municipality of Oiapoque-AP, with two surveys: before (2018) and after (2019) the implementation of Malakit. Individuals were recruited from resting places and submitted to a questionnaire with demographic variables, history and knowledge of malaria, and health issues in the mines. Simultaneously, a clinical evaluation was performed. The garimpeiros were mainly men from Maranhão, Pará, and Amapá, with a low educational level and worked on average for 10 years in the mining sites. The study population mentioned numerous health problems: malaria, followed by leishmaniasis, flu, body aches, headaches, and digestive problems. Other diseases mentioned were skin diseases, bat bites, hepatitis, and HIV infection. This vulnerable population is constantly subjected to heavy routines and exposed to different diseases and infections that can spread across borders. Knowledge of this is essential for developing public health policies that can be integrated into specific epidemiological situations.

This study examined how Information Use Environments (IUEs) influence the information behavior of people living with neglected tropical diseases (PLWNTDs) and how this affects their participation in diagnosis and treatment programs. The author demonstrated that local information use environments (IUEs) significantly impacted the information behavior of people living with neglected tropical diseases (PLWNTDs'), which can be harnessed to improve their involvement in diagnosis and treatment programs. The author compared user-centered and program-centered approaches within common IUEs in remote and impoverished areas, finding that NTDs persist due to a disconnect between program organizers and the affected individuals’ information use environments (IUEs). Data was sourced from published papers, and OpenAI (ChatGPT) was used to generate list of local sources (IUEs) in affected remote communities. The findings indicated that understanding local IUEs can help program organizers enhance participation rates of individuals with NTDs in diagnosis and treatment initiatives.

The Atlantic Canada Together Enhancing Acute Stroke Treatment (ACTEAST) project is a Modified Quality Improvement Collaborative (mQIC) designed to improve ischemic stroke treatment rates and time-based efficiency in Atlantic Canada. This study specifically evaluates the implementation of the mQIC in Nova Scotia using qualitative methods. The mQIC spanned six months and included two Learning Sessions, multiple webinars, and a per-site virtual visit. Each session was followed by an action planning period to guide implementation efforts over the following 2-4 months. The Consolidated Framework for Implementation Research (CFIR) was utilized to develop a pre-tested, semi-structured interview guide, which aimed to uncover barriers and facilitators to mQIC implementation. Interviews were conducted with 14 healthcare professionals, generating 454 references that were coded into 28 CFIR constructs. Notably, 84% of these references were positively framed as facilitators. Despite this, significant barriers were identified, including resource availability, competing priorities, communication challenges, and difficulties engaging key stakeholders. Some barriers were particularly prominent during specific phases of implementation. The study findings offer valuable insights into the implementation of quality improvement initiatives in stroke care. They underscore the importance of recognizing and addressing context-specific barriers, while also leveraging identified facilitators to drive successful implementation and ultimately improve patient outcomes.

(1) Background: The study of microbiome is being crucial for his role in major systemic diseases, in particular the oral and gut microbiota. In the last years the study of microorganism correlated for example with neurodegenerative disease is increasing the prospective of a possible link between gut microbiota and brain. Here we report a new case report about a patient evaluated genetically firstly for dementia and late-onset dyskinesia, and then tested with 16S metagenomics sequencing. (2) Methods: Starting from buccal swab, we extracted bacterial DNA and then we performed a NGS metagenomics sequencing based on the amplification of hypervariable regions of the 16S in bacteria. (3) Results: The sequencing revealed the presence of Spirochaetes Phylum, a pathogenic bacterium generally known to be able to migrate to the Central Nervous System and not only. (4) Conclusions: Oral infections as our results shows could be possible contributing factors to various neurodegenerative conditions.

Age diversity in the workplace is a growing challenge. This study aimed to assess work ability among Family and Community Nurses (FCNs) in a large Local Health Authority (LHA) in Tuscany, Italy. The Work Ability Index (WAI) was administered to 178 FCNs, along with demographic and occupational data. Results showed a significant negative correlation between chronological age and WAI, indicating decreasing work ability with age. Moreover, work setting, educational attainment, and health conditions influenced work ability. Nurses working in home settings and those with higher educational levels reported better work ability. A high prevalence of health conditions, particularly musculoskeletal disorders, was observed. These findings highlight the need for targeted interventions to support FCNs' work ability and address age-related challenges. This study provides a foundation for developing strategies to optimize the nursing workforce and ensure high-quality care delivery.

Autoimmune bullous diseases (AIBDs) are a group of conditions marked by the formation of blisters and erosions on the skin and mucous membranes. Knowing that, most of the AIBDs are severe and resistant to treatment, we decided to look upon the nutritional aspect as a light for the future for both - patients and clinicians. In this review, we would like to summarize the evidence of the role of nutrition in pathogenesis and treatment of the following AIBDs: i) pemphigus, ii) bullous pemphigoid and mucous membrane pemphigoid, iii) dermatitis herpetiformis, and iv) epidermolysis bullosa aqusita.

The human malaria parasite, Plasmodium falciparum, accounts for more than 500,000 deaths worldwide per year. From 2000 to 2019, the malaria global death toll fell from 864,000 to 576,000 deaths; however, progress on reducing this toll has since slowed, with the COVID-19 pandemic contributing to an increase in the mortality rate since 2020. The emergence of widespread resistance in P. falciparum to first-line treatment drugs has highlighted the need for new antimalarial drugs, and smarter approaches, including better combination therapies and mass drug administration. Nevertheless, recent successes of the first malaria vaccine (RTS,S/AS01) and the approval of a second (R21/MM), have renewed the promise of widely applicable vaccines in the future. Since 2015, the Eastern Mediterranean Region has experienced an overall increase in malaria cases and deaths. In the Arabian Peninsula, while most of the Gulf Cooperation Council (GCC) countries have been declared free of indigenous malaria (Bahrain, Kuwait, Qatar, and the United Arab Emirates), malaria is still endemic in two GCC countries (Saudi Arabia and Oman) and its neighbors (Yemen). Furthermore, a number of factors threaten malaria control in this region, at the level of the parasite (antimalarial drug resistance), the mosquito (the emergence of highly invasive species), the environment (climate change and increasing average temperatures), and society (imported malaria). In this review, we assess the current world-wide status of malaria in terms of public health, prevention and treatment, before providing an Arabian regional perspective, with a critical evaluation of the malaria situation in the GCC countries.

