Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations

A structural equation model of psychological capital, self-directed learning, and learned helplessness: Implications for postgraduate nursing education

BACKGROUND

Postgraduate nursing students face complex academic-clinical integration challenges that may precipitate learned helplessness and impede professional development. The mechanisms through which psychological capital and self-directed learning influence learned helplessness in nursing education remain incompletely characterized.

OBJECTIVE

This study aimed to (1) evaluate the prevalence and determinants of learned helplessness among postgraduate nursing students, and (2) analyze the mediating pathways between psychological capital and learned helplessness through self-directed learning components.

DESIGN

Multiple academic medical centers and affiliated teaching hospitals across Chinese provinces.

SETTING

Conducted across multiple universities and hospitals in various provinces of China.

PARTICIPANTS

Full-time and part-time postgraduate nursing students and clinical nurses with completed postgraduate degrees were recruited between September and October 2024.

METHODS

Validated instruments assessed psychological capital (PCQ-24), self-directed learning (SRSSDL), and learned helplessness (LHQ). Analyses included descriptive statistics, stepwise regression, and structural equation modeling with 5000-sample bootstrapping to evaluate cognitive and interpersonal mediation pathways.

RESULTS

Participants demonstrated moderate-to-high learned helplessness (41.86 ± 14.03). Multiple regression analysis identified four significant protective factors: higher levels of hope (β = -0.29), enhanced learning awareness (β = -0.20), stronger professional identity (β = 0.23), and supportive mentor communication styles (β = 0.23) (all P < 0.01). In the mediation analysis, cognitive self-directed learning accounted for 81.8 % of the psychological capital-learned helplessness relationship, while interpersonal relationships mediated 23.4 %.

CONCLUSIONS

Psychological capital significantly reduces learned helplessness through dual pathways, primarily through cognitive self-directed learning and secondarily through interpersonal relationships. Educational interventions should adopt a comprehensive approach: (1) implementing psychological capital training programs incorporating resilience workshops and reflective practices, (2) transitioning to competency-based, self-directed learning models, and (3) establishing adaptive mentorship frameworks that prioritize supportive communication styles. These evidence-based strategies could effectively mitigate learned helplessness and enhance academic success among postgraduate nursing students.

Investigation of the relationship between medical artificial intelligence readiness and individual innovativeness levels in nursing students

AIM

This study was conducted to identify nursing students' medical artificial intelligence readiness and individual innovativeness levels, to examine the relationship between these two concepts and to determine the variables that create a significant difference.

METHODS

A descriptive and correlational design was employed. The sample of the study consisted of undergraduate nursing students from two different universities in Istanbul province, both of which focus on similar educational goals (n = 386). Data were collected between March and May 2024 using a questionnaire involving a "Student Information Form," the "Medical Artificial Intelligence Readiness Scale," and the "Individual Innovativeness Scale." Descriptive statistical methods, t-test, ANOVA, and Pearson correlation test were used to analyze the data.

RESULTS

The mean age of the students was 21.78 ± 1.84 years (18-35), 78.8 % were female, and 35.5 % were 2nd- and 3rd-year students. The students' mean score was 69.36 ± 12.92 on the total Medical Artificial Intelligence Readiness Scale and 52.92 ± 7.37 on the total Individual Innovativeness Scale. In addition, gender, family structure, income status, choosing the nursing department willingly, following scientific/technological developments in the field, having received training in artificial intelligence, having knowledge about the use of artificial intelligence in the health field and nursing, and having attended training/seminars on innovation were determined to be effective variables on Medical Artificial Intelligence Readiness and Individual Innovation. There was a significant positive relationship between the mean total and subscale scores on the Medical Artificial Intelligence Readiness Scale and the Individual Innovativeness Scale (p < 0.05).

CONCLUSION

Nursing students' medical artificial intelligence readiness levels were above average, and their individual innovativeness levels were low. It was found that as the students' medical artificial intelligence readiness levels increased, their individual innovativeness levels increased, as well. Although increased readiness levels boost the level of individual innovation, promising practices should be integrated into education for more advanced relationships and higher scores.

Age-related changes in depression symptom networks in children in China with parental absence: A comparative analysis of youth aged nine to 18

BACKGROUND

The network perspective on psychopathology views depression as a system of interacting symptoms. Research shows that mental health problems change with age. Children with parental absence are at risk for depression, but it's unclear how their depressive symptom networks evolve across developmental stages.

METHOD

Network analysis was conducted on data from 179,519 children with parental absence who completed the depression scale CESD. The Graphical LASSO algorithm was used to construct depressive symptom networks for each age group. Global network metrics and centrality measures were then calculated and compared across age groups.

RESULTS

Depressive symptoms increased with age, with mean CES-D scores rising from 3.44 at age nine to 10.8 at age 17. Network density showed a general increase from age nine (0.045) to age 17 (0.047), while average path length decreased from age nine (18.380) to age 18 (15.338) and clustering coefficient decreased from age 9 (0.879) to age 18 (0.706). Closeness centrality demonstrated the most substantial age-related effect (F = 1445.111, p < 0.001, η2 = 0.225), with significant increases from early to late adolescence. Core emotional symptoms remained central across ages, while loneliness and feelings of failure became more central with age.

CONCLUSION

As children with parental absence age, their depressive symptom networks become more severe, interconnected, and efficiently structured. This suggests a need for age-specific interventions addressing both core symptoms and emerging adolescent self-evaluative concerns, advancing our understanding of developmental psychopathology in this vulnerable group.

Evaluation of diabetes mellitus medication-taking behavior among first- and second-generation Australians of Chinese heritage: A nationwide cross-sectional study

Aim

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

Method

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

Results

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

Conclusion

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

The epidemiology of antimicrobial resistant bacterial infection in Qatar: A systematic review and meta-analysis

BACKGROUND

Antimicrobial resistance (AMR) is the current silent pandemic responsible for approximately five million deaths annually. According to the WHO, antimicrobial resistance is one of the top global public health threats and the third leading cause of death worldwide.

METHOD

This systematic review and meta-analyses aims to provide Qatar's first comprehensive epidemiological assessment of AMR. We conducted extensive search of three databases (PubMed, Embase and Web of Science) using broad search terms with no restrictions. The meta-analysis of prevalence was done using the Freeman-Turkey transformation and random effects models. Subgroup analysis was performed for three categories; the composite isolates, otherwise responsive isolates, and otherwise resistant isolates.