The importance of diet shaping the gut microbiota is well known and may help with improving the overall health of an individual. Many other factors also have an influence, such as genetics, age, exercise, antibiotic therapy, or tobacco use. The purpose of this review is to summarize how three distinct dietary types (plant-based diet, Mediterranean diet, and Western diet) affect the composition of gut microbiota and the development of non-communicable diseases (NCDs). PubMed, Web of Science and Scopus databases were used for searching papers with an emphasis on keywords ‘‘dietary pattern’’, ‘‘gut microbiota’’ and ‘‘dysbiosis’’. Plant-based diet and Mediterranean diet promote the production of beneficial bacterial products, and more microbial diversity and therefore are generally considered healthy dietary types. On the other hand, the Western diet is a typical example of an unhealthy approach to nutrition which leads to an overgrowth of pathogenic bacteria. Moreover, understanding the impact of diet on the modulation of gut microbiota may give rise to new therapeutical strategies.

Iron supplementation is associated with side effects and thus reduces the intake compliance. Because it has fewer side effects, a recent trial recommended low-iron micronutrient powder (MNP) for the prevention of anemia in Bangladeshi children exposed to a high concentration of iron from drinking groundwater. In the present study, we hypothesize that the low-iron MNP is a potential intervention to prevent childhood anemia in the low groundwater-iron settings in Bangladesh. A cross-sectional study was conducted in Bangladesh with children aged 2-5 years who drank groundwater containing a low level of iron (0-&lt;2 mg/L).The combined intake of iron was calculated from the key sources--diet, groundwater and MNPs. The intakes of iron were compared against the standard reference intake. The children’s hemoglobin was measured using a photometer. Combined intake of iron from dietary, groundwater and low-iron MNP in children was 5.8±2.0 and 6.9±2.5 mg/day comprising 193% and 169% of the Estimated Average Requirement in the 2-3 year-old and 4-5 year-old subgroups, respectively. Combined intake of bioavailable iron from dietary and groundwater sources was 0.42±0.023 and 0.22±0.019 mg/day in children exposed to groundwater concentration 0.8-&lt;2.0 mg/L and 0.0-&lt;0.8 mg/L respectively (p&lt;0.001). The mean concentration of hemoglobin in the respective groups was 12.17±0.94 mg/dl and 11.91±0.91 mg/dl (p=0.30). The combined intake of iron from dietary and groundwater sources was associated with maintenance of hemoglobin concentration at the non-anemic level in most of the children. The finding highlights the potential of low-iron MNP in controlling childhood anemia in this setting.

(1) Background: Alzheimer’s Disease (AD) accounts for 70% of dementia cases and with no effective pharmacological treatments, new rehabilitation methods are needed. Motor activities and transcranial direct current stimulation (tDCS) have shown promise in stabilizing and enhancing cognitive functions. Objective: We want to investigate the effects of combined motor or cognitive activity with tDCS on cognitive functions in AD patients. (2) Methods: Patients with mild or moderate AD were randomized into four groups: motor activity or cognitive activity associated with anodic or sham tDCS (MotA, MotS, CogA, CogS). They received two weeks of treatment (45 minutes, 5 days/week), with the first 15 minutes using 2mA tDCS on the dorsolateral prefrontal cortex. Cognitive assessments were conducted pre-treatment (T0), post-treatment (T1), and one week after (T2). (3) Results: Twenty patients were included. Mann-Whitney test showed significant improvements in anodic groups (MotA+CogA) in the global cognitive status (p=.042), in selective attention (p=.012), and sustained attention (p=.012) at T1, but not at T2. In addition, MotA improved in the Picture Recognition Test (p=.027) and in sustained attention (p=.047) at T2. (4) Conclusion: Combined motor or cognitive activity with anodic tDCS could slow cognitive decline in AD patients, with notable improvements in global cognitive state and attention at T1.

The current study aimed to examine the relationship between sociodemographic variables (i.e., sex, age, marital status, educational level, socioeconomic status, and working mode) and physical activity levels declared by Chilean adults. The sample comprised 483 Chilean adults, 159 men (32.9%), and 324 women (67.1%) aged from 18 to 69 years old (36.5±12.0). The participants completed an ad-hoc sociodemographic online survey that included questions about characteristics of participants such as sex, age, educational level, household income, marital status, and working mode. Vigorous, moderate, and walking activities were measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), a self-administered questionnaire. Results: Men declared significantly higher vigorous and moderated physical activity than women. People aged 18 to 25, single or unmarried, and with the lowest household income, showed significantly higher scores in vigorous physical activity than those aged 26 to 45, cohabiting with a partner or married, and middle household income, respectively. Regarding working mode, people working on their job site said walking more than people not working, working on hybrid, and online mode. Our findings suggest that promoting strategies that increase physical activity during the pandemic is necessary to avoid health problems.