RESULTS

The search yielded a total of 1258 publications, of which 55 publications were included. The overall prevalence of all isolates was 13.64 % (95 %CI: 6.80 - 22.11, I2=99 %), all the studies were cross-sectional of convenience sampling, conducted in healthcare settings. The subgroup prevalence for the composite isolates was 8.87 % (95 %CI: 2.72 - 17.77, I2=98.7), otherwise responsive isolates was 11.37 % (95 %CI: 4.31 - 20.72, I2=98.3 %), otherwise resistant isolates was 23.55 % (95 %CI: 10.12 - 40.14, I2=99.1). The otherwise resistant isolates stratified analyses revealed that ESBL prevalence was 38.94 % (95 %CI: 21.63 - 57.79, I2=99.2 %), MDR was 15.99 % (95 %CI: 2.46 - 37.00, I2=99 %), MRSA was 52.37 % (95 %CI: 13.91 - 89.50, I2=88 %), Nosocomial infections prevalence was 23.55 % (95 %CI: 10.12 - 40.14, I2=98.2 %). The ESKAPE bacterial strains accounted for the majority of resistance.

CONCLUSION

Qatar's AMR overall prevalence is close to the global estimates, however the resistant isolates prevalence is higher than average according to the global estimates for high-income countries. The AMR public health response including national action plan to combat AMR and antimicrobial stewardship programs need to be orchestrated. AMR epidemiological research needs improvement in expanding coverage across diverse population groups to ensure greater clarity and precision in identifying bacterial infections and antibiotic classifications.

The relationships among nurses' spiritual health, sleep quality, and stress and the factors influencing stress during the late global COVID-19 pandemic: A cross- sectional study

BACKGROUND

COVID-19 has had a significant impact on healthcare workers. Although several studies have looked at the pandemic's physical and mental effects on nurses, little has been done to investigate their spiritual health and its relationship to stress and sleep quality during the late pandemic.

PURPOSE

This study sought to fill a knowledge gap in the literature about the relationships between nurses' reported stress, sleep quality, and spiritual health during the late COVID-19 epidemic.

METHODS

A cross-sectional study using purposive sampling was performed out in a medical center in Taiwan. A total of 376 nurses participated. The Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Spiritual Health Scale-Short Form were used for assessing nurses' stress levels, sleep quality, and spiritual health.

RESULTS

The results showed that the mean perceived stress score was 1.80 ± 0.50 (out of 4), the sleep quality score was 8.17 ± 3.29 (out of 21), and the mean spiritual health score was 3.66 ± 0.59 points (out of 5). Although 77.1% of the nurses in this study experienced sleep disorders (PSQI > 5), they had better sleep quality during the COVID-19 pandemic than those in other countries. Perceived stress, sleep quality, and spiritual health were significantly correlated. Nurses with support from their friends and family and hospital during the COVID-19 pandemic had lower perceived stress and higher sleep quality and spiritual health scores than their peers (p < .05). Age, work experience, sleep quality, and spiritual health were predictors of perceived stress in nurses during the late COVID-19 pandemic (F = 20.19, p < .001) and could explain 30.6% of the variation.

CONCLUSIONS

Spiritual health is correlated with the nurses' stress levels. Despite providing extrinsic support, we encourage nursing management to pay attention to nurses' spiritual needs and implement psychological education programs to help frontline nurses navigate ever-changing and discerning healthcare environments.

Inaccurate and misleading meta-analysis of E-cigarettes and population-based diseases

A random-effects meta-analysis by Glantz et al. recently concluded that the odds of several diseases among current e-cigarette users and smokers were similar. This report details serious deficiencies. We used descriptive analysis methods to assess the studies the authors selected for cardiovascular disease (CVD), stroke and chronic obstructive pulmonary disease (COPD) among e-cigarette users vs. nonusers. We examined all of the source studies for these categories. We demonstrate that the meta-analysis by Glantz et al. had three principal deficits that were avoidable: (1) mixing unjustified and incomprehensible disease outcomes, such as erectile dysfunction with fatal CVDs and influenza with COPD; (2) using survey datasets containing no temporal information about smoking/vaping initiation and disease diagnosis; (3) using longitudinal studies that didn't account for changes in vaping and smoking during follow-up waves. The meta-analysis by Glantz et al. is misleading and inaccurate. The deficits are only apparent to investigators thoroughly experienced with the data from the source studies. We conclude that Glantz et al. failed to meet basic criteria for the quality of source studies; the results of their meta-analysis are invalid.

Exploring the International Terminology Associated with Nurses Caring for Neonates, Infants, Children, Young People and Their Families

The terminology used for Registered Nurses specializing in caring for neonates, infants, children, young people (CYP), and their families varies globally. While many countries' nursing students qualify as "Registered Nurses" upon completion of undergraduate education, specialist titles like "Children's Nurses" in the United Kingdom or "Pediatric Nurses" in Italy denote expertise in CYP care. In countries like the United States and Canada, neonatal and pediatric nursing specialization typically requires postgraduate study. However, there is limited evidence on the range of international terms for nurses in this field. This expert opinion paper presents the results from a scoping survey designed to identify and catalog these terms across different countries. This exercise and the data collected were used to inform a larger cross-section study: "A Survey To map the glObal provision of children's nUrsiNg eDucation" (the ASTOUND study). Conducted between May and August 2024, the survey collected responses from 76 participants across 34 countries representing all continents. Content analysis and descriptive statistics revealed 20 distinct terms, with "Paediatric/Pediatric Nurse" (n = 28) as the most common, followed by "Children's Nurse" (n = 7), "Child Health Nurse" (n = 5), and others. Additional findings highlighted regional variation in terminology based on the clinical setting and population age range, underscoring historical and cultural influences on these terms. This initial survey provides a snapshot of global terminology. It underscores the need for further research, setting the stage for exploration in the ASTOUND study to map the provision of children's nursing education worldwide.

'Who wants to be a teacher in Ghana?' A structural equation modelling analysis of prospective language teachers' behavioural intentions to pursue a career in teaching

Despite its significant role in the development of society, the teaching profession is arguably one of the least preferred professions in Ghana. It has been argued that the declining interest in the teaching profession is partly contingent on the deteriorated conditions of service and the unfavourable reputation it has earned in Ghana in contemporary times. Amid these concerns, we were compelled to investigate prospective language teachers' behavioural intention to pursue a career in teaching. Using Ajzen's theory of planned behaviour, 111 prospective language teachers in two higher educational institutions in Ghana were engaged in this inquiry. The study's results, obtained through a partial least squares structural equation modelling analysis, indicated that prospective language teachers' behavioural beliefs, control beliefs, and subjective norms significantly influenced their intention to pursue a teaching career (R2 = 56.1%). We, thus, recommend that the Ministry of Education should consider addressing teachers' working conditions and launching public awareness campaigns to enhance the perception of teaching's importance. By improving teachers' professional identity, policymakers, particularly the Ghana Education Service, can attract prospective teachers and instill a positive view of teaching as an ideal profession for the youth.

Low levels of awareness and motivation towards cancer prevention amongst the general public in Sweden: a cross-sectional study focusing on the European Code Against Cancer

BACKGROUND

The European Code Against Cancer (ECAC) aims to increase the awareness of modifiable cancer risk factors among the general public. A goal set by the European Commission was that 80% of European citizens should be aware of this code by 2025. This study aims to examine the awareness and attitudes towards the ECAC among the general public in Sweden.

METHODS

A randomly selected sample of 1520 Swedes (18-84 years old) were recruited from a survey panel and invited to respond to an online study-specific questionnaire. The questionnaire included general questions regarding cancer prevention, as well as awareness and attitudes specific to the ECAC. Data were analysed univariately and with adjusted logistic regression, using post-stratification weights based on gender, age, education, and expressed political party orientation.

RESULTS

In total, 3.7% of the respondents had heard about the ECAC before taking this survey. Respondents with a college/university education were more likely to have heard about the ECAC (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.23-4.06). Males (OR 0.56; 95% CI 0.32-0.99), and those living alone (OR 0.47; 95% CI 0.23-0.95) were less likely to have heard about the ECAC. In total, 60.6% of the respondents agreed with the ECAC recommendations, while 27.4% reported that their motivation to improve their lifestyle increased after reading the ECAC.

CONCLUSIONS

Awareness of the ECAC among the general public in Sweden is very low. Still, a majority seem to agree with its recommendations. The results also indicate that the ECAC motivates some, but far from all, to improve their lifestyle habits to reduce their cancer risk. Consequently, further research is warranted on how the ECAC best could and should be used in order to improve cancer prevention awareness and motivation.

Problematic social media use and self-rated health among Swedish adolescents: is the association moderated by family support?

BACKGROUND

Recent studies have documented a range of adverse health outcomes associated with excessive social media use among adolescents. Fewer studies have examined potential protective factors in this context. Our study aims to bridge this gap by exploring the relationship between Problematic Social Media Use (PSMU) and poor Self-Reported Health (SRH) among Swedish adolescents, while also examining the potential buffering role of family support.

METHODS

The data was sourced from the 2017/18 cross-sectional Swedish Health Behaviour in School-aged Children (HBSC) study, encompassing 3,135 students aged 11, 13, and 15 years. PSMU was measured using the Social Media Disorder Scale and categorized into three levels: low risk of PSMU, moderate risk of PSMU and having PSMU. Poor SRH was defined as a binary variable, with 'Less than good health' as the outcome category. Family support was measured using three items that quantified the level of emotional support received, categorized into an index of low, moderate, and high family support. Logistic regression analyses were performed to examine the association between PSMU and poor SRH, adjusting for age, gender, and family affluence. The potential moderating effect of family support was analyzed by including variables to test for both multiplicative and additive interaction between PSMU and family support on the risk of poor SRH.

RESULTS

After adjustment for covariates, the results revealed a graded association between PSMU and poor SRH, with adolescents classified as having PSMU showing the highest odds of poor SRH, followed by those at moderate risk for PSMU. No statistically significant interaction was found on the multiplicative scale. The additive interaction analysis indicated potential trends of a buffering effect of high family support on the risk of poor SRH among adolescents with PSMU, although this was not statistically confirmed [due to small numbers in some of the cells].

CONCLUSIONS

Our study revealed a significant, graded relationship between PSMU and poor SRH, highlighting the need to limit excessive social media use among adolescents to prevent health issues. The finding, that high family support may serve as a potential protective factor against poor SRH in adolescents with PSMU underscores the role of family engagement in safeguarding adolescent well-being.

Perceptions of complementary, alternative, and integrative medicine: A global cross-sectional survey of cardiology researchers and clinicians

BACKGROUND

Complementary, alternative, and integrative medicine (CAIM) has been increasing in popularity among patients with cardiovascular illnesses. However, little is known about perceptions of CAIM among cardiology researchers and clinicians. In response, this study aimed to assess the practices, perceptions, and attitudes towards CAIM among cardiology researchers and clinicians.

METHODS

An anonymous, digital cross-sectional survey was administered to researchers and clinicians who have published articles in cardiology journals indexed in OVID MEDLINE. The survey was sent to 37,915 researchers and clinicians and included 5-point Likert scales, multiple-choice questions, and open-ended questions. Basic descriptive statistics were drawn from quantitative data, and a thematic content analysis was conducted to analyze open-ended responses.

RESULTS

Among the 309 respondents, the majority (n = 173, 55.99%) identified themselves as both researchers and clinicians in the field of cardiology. While 45.78% (n = 114) of participants expressed agreement regarding the safety of CAIM therapies, 44.40% (n = 111) disagreed on their efficacy. Most respondents believed in the value of conducting research on CAIM therapies (79.2%, n = 198). Respondents perceived mind-body therapies (57.61%, n = 159) and biologically based practices (47.46%, n = 131) as the most promising interventions for the prevention and treatment of cardiovascular conditions. Biofield therapies were the least favoured for integration into mainstream medical practices (11.93%, n = 29).

CONCLUSIONS

While cardiology researchers and clinicians perceive CAIM therapies to have potential, many are hesitant about integrating such interventions into the current medical system due to a perceived lack of scientific evidence and standardized products. Insights from this study may help establish educational resources for healthcare practitioners.

Understanding the experiences of nursing students in the context of telenursing in Saudi Arabia: a cross-sectional study

BACKGROUND

In nursing education, telenursing presents many challenges that contribute to psychological distress among nursing students. Understanding these challenges is essential for improving learning outcomes and student well-being. This study aimed to examine factors contributing to psychological distress among nursing students engaged in telenursing, as well as the possible relationships between these factors.

METHODS

This cross-sectional study was conducted with a purposive sample of 204 students. A structured questionnaire was distributed to collect data from the nursing students. Using SPSS (version 28), uni-, bi-, and multivariate analyses were performed to explore the relationships between variables.

RESULTS

Most participants reported moderate knowledge (mean: 7.77, standard deviation [SD]: 1.95; range: 0-10), attitudes (mean: 37.15, SD: 6.70; range: 12-50), and psychological distress (mean: 14.09, SD: 3.99; range: 6-24) related to telenursing. Significant differences were found in access to computers and distress levels (p = 0.016). Attitude was negatively related to psychological distress (r = -0.207, p = 0.003) and positively associated with knowledge (r = 0.295, p < 0.001). In the regression analysis, the models for knowledge, attitude, and psychological distress were significant (p < 0.05).

CONCLUSIONS

This study highlights the need for educators to foster a learning environment that supports student success and well-being. Implementing technology training programs, encouraging positive attitudes toward telenursing, and developing strategies to reduce distress are recommended. Future interventional studies should focus on improving nursing education and practice while fostering a supportive environment.

Impact of dental caries on the quality of life of adolescents: A systematic review and meta-analysis

OBJECTIVE

To evaluate the impact of dental caries on daily activities, assessed by the Oral Impacts on Daily Performances (OIDP) and Child-OIDP in adolescents.