Quality of life (QoL) focuses on a person’s ability to live a fulfilling life. In the elderly population, it helps in determining successful aging. Because of a scarcity of information regarding predictors of QoL in the elderly population in developing countries, this study was undertaken to assess the overall QoL and its predictors in the elderly population in an urban setting of Bangladesh. In this cross-sectional study, 275 participants were enrolled by systematic sampling at the outpatient department of a tertiary care hospital in Dhaka, Bangladesh. Data were collected by using a pretested semi-structured standard questionnaire for QoL (OPQOL-35). Pearson’s correlation was used to assess the association between QoL and sociodemographic factors. The Chi-square test was done for assessing the statistical significance between categorical variables. Multivariate linear regression was conducted to identify predictors of QoL, after controlling for potential confounders. The median age of the participants (n = 275) was 65 years (range, 60 to 85; 25th and 75th percentile, 60 and 68, respectively). The majority (78%) of them were married and 20% were widowed or divorced. The median score of QoL was 113 (25th and 75th percentile, 101 and 124, respectively). Most of the participants had a very poor (bad as can be) or poor (bad) QoL. Only 7.3% were observed to have “good” QoL (scores 140 or more). Females had significantly poorer QoL scores compared to males (p = 0.01). Educational status, marital status, body mass index and sleep duration significantly predicted QoL in a multiple regression analysis. In conclusion, the QoL of the elderly individuals in Bangladesh was very poor or poor. Future research should focus on service-oriented interventions, especially targeting women. Counseling of elderly people for enhancing their quality of life may include improving sleep patterns, healthy diets, regular exercise, and caring for their mental health.

A recent publication regarding a March 2023 Google Scholar search found Japan unique in healthcare providers’ reaction to COVID-19 vaccines. According to one article, negative sentiment by healthcare providers toward vaccines defines the research in this area, with concerns about side effects outweighing worries regarding infection. This current study investigates the anomaly through a scoping review of “COVID-19, Japan, vaccine hesitancy” in six relevant databases: Cochrane COVID-19 Study Register, OVID, ProQuest, PubMed, Scopus, and Web of Science. By following PRISMA guidelines, the intent is a more thorough examination of this unusual evalua-tion of COVID-19 vaccines by Japanese healthcare providers than offered by the March 2023 search. The finding is that of the 997 returns, only four were relevant for assessment inclusion. Of these four, three, published in Vaccines, support vaccine hesitancy in Japanese healthcare providers and their becoming more so regarding a subsequent dose of the vaccine. One article published in BMJ Open did not find this. Yet, the design of none of the studies was specific to investigating vaccine hesitancy in Japanese healthcare providers, making the conclusion questionable. Suggest-ed future research directions include investigating the primacy of those databases searched and the need for timeliness in examining COVID-19 anomalies.

The work and life routine of long-haul truck drivers involves the use of truck stops and rest areas to meet their basic human needs. These extensions of their workspaces while on the road, do not always offer adequate physical structures and services that drivers need for optimal health. Aim: To evaluate long-haul truck drivers’ perceptions about the services of food, safety, physical activity, rest and personal hygiene offered at truck stops and rest areas in Brazil. Method: Quantitative study conducted with long-haul truck drivers from the Southern region of Brazil. For data collection, a sociodemographic questionnaire and a Likert scale on food, rest, personal hygiene, safety and physical activity services were used, offered in general at the truck stops and rest areas along Brazilian roads, from March to August 2023. The data were analyzed with simple frequency descriptive statistics. Results: 175 long-haul truck drivers participated, 70.29% declared that the services of the truck stop and rest areas were charged; more than half (53.59%) of the professionals evaluated the rest service as “good” or “excellent”; the food services, was “good” or “excellent” for 42.24% of the drivers. The spaces for physical activities were the worst evaluated as “bad” or “terrible”, by 41.61%, followed by bathroom service (28.42%) and safety (34.24%), evaluated as “bad” or “terrible”. Conclusions: In the perception of long-haul truck drivers, the rest and feeding services had better evaluations, on the other hand, the services of bathroom, safety and physical activity presented worse evaluations. The perception of drivers demonstrates the lack of investments to improve basic services such as personal hygiene, safe environment and physical exercises, fundamental to the health of the worker, aiming to reduce vulnerability, sedentary lifestyle, and meeting the basic human needs of long-haul truck drivers.

Background: Recent studies suggest an association between long-term air pollution, diet, and health outcomes, but there are limited studies on how short-term air pollution affects dyslipidemia in particular. We aimed to investigate this association with modified fruit and vegetable consumption.Methods: The Cardiovascular Disease Association Study (CAVAS) included 8,779 participants between 2007 and 2016. Particulate matter (PM_2.5) and nitrogen dioxide (NO₂) levels were estimated using community multiscale air quality models. Short-term air pollution exposure was defined as a moving average over a lag time from “lag 1 days” to “lag 14 days.” Fruit and vegetable intake was categorized into 'total vegetables (TV),’ 'non-salted vegetables (NSV),' 'salted vegetables (SV),' 'fruits (F),' 'non-salted vegetables + fruits (NSVF),' and 'total vegetables + fruits (TVF).' Dyslipidemia was defined by total cholesterol ≥240 mg/dl, LDL cholesterol ≥160 mg/dl, HDL cholesterol <40 mg/dl, serum triglycerides ≥200 mg/dl, or physician-reported dyslipidemia.Results: Higher short-term PM_2.5 concentrations were associated with an increased risk of dyslipidemia (odds ratio (OR) = 1.012, 95% CI: 1.003, 1.020 for a lag of 14 days). High PM_2.5 groups (≥23.3 μg/m³) with a higher TV intake (≥186.1 g/day) were associated with a decreased risk of dyslipidemia (OR = 0.88, 95% CI: 0.78, 0.99). Additionally, high PM_2.5 groups (≥23.3 μg/m³) with a higher intake of SV (≥110.6 g/day) were associated with a decreased risk of dyslipidemia (OR = 0.86, 95% CI: 0.76, 0.97). Conclusion: Our study suggests that vegetable consumption is an important dietary factor for attenuating risk of dyslipidemia associated with short-term air pollution exposure.

(1) Background: With the global population aging, the demand for effective rehabilitation products for the elderly is increasing. Traditional products often fail to meet the comprehensive needs of elderly users, who require solutions addressing physical, psychological, and social aspects; (2) Methods: Using the Analytic Hierarchy Process, Quality Function Deployment, Axiomatic Design, and the System Usability Scale to identify and prioritize user needs, market research and user interviews were conducted to understand the preferences of the elderly and obtain design specifications. The focus was on multimodal sensory feedback, which was validated through the study; (3) Results: Elderly users have a strong preference for rehabilitation products that are durable, easy to use and have comprehensive sensory feedback. Intelligent rehabilitation bed as the carrier, strengthened structure, high strength material, ergonomic adjustment, integrated health monitoring system. Using digital technology for real-time health monitoring and personalized feedback to provide a comprehensive recovery experience, high user satisfaction was reported in the evaluation; (4) Conclusion: It is important to emphasize user-centered design and integrate multi-modal sensory feedback to meet the comprehensive rehabilitation needs of elderly users. Future studies should expand user samples and expert opinions to refine and validate the design and improve its effectiveness and usability.

Differences in metabolic regulation among obesity phenotypes, specifically metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) women, may lead to varied responses to interventions, which could be elucidated through metabolomics. Therefore, this study aims to investigate the differences in metabolite profiles between MHO and MUO women and the changes following a lifestyle intervention. Serum from 36 MHO and 34 MUO women, who participated in a lifestyle intervention for weight loss were analyzed using an untargeted proton nuclear magnetic resonance spectroscopy (1H NMR) at baseline and 6 months post-intervention. Anthropometric, clinical and dietary intake parameters were assessed at both time points. Both groups showed differential metabolites profile at baseline and sixth month. Seven metabolites including trimethylamine-N-oxide (TMAO), arginine, ribose, aspartate, carnitine, choline and tyrosine significantly changed between group post-intervention, in which all showed a decreasing pattern in MHO. Significant reduction in body weight and BMI in the MUO correlated with changes in carnitine and tyrosine levels. In conclusion, metabolite profiles differed significantly between MHO and MUO women before and after a lifestyle intervention. Changes in carnitine and tyrosine levels in MUO correlated with weight loss, suggesting potential targets for therapeutic intervention.

The different sociocultural context and lifestyle may influence oral health. To evaluate the interference of these factors, we conducted a quantitative-qualitative cross-sectional study. The research was carried out in a private dental office, in an urban area, and in the Family Health Unit (USF), in a rural area. Fifty patients of each location participated on the research. A semi-structured questionnaire covering sociocultural profile, oral hygiene habits, drug consumption, use of medicinal plants, and antibiotics usage was applied. Also, laboratory tests to evaluate the tendency to have dental decay and Streptococcus sp colony counting was performed. There was no significant difference between patients in the two groups regarding gender, race, marital status, type of residence, number of residents in the same household, and type of employment. Private clinic participants were more prone to consuming alcohol and/or cigarettes and reported to brush the teeth more often. There was no association between salivary acidity and higher biofilm bacterial density. The usage of medicinal plants was more evident in the public service. Data presented here revealed that social inequality between private and public dental assistance are greater from the point of view of investment in public health for the population with difficult access and not from cultural or educational level diversity.

Taking due account of users' perspectives is crucial for improving the quality of healthcare services. This study aimed to analyse the representations and evaluation criteria that users of a public health agency express towards care and treatment services and to explore whether and how the content and meaning of their communications varied according to pre-pandemic, pandemic or post-pandemic periods. 501 communications (73.4% complaints, 16% appreciations, 10.6% enquiries) sent to the public relations office of an Italian health agency were collected. An automatic content analysis procedure (ACASM) was applied to the textual corpus. Four main thematic cores were identified concerning the request for care and respect, the value of the doctor-patient relationship and the difficulties in contacting services and accessing care. Two main latent dimensions of meaning were identified, which capture the dialectic between the demand for relationships and the demand for access to care, and between attention to the relational competence of health workers and attention to the needs and rights of users. Communications collected during the pre-pandemic and post-pandemic periods mainly concern the difficulty of access to care; those collected during the pandemic period mainly concern the doctor-patient relationship. Interpersonal aspects and timely access to care appear to be crucial in users' assessment of the quality of care.

The implementation and sustainability of evidence-based practice (EBP) is a complex process. Best practice guidelines (BPGs) can facilitate the translation of knowledge from theory into practice, but they require working groups to adapt recommendations and encourage adherence to them. The aim of this study was to identify facilitators and barriers of BPGs in the Registered Nurses’ Association of Ontario®, within the framework of Best Practice Spotlight Organisations® (BPSOs®), in a hospital setting. The study was conducted using the modified Delphi method (two rounds) with a cohort of BPSO® Best Practice Champions. The facilitators and barriers included in the first round were identified through a bibliographic search. The degree of concordance was determined in the second round using the highest mean resulting values. A total of 44 nurses responded, with a mean age of 42.57±8.563. Facilitators included: Work Environment; Working in a hospital that encourages research; and Dedicating time to EBP (p&lt;0.001). Barriers: Excessive workload; Professional mobility (p&lt;0.001); and Lack of time (p=0.002). As such, it is necessary to approach human resource management by implementing new policies that guarantee systemic sustainability. The BPSO® programme is an excellent framework for promoting the translation of theoretical knowledge into practice and effecting institutional change.

Background/Objectives: Instability is one of the main symptoms in patients with vestibular and neurological disorders and therapeutic exercise interventions are increasing its popularity as a way of treatment for those. Additionally, the limits of stability measurement are known to be a good tool for balance evaluation and monitoring of this interventions. The aim of this work is to understand better how a specific protocol provokes changes on this variable and study the characteristics of those who respond and non-respond to it. Methods: A retrospective study was developed with the data of 40 patients treated in the Otorhinolaryngology department in Clínica Universidad de Navarra (Madrid, Spain). Those had an initial reduction in limits of stability, completed the protocol proposed with home-based and hospital-based exercises with frequent limits of stability remeasurement, and assist to the follow-up retest after 1-2 months. Results: A progressive improvement in limits of stability measure was developed through the intervention and partially retained at follow-up visit. Differences were found between responders and non-responders patients. More specifically an initial measure of the limits of stability was able to differentiate those groups with a cut-off data of 56cm2. Conclusions: The protocol proposed was able to induce motor learning in patients included in this study with good retention after 1-2 months. Besides, there is some variability in how patients respond to the treatment. Age and diagnostic should be considered, and an interesting cut-off data for clinal decision making was found.