METHODS

Studies published in any language mentioning the relationship between dental caries and OIDP or Child-OIDP were included. PubMed, Scopus, Web of Science, LILACS/BBO, and grey literature were assessed to identify relevant studies published up until March 2024. The quality of the studies was assessed using the Joanna Briggs Institute tool for cross-sectional studies. For the meta-analysis and the leave-one-out sensitivity analysis, the R software was used. The subgroup analysis was conducted considering the version of the tool (OIDP or Child-OIDP) and the outcome (presence or experience of dental caries).

RESULTS

Of the 1,663 studies, 20 were included, all cross-sectional, with 17 of them conducted in schools. A total of 16 studies were considered to have high methodological quality. Individuals in the Child-OIDP and experience of dental caries subgroups showed a worse impact (PR=1.66; 95%CI 1.19-2.31; and PR=1.72; 95%CI 1.23-2.43, respectively). The heterogeneity of the studies was high (I2=97%; T2=0.17; p<0.01), and we did not identify any single study as the main source for this fact in the sensitivity analysis.

CONCLUSION

Dental caries negatively affect adolescents' daily activities. Despite nonsignificant differences between instruments and dental caries classifications, variations in effect estimates highlight the need for further research. New studies are suggested to confirm these findings, given the high heterogeneity found (PROSPERO CRD42021247951).

Calculating epidemiological outcomes from simulated longitudinal data

Microsimulation models generate individual life trajectories that must be summarized as population-level outcomes for model calibration and validation. While there are established formulas to calculate outcomes such as prevalence, incidence, and lifetime risk from cross-sectional and short-term longitudinal studies, limited guidance exists to calculate these outcomes using long-term longitudinal data due to the rarity of large-scale studies covering events across the human lifespan. This technical report presents various methods to calculate epidemiological outcomes from simulated longitudinal data, from replicating a real-world study design to fully incorporating longitudinal disease and exposure durations. We provide an open-source code base with functions in R to calculate the prevalence, incidence, age-conditional risk, lifetime risk, and disease-specific mortality of a condition from individual-level time-to-event data. In addition, we provide guidance and code for calculating cancer-related outcomes from individual-level data, such as the stage distribution at diagnosis, the distribution of precancerous lesion multiplicity, and the mean dwell and sojourn time. Given the various possible formulations for certain outcomes, we call for increased transparency in reporting how summary outcomes are derived from microsimulation model outputs, and we anticipate that this report will facilitate the calculation of epidemiological outcomes in both simulated and real-world data.

Dietary Vitamin C Intake Affects Lung Function Through White Blood Cell

As an antioxidant, vitamin C has been increasingly used in the treatment of various pulmonary diseases in recent years. However, the mechanism by which vitamin C affects lung function remains unclear to this day. Given its low cost and low risk, vitamin C is highly suitable for widespread use as a conventional treatment, making research into its mechanisms of influencing lung function necessary. Considering the potential association between vitamin C and white blood cells (WBCs), it may influence lung function by affecting white blood count (WBC). The potential impacts of WBCs on the lungs may include damage to the lung parenchyma through proteases released by these cells, as well as the effects of inflammatory factors on alveolar epithelial cells, among other mechanisms. This study aims to explore the potential relationship between dietary vitamin C intake, WBC, and lung function through a cross-sectional study. This cross-sectional study included data from 15,738 participants in the National Health and Nutrition Examination Survey (NHANES) from three time periods: 2007-2008, 2009-2010, and 2011-2012. Parallel mediation analysis was conducted using a multivariable logistic regression model to assess the relationships between dietary vitamin C intake, WBC, and lung function. Following the cross-sectional study, we further incorporated Mendelian randomization (MR) analysis to strengthen the validity of the findings. The results of this cross-sectional study showed that dietary vitamin C intake was negatively associated with WBC (p < 0.05, β < 0), while WBC was also negatively associated with lung function. In contrast, dietary vitamin C intake was positively associated with lung function, with a significant positive mediation effect (p < 0.05, β > 0). These findings suggest that vitamin C may influence lung function by modulating WBC levels. The study may reveal part of the mechanism through which vitamin C affects lung function, specifically through the mediation of WBC. The roles of inflammation and proteases could be potential underlying mechanisms. However, further research is required to clarify the biochemical mechanisms. This study provides a reference for the clinical use of vitamin C in the treatment of related pulmonary diseases and promotes further research into its broader effects.

Relationships Between Insomnia and Quality of Life in Patients With Advanced Liver Cancer: A Secondary Analysis of a Multicenter Cross-Sectional Study

BACKGROUND

This study aims to evaluate the symptom burden of advanced liver cancer, explore factors related to quality of life (QoL), and investigate the relationship between insomnia and QoL.

METHODS

This is a secondary analysis of a multicenter cross-sectional study that included data from patients with advanced liver cancer (n = 364) recruited from 10 cancer centers across China. Participants were required to complete Patient Health Questionnaire-9 (PHQ-9), MD Anderson Symptom Inventory (MDASI), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L). Factors associated with QoL were identified through a multiple stepwise linear regression model and the LASSO regression approach. The mediating effect between insomnia and quality of life was tested using the bootstrap method.

RESULTS

The three most prevalent symptoms were fatigue (17.0%), sleep disturbance (16.2%), and pain (15.8%). Insomnia, depression, and the 13 core symptoms in the MDASI were strongly correlated with reduced QoL (all p < 0.001). The mediating effect analysis showed that depression, dry mouth, pain, forgetfulness and fatigue were partial mediating variables between insomnia and QoL.

CONCLUSION

Various physical and psychological symptoms could affect the QoL in patients with advanced liver cancer. Insomnia and related symptoms such as depression, dry mouth, pain, forgetfulness and fatigue should be identified and appropriately addressed to improve QoL for this population.

Midwives' opinions and engagement with midwifery research: A cross-sectional study

BACKGROUND

Midwives' engagement in research is vital for advancing evidence-based practice and enhancing quality care. Despite the expectation that midwives incorporate evidence into their practice, the profession has historically been underrepresented in research.

AIM

To investigate midwives' opinions about midwifery research and assess their level of engagement in midwifery-led research.

METHODS

A cross-sectional design and a convenience-based sampling approach at one metropolitan hospital were used. Data were collected using an online survey with a combination of closed, multichoice and open-ended questions. Data were analysed using SPSS for descriptive and univariate statistics. Content analysis was used for free-text responses.

FINDINGS

Sixty midwives participated, with a response rate of 16 % (60/380). Most participants expressed positive attitudes toward research,. Less positive attitudes were obtained for confidence and access to resources. A small proportion reported they had authored or co-authored a peer-reviewed journal article (6.7 %), and presented at a conference (8.3 %) or within their healthcare organisation (18.3 %). Midwives reported significant barriers to engagement in research, particularly related to lack of time, low-confidence, and minimal research education.