Introduction Delayed intra-operative neuro-monitoring (IOM) events can be defined as loss of responses, after baseline traces were present upon completion of instrumentation and deformity correction. This study reports this subgroup of events, assesses their incidence and evaluates potential causative factors. Methods We reviewed 1881 consecutive patients who underwent spinal deformity correction between 2011 and 2021. Surgeries were performed using a standardised anaesthetic regimen and multimodal IOM protocol. Results 44 patients (2.4%) had an IOM event. 9 patients (6F:3M) had a true positive delayed event after posterior segmental pedicle screw instrumentation. Mean age was 12.5 (2-17) years with mean thoracic Cobb angle of 78° (51-94°). Mean estimated blood loss was 28%. Titanium beam shaped rods were utilised in 3 patients and 5.5mm titanium rods in 5 patients. Motor evoked potentials were lost on average 18 (10-30) minutes after completion of instrumentation. 7 patients had bilateral loss and 2 patients had unilateral loss of MEP traces. Sensory evoked potential amplitude was preserved in all cases. There was a transient latency shift in one patient. MEPs returned within 20 minutes of rod release. The rod was re-contoured to incorporate more scoliosis in 1 patient. 2 patients had beam rods exchanged to 5.5mm titanium rods. 6 patients had rod removal with retention of pedicle screws and staged completion of instrumentation at mean 5 (1-7) days later. No patients had a postoperative neurological deficit. Conclusion Delayed IOM loss represented 15% of all events. Increased cord tension and hypo-perfusion were considered likely mechanisms. Rod release restored MEPs in all cases. The timing of events emphasises the importance of continued monitoring for minimum 30 minutes after completion of spinal instrumentation or until wound closure.

The COVID-19 pandemic profoundly impacted older people in residential aged care facilities (RACFs), especially those with dementia. This retrospective cohort study investigates the impact of the pandemic on agitation incidents within this population in 40 Australian RACFs. We compared pre-pandemic data (January-October 2019) with during-pandemic data (same months in 2020 and 2021) from electronic health records (EHRs) using Python to extract information from nursing notes. Various statistical analyses, including descriptive statistics to summarize the data, and a chi-square test to examine any significant association between the COVID-19 pandemic and the prevalence of dementia and agitation in dementia. Dementia prevalence dropped by 1.98% in 2021 compared to 2019, and by 4.09% compared to 2020 (p < 0.05). Overall agitation symptoms decreased by 20.1% from 2019 to 2021 (p < 0.05), but six specific symptoms increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%) (p < 0.05). Conversely, pacing decreased by 15.88% and speaking loudly de-creased by 10.9% (p < 0.05). Over half of the care recipients experienced agitation symptoms 2-5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021 (p < 0.05). It is important to exercise caution regarding the accuracy of these findings due to the reduced opportunity for busy care staff to record behavioral changes caused by the isolation of individuals in their rooms during the pandemic.

Background: For the past two decades, the Copenhagen Psychosocial Questionnaire (COPSOQ) has been established as a valid instrument to measure psychosocial stress at work. Nowadays, the COPSOQ international network is responsible for the monitoring and improvement of COPSOQ. 2019, a new questionnaire was published, and the Greek version is now being validated. Methods: Measurement qualities of the Greek COPSOQ III have been explored in adherence to the usual requirements of a validation study as defined by DIN EN ISO 10075-3. A sample of observations from 2.189 participants surveyed with the COPSOQ in Greece was used to validate the current version with appropriate statistical analyses. Exploratory factor analysis was used to assess statistical relations for many scales. Results: With its 108 items and 40 scales, the Greek COPSOQ III includes all psychosocial work factors that have been internationally validated and remain compatible with about 72% of the COPSOQ III German version content. Beyond primary results, congruence with widely used theoretical approaches like the Demand-Control(−Support) model (DCM) or the Job Demands-Resources model (JDR) is generally satisfactory. In summary, our validation study for the Greek COPSOQ III version showed adequate reliability and validity, which is in line with the COPSOQ III questionnaire from other European countries, and it is also compatible with the validation of the German COPSOQ III (Lincke, 2021). Our regression analysis showed that the 34 psychosocial work factors (34 “context” scales) could adequately predict the scores of the satisfactory and health scales (6 “outcome” scales). The analysis also indicated the top five (5) predictors (context variables) for each of the six (6) “effect” scales (outcome variables). Conclusions: With the launch of COPSOQ III in Greece, current and new workplace psychosocial aspects could be explored. COPSOQ III(GR) is a beneficial instrument for enterprise research and risk assessment.

In contrast to global AIDS data, which show a higher number of diagnosed HIV cases in women, the Indonesian National AIDS report reveals that the percentage of HIV cases in the country is significantly higher in men. Using a conceptual model of how social networks impact health, this paper describes how structural conditions, such as poverty, lack of job opportunities, and lack of income determined the engagement of Indonesian male labour migrants and motorbike taxi (also known as ojek) drivers in their respective professions and shaped their social networks. It also describes how these social networks created opportunities for various psychosocial mechanisms, including social influence, peer pressure, and intimate contact, that facilitated HIV infection through different behavioural pathways, such as unprotected sex with multiple partners and injecting drug use (IDU) practices. A qualitative design using face-to-face in-depth interviews was employed to collect data from participants in Yogyakarta municipality and Belu district, Indonesia. Participants were recruited using the snowball sampling technique, starting from two HIV clinics in the study settings. Data analysis was guided by a qualitative data analysis framework. The findings highlight the significance of structural conditions, such as poverty, poor family conditions, precarious employment, and lack of income, in determining the participants' engagement in labour migration and motorbike taxi driving. Involvement in these occupations allowed them to become acquainted with fellow labour migrants and ojek drivers, leading to cohabitation in the same shelters or areas and daily interactions, which fostered the development of social networks among them. These social networks then provided opportunities for various psychosocial mechanisms, including social influence through peer pressure and person-to-person contact. The influence and pressure experienced by the participants were reflected in their behaviours related to sex, condom use, and IDU, ultimately contributing to the transmission of HIV among them. The findings underscore the importance of public health interventions, such as HIV information and education, that take into account the dynamics of social networks in order to develop effective strategies for increasing understanding of HIV transmission and prevention, reducing vulnerability, and promoting safer behaviours among male labour migrants and ojek drivers.