DISCUSSION

The findings illustrate the recognition by midwives of the essential role that clinical experience, scientific knowledge, and research play in the practice and advancement of midwifery. However, midwives perceive there are barriers to their involvement in research.

CONCLUSION

Larger studies are needed to develop, implement and evaluate targeted interventions to promote midwifery-led research. Strategies are needed to increase midwives' engagement in research, including the provision of adequate time, involvement in research activities, and access to resources.

Children and adolescents assisted in a referral oral medicine diagnostic service: 20 years of experience in Brazil

BACKGROUND

Several lesions can affect the oral and maxillofacial region, with trends influenced by lifestyle and age.

AIM

To investigate the occurrence of oral and maxillofacial lesions in paediatric patients assisted in an oral medicine diagnostic service in Brazil over 20 years.

DESIGN

A retrospective cross-sectional study was performed in an oral medicine diagnostic service (1999-2019). Data included sex, age, anatomic site, and diagnosis from clinical records of children (0-9 years) and adolescents (10-19 years). Lesions were diagnosed through clinical examination. Biopsy and histopathologic examination were performed when necessary.

RESULTS

Among 10 530 records, 702 (6.67%) were from patients aged 0-19 years diagnosed with oral or maxillofacial lesions. A high frequency of females was observed (58.1%). Reactive/inflammatory lesions were the most common group of lesions (45.2%), followed by abnormalities of teeth/developmental defects (17.8%) and pulpal and periapical diseases (8.5%). Mucocele/ranula was the most common lesion in children (29.3%) and adolescents (25.3%). Lips were the most affected anatomic sites.

CONCLUSION

Most lesions were benign, and mucocele/ranula was the most frequent. Our results did not differ from those of histopathological-based studies, but they provided information on the occurrence of oral and maxillofacial lesions to dentists and paediatricians.

Noise disturbance and lack of privacy: Modeling acoustic dissatisfaction in open-plan offices

Open-plan offices are well-known to be adversely affected by acoustic issues. This study aims to model acoustic dissatisfaction using measurements of room acoustics and sound environment during occupancy, and occupant surveys (n = 349) in 28 offices representing a diverse range of workplace parameters. As latent factors, the contribution of lack of privacy (LackPriv) was 25% higher than noise disturbance in predicting acoustic dissatisfaction (AcDsat). Room acoustic metrics based on sound pressure level (SPL) decay of speech (Lp,A,s,4m and rC) were better in predicting these factors than distraction distance (rD) based on speech transmission index. This contradicts previous findings, which may partly be due to the cross-sectional study design. Specifically, the trends for SPL-based metrics in predicting AcDsat and LackPriv go against expectations based on ISO 3382-3. For sound during occupation, LA,90 and psychoacoustic loudness (N90) predicted AcDsat, and a SPL fluctuation metric (MA,eq) predicted LackPriv. However, these metrics were weaker predictors than ISO 3382-3 metrics. Medium-sized offices exhibited higher dissatisfaction than larger (≥50 occupants) offices. Dissatisfaction varied substantially across parameters including ceiling heights, number of workstations, and years of work, but not between offices with fixed seating compared to more flexible and activity-based working configurations.

Impact of alcohol consumption on atherosclerosis: a systematic review and meta-analysis

Introduction

Atherosclerosis, a chronic vascular disease, impacts various arterial systems, such as the coronary, carotid, cerebral, renal, and peripheral arteries. Dietary factors, especially alcohol consumption, significantly contribute to the progression of atherosclerosis. However, systematic evaluations of alcohol's impact on atherosclerosis are still limited. This study investigates the impact of alcohol consumption on atherosclerosis via meta-analysis and assesses the moderating effects of drinking frequency, gender, and other factors.

Methods

By December 2024, a comprehensive literature search was conducted across PubMed, Embase, Cochrane, and Web of Science databases. Studies evaluating the relationship between alcohol consumption and atherosclerosis were rigorously selected and assessed for quality. The study protocol was registered with the INPLASY database. Data extraction and statistical analysis were conducted using STATA 18.0 software. A total of 26 studies involving 326,513 patients across 10 countries were included. Considering that different biological mechanisms may regulate atherosclerosis in different arterial locations, we conducted subgroup analyses to explore differences in country, study type, arterial site, diagnostic criteria, type of alcohol, and gender.

Result

The results show that the overall analysis did not show a significant promoting effect of alcohol consumption on the development of atherosclerosis (OR = 0.91, 95% CI 0.79-1.05). Subgroup analyses revealed several important trends. Alcohol consumption may increase the risk of atherosclerosis in specific countries (Japan, South Korea, Brazil, and Denmark), types of studies (cohort and case-control studies), arterial locations (coronary arteries), and diagnostic criteria (clinical diagnosis and computed tomography). Interestingly, we found that alcohol consumption may increase the risk of atherosclerosis in women. Furthermore, varying levels of alcohol consumption appear to result in differing risks of the disease.

Conclusion

The impact of alcohol consumption on atherosclerosis is not singular and may interact with multiple factors, including environmental factors, lesion location, and individual characteristics.

Systematic review registration

https://inplasy.com/inplasy-2025-1-0031/, INPLASY202510031.

Exploring undergraduate medical imaging students' perception of clinical stressors in Ghana

INTRODUCTION

Despite the benefits of clinical training, stressors naturally arise during students' training. These stressors may negatively impact the emotional and psychological wellbeing of the students. There is paucity of literature on the clinical stressors and the challenges faced by medical imaging students in Ghana. This study explored undergraduate medical imaging students' perceptions of stressors during clinical training and suggested measures that may lessen burn out.

METHODS

Cross-sectional study design was employed. The study population consisted of 293 medical Imaging students from College of Health and Wellbeing Kintampo (CoH-K), Kwame Nkrumah University of Science and Technology (KNUST), University of Cape Coast (UCC), University for Development Studies (UDS), University of Ghana (UG), and University of Health and Allied Sciences (UHAS). A self-administered questionnaire with closed-ended questions and a section for open remarks was used for data collection and subsequently analysed using IBM SPSS version 26.

RESULTS

63.50% were males and final year students were the majority (48.80%). The highest ranked stressor was, ''theory to practical" (89.42%) while "sexual harassment from superiors" ranked lowest (0.12%). UCC recorded the highest responses (35.8%). The coping mechanism, "Reflecting on situations and making better plans for future experiences" ranked highest (89.08%) while "taking alcohol or hard drugs" ranked lowest (2.39%).

CONCLUSION

The data highlighted various clinical stressors experienced by students identifying theory to practical gap as the most prominent. It also provided valuable insights into the coping mechanisms adopted by the students to manage clinical stressors, with reflection, support-seeking, and relaxation techniques being prominent strategies.