During the COVID-19 pandemic, the term “behavioural fatigue” became the centre of policy debates in Great Britain. These debates involved deciding when to go into lockdown and whether behavioural interventions could be effective. Behavioural interventions can only succeed where people’s capabilities, opportunities, and motivations to perform target behaviours are supported. Our retrospective data analyses examine the relationships between people’s capabilities, opportunities, motivations, and behaviours, i.e., adherence to lockdown guidelines. Our cross-sectional analyses include 17,962 unique participants in Great Britain who completed a survey over the initial 30 days of the first lockdown (April 2020). We examine trends in responses to each scale and then the relationships between the scales using Granger’s causality test with tests for stationarity and cointegration. A mixture of increasing and decreasing trends were identified for capabilities and opportunities. Decreasing trends were identified for motivation and behaviour. Granger’s causality tests found that capability forecasts opportunity and behaviour and that motivation forecasts opportunity. The discussion reiterates that to realize and maintain behaviour changes, policies surrounding people's capabilities, opportunities, and motivations must continue to support target behaviours.

Background: COVID-19 has a major impact on businesses, with employee absenteeism resulting in lost productivity and medical costs to employers as well as lost wages and medical costs to employees. The aim of this analysis was to assess the economic impact of workplace COVID-19 vaccination in the United States (US).Methods: A decision tree economic model, populated with US data for the working-age population, estimated the burden of COVID-19 in the workplace (symptomatic infections, long COVID cases, inpatient/outpatient care, absent days) with and without vaccination. Disease burden and impact of seasonal influenza vaccination was studied for context. Results: Without workplace vaccination, an average US business (with 10,000 employees), had an estimated 18,175 absent days from COVID-19, resulting in employer lost productivity costs of $ 5.08 million. Implementing COVID-19 workplace vaccination (at 70% US Healthy People target vaccination rate) prevented an estimated 3,132 absent days, saving employers $ 876,453 in lost productivity costs and $240,633 in medical costs. It also saved employees $ 182,196 in medical costs and $198,250 in lost wages . Seasonal influenza caused around 5,333 absent days, and seasonal influenza vaccination (at 70% coverage) prevented 1,675 absent days, saving employers $ 468,394 in lost productivity and saving employees $ 27,757 in medical costs. Conclusions: COVID-19 remains a burden to US businesses. Implementing COVID-19 workplace vaccination and increasing vaccination coverage rates for COVID-19 and seasonal influenza has the potential to prevent a significant number of absent days, while providing employers and employees with cost savings from averted disease and its consequences.

Population-based data on hematologic malignancies (HM) are rare in Greece regarding adults (≥18 years old). The aim of this study was the assessment of the burden of these malignant neoplasms (MN) for adults in Crete. The study assessed temporal trends of incidence and mortality, depicted their spatial distribution and extracted net-survival curves of patients. Population-data on these MN were obtained from the database of the Cancer Registry of Crete, for a 22 year time period (1/1/1992-31/12/2013). All HM were classified into four main groups of diseases: (1) Hodgkin’s lymphoma (HL); (2) Non-Hodgkin’s lymphomas (NHLs); (3) Multiple myeloma (MM); and (4) All chronic and acute leukemias. Annual, gender-specific, age standardized incidence and mortality rates were estimated (ASIR/100.000/year; ASMR/100.000/year). A total of 3,380 newly diagnosed cases were included in the final analyses; All ASIRs/100,000 increased significantly throughout the study period presenting differences in their geographical distribution of rates among municipalities of Crete. ASIRs for NHLs, HL, MM, leukemias and for all 4 MN were 13.1, 2.6, 4.7, 11.7 and 32.1, respectively, in 2013. Five-year net-survival for patients diagnosed with NHLs, HL, MM and leukemias were: 82%, 85%, 52% and 56%, respectively. This first research article studying a long period of time for adults in Greece generates hypotheses on the existence of risk factors that may partly explain this variation of rates.

Plantar fasciitis is one of the most common causes of foot pain; in a significant percentage it is also associated with bone edema of the heel. A prospective randomized clinical trial was designed, in which 48 patients suffering from plantar fasciitis, with or without bone edema, were treated with temperature controlled high energy adjustable multi-mode emission laser and exercises (laser group) or with exercises only (control group). Patients were evaluated at recruitment (T0), at 2 (T1) and 6 months (T2), monitoring pain (with Visual Analogue Scale), functionality (with Foot Function Index) and perception of improvement (with Roles and Maudsley Score) and fascia thickness (with ultrasound examination). In both groups there was a significant improvement in pain, functional recovery, perception of remission and a reduction in plantar fascia thickness at T1 and T2. The laser group presented statistically better values at T2 for the Roles and Maudsley Score (z: 2.21; 0.027). Regression analysis showed that a greater reduction in fascia thickness occurred in the laser group (p-value: 0.047). In conclusion, the two conservative treatments were effective in patients suffering from plantar fasciitis, even in the presence of bone edema, but with lesser results.

Background: Cardiometabolic risk factors (CRFs) are significant health concerns among adults with overweight and obesity. Resistance training (RT) is known to manage CRFs, but the impact of moderate-frequency RT (two to three times weekly) remains unclear. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing moderate-frequency RT with non-exercise control or usual care in overweight and obese adults. Searches were performed in PubMed, Web of Science, EMBASE, and Cochrane Library up to February 2024, following the PRISMA 2020 guidelines. Eligible studies included non-athletic adults (BMI ≥ 25) aged 18 years or older, with RT interventions lasting 7 weeks or longer. Results: Fifteen RCTs were included. Moderate-frequency RT significantly reduced systolic blood pressure by -4.66 mmHg (95% CI -9.34 to 0.02, p=0.01) and mean arterial pressure by -6.48 mmHg (95% CI -10.63 to -2.33, p=0.002) compared to controls. Additionally, RT significantly lowered fasting insulin levels by -12.52 mmol/L (95% CI -24.17 to -0.88, p=0.04) and HOMA-IR by -1.49 (95% CI -1.63 to -1.35, p＜0.00001). Improvements were more pronounced in participants with dietary control. Conclusion: Moderate-frequency RT effectively improves CRFs in overweight and obese adults, suggesting its potential as a beneficial intervention for this population. PROSPERO registration number: CRD42022343167.