IMPLICATIONS FOR PRACTICE

Institutions of higher education in Ghana should institute measures to improve students' wellbeing in the clinical areas.

Laryngeal Hypersensitivity From the Perspective of Pain Science: An Integrative Review of Empirical Studies on Associated Factors and Processes

OBJECTIVE

Laryngeal hypersensitivity (LHS) is a state of heightened sensorimotor response to stimuli in the upper airway. Although its clinical picture is becoming progressively clearer with recent research progress, specificities about its associated factors and processes remain to be clarified. The aim of this integrative review was to synthesize published empirical data from human studies on LHS, focusing on related factors and pathophysiology.

STUDY DESIGN AND DATA SOURCES

Integrative review of the literature; Pubmed, EMBASE, and Web of Science.

METHODS

Keywords associated with the following three main concepts were used to query databases: (1) manifestations potentially associated with an irritable larynx (dysphonia, inducible laryngeal obstruction (ILO), chronic cough, and globus); (2) hypersensitivity; and (3) pathophysiology. Peer-reviewed studies in English providing empirical original research data on the pathophysiology of LHS were included, with no restriction based on study design.

RESULTS

In total, 54 papers met the inclusion criteria. Factors potentially associated with LHS were identified, namely (1) psychological and lifestyle factors, (2) upper airway inflammation and injuries from exogenous/endogenous irritants, infections, or mucosal atrophy, (3) sex hormones, (4) metabolic abnormalities, and (5) aberrant respiratory behavior. Given the parallels between pain-related mechanisms and suggested LHS mechanisms, processes identified as putatively contributing to LHS were categorized in light of the current pain literature. Findings suggest that LHS may stem from a peripheral tissue insult, a neuropathic insult, and/or maladaptive neuroplasticity. Gaps in the literature were identified, in part driven by an uneven repartition of research across the various alleged manifestations of LHS. In fact, a large majority of studies pertained to chronic cough, with very few addressing muscle tension dysphonia, ILO, and globus.

CONCLUSION

Future research can focus on the potential role of hypersensitivity in manifestations such as muscle tension dysphonia and ILO, and on the development of guidelines to identify the specific underlying factors and mechanisms at play in LHS symptoms.

Student well-being: the impact of belonging, COVID-19 pandemic related student stress, loneliness, and academic anxiety

Introduction

This research investigates the relationship between collegiate community and degree department belonging, loneliness, COVID-19 pandemic related student stress, coping self-efficacy, and academic anxiety among UK collegiate context. The study focuses on how these factors have shaped students' academic and social experiences in the post-pandemic era, with particular emphasis on variations based on gender as well as home versus international status among both undergraduate and postgraduate cohorts.

Methods

This study utilized structural equation modelling (SEM). A sample of 430 students was administered, with 284 (66%) completed by female students and 120 (28%) by male students. The number of undergraduate students was (N = 244, 56.7%), and (N = 184, 42.8%) participants were postgraduate students.

Results

The research findings indicate that stress related to COVID-19 has adversely affected both types of belongingness- collegiate community and degree department belonging -while concurrently elevating academic anxiety across diverse demographic groups. Loneliness emerged as a significant mediating variable, with pronounced effects observed among international and male students. The presence of academic anxiety exacerbated feelings of loneliness and diminished coping self-efficacy, particularly in female and undergraduate cohorts. International students experienced notable disruptions in their sense of collegiate belonging and heightened levels of loneliness. Undergraduate students demonstrated greater susceptibility to stress-induced declines in belongingness, whereas postgraduate students reported more severe ramifications of loneliness on their academic and social relationships.

Discussion

These results underscore the necessity for targeted interventions designed to foster social connectedness, alleviate academic anxiety, and bolster support systems within the post-pandemic educational framework.

Risk of Bias Evaluation of Cross-Sectional Studies: Adaptation of the Newcastle-Ottawa Scale

Cross-sectional studies are widely utilized in medical research to estimate prevalence and examine associations. As such, they can serve as a significant source of data for systematic reviews. However, specific considerations are necessary when evaluating the risk of bias (RoB) of cross-sectional studies, as several potential biases can undermine the validity, reliability, and robustness of their findings. This article introduces a novel, context-specific tool designed to assess the RoB of cross-sectional studies for use in systematic reviews. The proposed tool represents an adaptation of the Newcastle-Ottawa Scale (NOS), originally developed for cohort and case-control studies. Similar to the original NOS, the new tool (named "NOS-xs") features a nine-star rating system to assess six specific items across three main domains: (i) study sample selection, (ii) assessment of exposure(s) and outcome(s), and (iii) confounding factors. Based on the number of awarded stars, studies are categorized as having high (0-3 stars), moderate (4-6 stars), or low (7-9 stars) RoB. The NOS-xs tool maintains consistency with the original NOS tool, facilitating its integration into systematic reviews that also include cohort and/or case-control studies. While the NOS-xs is suited to analytical cross-sectional studies (i.e., association studies), a simplified version ("NOS-xs2") is also introduced for descriptive cross-sectional studies (i.e., prevalence studies). The NOS-xs2 features a four-star rating system to assess three of the six specific items included in the NOS-xs. To streamline their application, spreadsheets for both NOS-xs and NOS-x2 are provided.

Barriers and Facilitators to Implementing a Nurse-Led Information System for Older Adult Patients' Post-Discharge Self-Care: An Exploratory Sequential Mixed-Methods Study

AIM

To explore determinants impacting an Electronic Health Record-based information system implementation and their association with implementation fidelity based on the Theoretical Domains Framework (TDF) from nurses' perspectives.

DESIGN

Exploratory sequential mixed-method design.

METHODS

In stage one, semi-structured interviews with 53 purposively selected nurses informed the exploration of TDF domains influencing the implementation of the information system with directed content analysis. In stage two, a cross-sectional survey, informed by the qualitative findings, was conducted among 482 nurses to identify the most relevant and relatively important TDF domains by running generalised linear regression models.

RESULTS

The qualitative interviews generated 13 TDF domains that were identified as major influencing factors, including technology characteristics, knowledge, attitudes, role agreement, self-efficacy, goal-setting, information circulation, and communication among nurses. Quantitative findings showed that 70% of nurses used and printed the written form through the information system, and only 34% offered verbal education consistently. Regression analysis identified nine domains that were relevant and important factors for implementation fidelity, including knowledge, skills, role identity, beliefs in consequences, beliefs in capabilities, intentions, goals, memory and decision processes, and environmental context.

CONCLUSION

Our findings confirmed previous evidence on determinants of implementing digital health technologies, including knowledge, competencies, perceived effectiveness, role agreement, intentions, decision processes, and environmental context. Additionally, we highlighted the importance of goal-setting for successful implementation.

IMPACT

This study investigated the relatively important associated factors that can impact the successful implementation of the nurse-led information system for post-acute care based on nurses' perspectives. These results can guide nurse practitioners in implementing similar initiatives and support evidence-based decision-making. Researchers can also further investigate the relationships between the identified determinants.

REPORTING METHOD

Journal Article Reporting Standards for Mixed Methods Research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Embracing change: impermanence acceptance mediates differences in death processing between long-term ayahuasca users and non-users

RATIONALE

The human psyche's interaction with death fundamentally shapes cognition, emotions, and behavior in both individuals and society. Death-related psychological phenomena have been shown to be influenced by psychedelic interventions. However, the literature lacks a comprehensive assessment of death-related processes in non-clinical settings, the mechanisms underlying long-term changes, and particularly the effects of ayahuasca on these dimensions.

OBJECTIVES

This cross-sectional study investigates death processing, potential mechanisms of change, and their predictors in ayahuasca veterans (N = 54) compared to non-users (N = 53).

METHODS

A battery of questionnaires and behavioral assessments were used to evaluate different aspects of death processing in both ayahuasca veterans and non-users. These assessments measured death fear and anxiety, death-acceptance, death-avoidant behaviors, and the accessibility of death-related thoughts. Mediators tested included personality traits, beliefs about the afterlife, trait mindfulness, and the concept of impermanence.

RESULTS

The findings demonstrated lower levels of death anxiety, avoidant behavior, and fear of death, as well as greater death acceptance in ayahuasca veterans. Mediation analyses revealed that group differences were not due to demographics, personality, trait mindfulness, ontological beliefs, or impermanence awareness, but rather to impermanence acceptance. Finally, within the ayahuasca group, lifetime ego dissolution experiences predicted the degree of impermanence acceptance.

CONCLUSIONS

These findings reveal significant, multi-dimensional differences in death processing between ayahuasca and non-psychedelic users. Impermanence acceptance emerged as the key mechanism of change. Additionally, the results highlight the role of acute ayahuasca experiences in producing lasting effects. Future interventions may focus on promoting impermanence acceptance as a strategy for managing existential fear.

A cross-country analysis of Polish, Serbian, and Czech medical students' competencies in working with individuals with intellectual disabilities

BACKGROUND

The complexity of difficulties and limitations associated with intellectual disabilities entails the need for accessing support in healthcare services by competent physicians. The way medical education is structured in different countries may influence how well medical students are prepared to address the needs of patients with intellectual disabilities.

METHODS

Three self-constructed scales were used to compare the self-assessed competencies of undergraduate medical students from Poland, Serbia, and the Czech Republic working with individuals with intellectual disabilities and to understand the significance of selected variables differentiating these competencies across countries.

RESULTS

A total of 357 medical students from the three countries constituted the study sample. The students generally acknowledged the necessity of preventing discriminatory practices in healthcare and recognized the importance of special protection for individuals with intellectual disabilities. Differences were observed in their social distance and self-assessed competencies in working with these patients. Additionally, sociodemographic factors and prior experience played differing roles.

CONCLUSIONS

The education of future doctors should include the opportunity to develop knowledge and skills to work with patients with disabilities.

Associations between key job resources, job demands, and affective organizational commitment among nursing professionals in German hospitals: a cross-sectional study

BACKGROUND

Hospitals in industrialized countries like Germany face persistent shortages of nursing professionals, making staff retention through affective organizational commitment essential. However, factors associated with this commitment among nursing professionals in German hospitals remain understudied. Guided by affective events theory and the job demands-resources model, this study examines the associations between key job resources, job demands, and nursing professionals' affective organizational commitment in general wards.

METHODS

To investigate the relationships between job resources and demands and affective organizational commitment of nursing professionals, this study employed a cross-sectional survey. The dataset for analyses comprised 312 nursing professionals working in general wards in Germany and was analyzed using multiple linear regression.

RESULTS

The investigated variables explained 44% of the variance in nursing professionals' affective organizational commitment. Fair and authentic management was positively associated with affective commitment, while work overload and inadequate remuneration showed negative associations. No significant relationships emerged for other examined job resources, such as supervisor support or job autonomy, or for job demands like work-life interference.

CONCLUSIONS

These findings align with theoretical perspectives suggesting that specific job resources and demands may play a role in nursing professionals' affective organizational commitment. Based on the observed associations between job resources and demands and affective organizational commitment, this study offers considerations for hospital management. Three areas might warrant management attention: cultivating fair, authentic, and moral leadership practices among nurse managers; systematically mitigating work overload; and ensuring attractive remuneration packages. Future research, particularly longitudinal or experimental studies, is needed to further investigate the causal relationships underlying the observed associations.

An exploration of the relationship between attitudes and experiences of prevention and oral health behaviours of the public within six European countries

OBJECTIVES

To survey the public's self-reported attitudes and knowledge towards prevention in oral healthcare and to explore their relationship with tooth brushing frequency and frequency of dental visits.

METHODS

Adults (18+) were approached by email to complete a questionnaire about their attitudes and knowledge towards prevention in oral healthcare in UK, Ireland, Denmark, Germany, the Netherlands and Hungary. Tooth brushing frequency and dental attendance were assessed to see if there was an association with: cost, motivation, responsibility, advice received, personalised advice and knowledge.

RESULTS

3372 participants were recruited. Participants who visited the dentist less often were more likely to see cost as a barrier, with the adjusted odds ratio (aOR) of the last visit being more than 2 years ago versus last visit less than one year ago being 2.58 (95% CI: 2.05 to 3.24). For both motivation and perceived responsibility to care for teeth/gums there was a relationship with frequency of brushing. Comparing those brushing ≥ twice-a-day to participants brushing less than once-a-day or never, the adjusted mean difference for the motivation score was - 1.18 (95% CI: -1.67 to - 0.68) and the aOR for perceived responsibility was 0.15 (95% CI: 0.09 to 0.25). Those who brushed their teeth less frequently were less likely to report receiving preventive advice, with the aOR for those brushing their teeth less than once-a-day or never compared to those who brush ≥ twice-a-day being 0.57 (95% CI: 0.36 to 0.90). Participants who brushed their teeth less frequently (aOR of less than once-a-day or never versus ≥ to twice-a-day 0.50 (95% CI: 0.31 to 0.79)) or visited the dentist less frequently (aOR of 2 or more years ago versus less than one year ago 0.30 (95% CI: 0.23 to 0.38)) were less likely to agree their dental professional knows them well enough to provide personalised oral health advice.

CONCLUSIONS

Self-reported frequent tooth brushing and regular dental visits correlated with higher motivation, responsibility, and personalized advice from dental professionals. Less regular dental visits were correlated with viewing cost as a barrier. Strengthening dentist-patient relationships and addressing barriers such as cost could further improve preventive dental behaviours and oral health outcomes. Demonstrating the successful use of a tool to allow for the first time multiple country exploration of the relationship between attitudes towards prevention and oral health behaviours.