Background: Young people with intellectual developmental disabilities have a persistent delay in the development of executive functions. Virtual reality (VR) is increasingly being used as a cognitive intervention tool, with significant effectiveness demonstrated in different types of populations. Methods: This pilot study aims to investigate the impact of a cognitive training program utilizing VR on young adults diagnosed with intellectual developmental disability (IDD). The participants (N=15) served as their own control group and were assessed three times: weeks 0, 8 and 16, with a rest period (0-8 weeks) and an intervention period (8-16 weeks). The assessments included measures of cognitive function, provided by E-Prime®. Results: Overall, an improvement in working memory and inhibitory control was found after the intervention, but not in sustained attention. Conclusions: These findings suggest that VR-based cognitive training holds promise as an effective intervention for enhancing cognitive abilities in young adults with intellectual developmental disability.

Background: Health care providers (HCPs) may required to initiate a cardiopulmonary resuscitation (CPR) while patients are in a prone position. Healthcare providers must possess the necessary information, abilities and experience to do cardiopulmonary resuscitation in a prone position (PPCPR) confidently. Aim: This study aimed to assess healthcare providers' (HCPs) preparedness to perform cardiopulmonary resuscitation in a prone position at specialized units in Jordan's healthcare sectors. Methods: In eight tertiary hospitals, a descriptive cross-sectional survey was carried out. An on-line questionnaire was conducted among 332 healthcare professionals who are employed in operating rooms, intensive care units or interventional procedure rooms. Results: Preparedness levels among healthcare providers were 24.4% excellent, 2.1% acceptable and 73.5% poor. The average preparedness score was 32.38 (SD = 39.90), indicating significant variability. A lack of targeted training was associated with lower preparedness levels. Notably, providers with Advanced Cardiac Life Support (ACLS) training showed significantly higher preparedness. Conclusion: The HCPs in Jordan are poorly prepared to perform PPCPR whenever indicated. However, the study findings represent a significant step towards improving HCPs' preparedness to perform PPCPR. They serve as a baseline assessment and highlight the gaps in HCPs' readiness, which help their organizations develop and implement targeted training strategies and interventions. Nevertheless, incorporating this training in the hospital orientation, training policies, and clinical guidelines is equally important to enhance their capabilities for better outcomes. Implications for Clinical Practice: The findings emphasize the urgent need for hospitals to integrate PPCPR training into their standard orientation and ongoing training programs. Providing comprehensive ACLS training and regular PPCPR drills will enhance HCPs' competence and confidence, leading to improved patient outcomes during emergency situations involving prone position CPR.

Dopaminergic replacement therapy remains the mainstay of symptomatic treatment for Parkinson’s disease (PD), but many unmet needs and gaps remain. Device based treatments or device-aided non-oral therapies are typically used in the advanced stages of PD, ranging from stereotactic deep brain stimulation to levodopa or apomorphine infusion therapies but there are concerns due to a number of procedural, hardware, or long-term treatment-related side effects of these treatments, and limited nonmotor benefit in PD. Therefore, there is an urgent unmet need for low risk adjuvants or standalone therapies which can address the range of burdensome motor and nonmotor symptoms that occur in PD. Recent studies suggest that non-invasive neurostimulation of the vestibular system may be able to address these gaps with stimulation of the vestibular brainstem sensory network which extensively innervates brain regions regulating both motor and a range of nonmotor functions. Therapeutic non-invasive vestibular stimulation is a relatively modern concept that may potentially improve a broad range of motor and nonmotor symptoms of PD, even at early stages of the disease. Here we review previous studies supporting the therapeutic potential of vestibular stimulation for the treatment of PD and discuss ongoing clinical trials and potential areas for future investigations.

In China, preschool teachers have a significant influence on the development of young children aged 3-6. It is imperative to understand their mental health and the factors associated with it to inform policies, optimize their mental well-being, and support their job performance. This study aimed to investigate the factors contributing to anxiety symptoms among preschool teachers. A sample of 393 Chinese preschool teachers (279 females, 114 males) aged 21-56 completed online questionnaires collecting their socio-demographic and work-related information and assessing anxiety symptoms, interpersonal difficulties, personality traits, perceived stress, resilience, and inner strength. Pearson correlation and multiple linear regression analyses identified significant predictors of anxiety symptoms. The prevalence of anxiety symptoms among the studied cohort was found to be 12.2%. Statistically significant factors positively correlated with anxiety symptoms included objective work-related stress (B=0.149, p<.001), interpersonal difficulties (B=0.921, p<.001), perceived stress (B=0.108, p=.001), and neuroticism (B=0.071, p=.002). The findings highlight the urgent need for measures to reduce work-related stress and anxiety. However, when negative mental health predictors were included, the effect of positive psychological factors became nullified. Positive mental health might have a moderating role in such a negative mental health outcome as anxiety. Therefore, further research is required to understand the impact of positive mental health factors more clearly.

Background: Alarming data indicates that low back pain (LBP) affected around 619 million people globally in 2020, that presenting significant health and economic burden. Importantly, the chronic LBP (cLBP) strongly impairs quality of life and leads to disability and premature retirement thus emphasizing the urgent need for providing deeper insight into the factors that affect treatment outcomes and offer thorough guidance for the assessment and management of this disease. Taking into consideration the rising prevalence of cLBP and knowledge gap referring to the overall health benefits of balneotherapy (BT), the aim of this study was to assess the effects of BT on functional status, quality of life and psychological symptoms in patients with cLBP. Methods: A total 210 patients were recruited and divided into two groups: patients receiving conventional pharmacological therapy (CT) and receiving BT. The effectiveness of the treatment was assessed on the basis of Visual Analog Scale for pain intensity, EuroQol (EQ-5D) for the patient’s self-rated health and Work Ability Index Questionnaire to evaluate functional ability. In order to provide deeper insight into the quality of life and also factors associated with the functional status and mental health affected by BT, we also used the Short Form Health Survey Questionnaire and Center of Epidemiologic Studies Depression Scale. Results: Our findings suggest that BT significantly contributed to reduction of pain, better functionality and disability perception status. Conclusions: Understanding the association between individual perceptions of functionality, emotional and social elements provides basis for providing comprehensive guidelines and recommendations for cLBP management.

Marijuana is the most used illicit drug among youths in the United States. The objectives of the study were to identify the association between marijuana use and other risk behaviors including suicidality among high school students. The 2021 Mississippi Youth Risk Behavior Survey data sets were combined for this study. Crude odds ratio (OR) and adjusted odds ratio (AOR) with a 95% confidence interval were generated using the survey packages in R to account for weights and the complex sampling design of YRBS data. Tobacco products and alcohol use were significantly associated with marijuana use. Students who responded “Yes” to questions “currently used an electronic vapor product?”, “currently smoked cigarettes or cigars?” or “currently drank alcohol?” were more likely to use marijuana compared to students who responded “No”, after adjusting for other risk factors. Marijuana use is also significantly associated with students who had sex, compared to those who never had sex. The adjusted odds ratio is nearly doubled in those who had sex with the same sex or both sexes, compared to those who had heterosexual sex only. After adjusting for other health risk factors, the association between current marijuana use and attempted suicide was not statistically significant. The impact of students’ not sleeping in their parent's or guardian's home on current marijuana use was not significant after adjusting for other risk factors. Marijuana use is evenly burdened between males and females and between all race categories among Mississippi high school students. The identified associations seem to indicate that electronic vapor, tobacco products, and alcohol use could be the forerunners for drug use and should be treated accordingly in drug use prevention programs.

The association of alcohol intake with kidney stone disease (KSD) is not clear. We examined the National Health and Nutrition Examination Survey (NHANES) 2007-2018 and used logistic regression analyses to determine the independent association between alcohol intake and prevalent KSD. 29,684 participants were eligible for the final analysis including 2,840 prevalent stone formers (SF). Mean alcohol intake was 37.0±2.4 g/day among SF compared to 42.7±0.9 among non-SF (p=0.04). Beer [Odds ratio (OR)=0.76, 95% CI: 0.61-0.94, p=0.01] and wine (OR=0.75, 95% CI: 0.59-0.96, p=0.03) intakes were strongly associated with lower odds of prevalent KSD while liquor intake had no association. The effect from beer was dose dependent with an OR of 0.34 (95% CI: 0.20–0.57, p56g/day of beer to non-drinkers. Interestingly, the effect from wine was only significant among participants drinking moderate amount, with an OR of 0.54 (95% CI: 0.36–0.81, p=0.003) compared to non-drinkers. These effects were consistent in spline models. This study suggests that both moderate to heavy beer intake and moderate wine intake are associated with a reduced risk of KSD. Future prospective studies are needed to clarify the causal relationship.

(1) Background: Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) have potential to impact long-term health outcomes. Understanding these interrelationships can inform the development of interventions to promote societal health (2) Methods: D/PMH was defined as a diagnosis of depression and/or more than 14 days of poor mental health in the previous month. Those reporting poor physical health for more than 14 days in the previous month or categorising their physical health as ‘fair’ or ‘poor’ were deemed to have PG/PPH. Seven categorical questions based on subscales in the Child and Youth Resilience Measure-28 were used to define PCEs.(3) Results: Increased ACEs exposure use significantly associated with increased odds of D/PHM (p&lt;0.001), increased odds of PG/PHH (p=0.010) and decreased odds of AR-SES (p&lt;0.001). Increased exposure to PCEs was significantly associated with decreased odds of D/PHM (p&lt;0.001), increased odds of PG/PHH (p&lt;0.001) and decreased odds of AR-SES (p&lt; 0.001). For all outcomes, exposure to PCEs reduced the strength of the association between ACEs and outcomes. (4) Conclusions: A positive dose response between the number of ACEs and adult D/PMH, PG/PPH and lower AR-SES exists within the Australian population. PCEs weaken this association, demonstrating their mitigating potential. PCEs promoted adult outcomes, irrespective of ACEs.

Lassa Fever is a deadly viral haemorrhagic disease, causing annually several hundreds of deaths in the Gulf of Guinea. This zoonotic disease is primarily transmitted to humans by rodents of the genus Mastomys, while secondary interhuman transmission accounts for approximately 20% of cases. Although this disease has been endemic in rural zones of the Gulf for hundreds of years, it is also characterised by epidemic outbreaks in the dry season, responsible for heavy death tolls. No licensed vaccine or satisfying treatment is currently available. Disease management is hindered by the incomplete knowledge of the epidemiology and distribution of the disease, resulting from an inadequate health and surveillance system. Additional scientific constraints such as the genetic diversity of the virus and the lack of understanding of the mechanisms of immune protection complexify the development of a vaccine. The intricate socio-economic context in the affected regions, and the lack of monetary incentive for drug development, allow the disease to persist in some of West Africa’s poorest communities. The increase in the number of reported cases and in the fatality rate, the expansion of the endemic area, as well as the threat Lassa Fever represents internationally should urge the global community to work on the disease control and prevention. The disease control requires collaborative research for medical countermeasures and tailored public health policies. Lassa Fever, created by the interconnection between animals, humans, and ecosystems, and embedded in an intricate social context, should be addressed with a ‘One Health’ approach. This article provides an overview of Lassa Fever, focusing on Nigeria, and discusses the perspectives for the control of disease.