Biopsychosocial impacts of mother loss on daughters in Australia: Cross-sectional study

We aimed to describe the biopsychosocial impacts of a mother's death at any stage in life on adult daughters in Australia. A total of 2735 mother-bereaved daughters completed an online survey about their experiences of mother loss and its impacts. We assessed several biopsychosocial outcomes, including symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD), prolonged grief disorder (PGD), quality of life (QoL), sleep disturbance, and pain. Using multiple regressions, we examined how mother and daughter's age at the time of death, daughter's levels of maternal and general attachment anxiety and avoidance, daughter's dependence on their mother prior to their death, daughter's provision of personal care to their mother prior to their death, and daughter's expectation of their mother's death were associated with biopsychosocial outcomes. Older, anxiously attached, dependent daughters who provided care and faced unexpected loss experienced poorer outcomes. General attachment anxiety was the strongest and most consistent predictor.

Global and regional estimates of vaccine-associated herpes zoster and their related vaccines from 1969 to 2023

Vaccine-induced immunosuppression can reactivate the varicella-zoster virus, potentially leading to the development of herpes zoster. However, the literature on this topic is inconsistent, resulting in limited clarity. Therefore, we aimed to enhance our understanding of vaccine-associated herpes zoster and establish guidelines for future research, utilizing a global database to improve global public health. We investigated vaccine-associated adverse events in herpes zoster using reports (~ 13 million reports) from the WHO international pharmacovigilance database. Data were analyzed for the global number of reports, reported odds ratios (ROR), and information components (IC) to determine the potential association between 18 vaccines and vaccine-associated herpes zoster reports in nearly 170 countries and territories from 1969 to 2023. Of 7,805,380 vaccine-associated adverse events, there were 51,985 herpes zoster reports. Vaccine-associated herpes zoster showed the highest strength of association with COVID-19 mRNA vaccines (ROR, 11.85 [95% CI, 11.70-12.01]; IC, 2.74 [IC0.25, 2.72]), followed by encephalitis (ROR, 4.07 [95% CI, 3.37-4.92]; IC, 2.00 [IC0.25, 1.68]), influenza (ROR, 3.44 [95% CI, 3.28-3.62]; IC, 1.77 [IC0.25, 1.69]), and ad5-vectored COVID-19 vaccines (ROR, 3.05 [95% CI, 2.97-3.14]; IC, 1.54 [IC0.25, 1.50]). The ROR and IC of vaccine-associated herpes zoster in males (ROR, 7.94 [95% CI, 7.80-8.08]; IC, 2.47 [IC0.25, 2.45]) and females (ROR, 6.71 [95% CI, 6.62-6.80]; IC, 2.30 [IC0.25, 2.28]). The ROR and IC increased with advancing age. Our findings emphasize the need to consider the immune status of vaccine recipients and to implement appropriate compensation and management manuals for vaccine-associated herpes zoster.

Physical and Physiological Demands of Official Beach Soccer Match-Play in Relation to Environmental Temperature

Environmental temperature (Te) is a main atmospheric parameter that may affect the physical and physiological demands of outdoor sports. Thus, this study aimed to examine the relationship of Te with the physical and physiological demands of beach soccer match-play. Physical and physiological demands were collected from 60 male players during Portuguese elite beach soccer championship matches using a 10 Hz wearable global positioning system, heart rate, and the rate of perceived exertion (RPE). A bilateral counter-movement jump (CMJ) test assessed lower limb power performance before and immediately after the match. Fluid loss was determined by body mass weighing before and after the end of the match. Te and wet-bulb globe temperature (WBGT) parameters were continuously recorded. The matches occurred across Te ranging from ~20.0 °C to 43.0 °C. Physical demands, CMJ height, peak heart rate (HRpeak), mean heart rate (HRmean), and RPE were not correlated with Te. However, a significant correlation was found between fluid loss and Te (r [95% CIs] = 0.67 [0.43-0.75]; p < 0.001). Beach soccer players maintained physical performance independent of Te. The specific characteristics of the sport may have promoted adequate thermoregulatory adaptations, helping maintain the players' physical performance, particularly in matches played under high Te conditions. Elite beach soccer players maintained their physical performance independently of Te and despite experiencing dehydration (a body mass decrease of more than 2%) when the Te exceeded 35 °C.

Alcohol use, heavy episodic drinking, and associated cardiovascular risk in Guyana

Objective

To determine associations between demographic characteristics, alcohol use, heavy episodic drinking (HED), and cardiovascular risk factors using the 2016 Guyana World Health Organization (WHO) STEPwise noncommunicable diseases risk factor survey.

Methods

A weighted sample was used in a secondary analysis of data obtained from an online database. Descriptive statistics, binary logistic regression, and linear regression models were applied to identify which subpopulations were at highest risk of HED or cardiovascular disease.

Results

Data from 2 662 individuals (77% response rate) were analyzed. In the unweighted sample, females made up 59.9% (95% CI [58.04, 61.76]) of the respondents and the average age was 40.7 years. Indo-Guyanese comprised 39.4% (95% CI [37.54, 41.26]) of the sample. The maximum educational level completed was primary level in 44.5% (95% CI [42.61, 46.39]) and secondary in 32.5% (95% CI [30.72, 34.28]). Of those who had ever drunk, 80.1% (95% CI [78.30, 81.90]) confirmed alcohol use in the past 12 months. Younger males were significantly more likely to consume alcohol. Using the weighted sample, Amerindian individuals had lower odds of alcohol use (odds ratio [OR] 0.36; 95% CI [0.25, 0.51]) compared to Indo-Guyanese. Residents of the Demerara-Mahaica region had the highest use at 86.1% (OR 4.74; 95% CI [2.86, 7.86]). Regarding HED, 16.4% (95% CI [14.73, 18.07]) of the entire sample, and 41.1% (95% CI [38.88, 43.32]) of those who drank in the past 30 days, reported having at least six drinks (defined as HED) in one sitting. The 25-29 age group showed an increase in odds for HED (OR 2.09; 95% CI [1.13, 3.89]). Men were more likely to engage in HED than women (OR 6.13; 95% CI [4.73, 7.95]). People of African (OR 0.78; 95% CI [0.61, 1.00]) and Amerindian descent (OR 0.48; 95% CI [0.31, 0.73]) had lower odds of HED than Indo-Guyanese. In the adjusted models, HED was positively correlated with elevated blood pressure (adjusted OR [aOR] 1.40; 95% CI [1.05, 1.88]), obesity (aOR 1.49; 95% CI [1.13, 1.95]), and elevated triglycerides (β coefficient 28.38, p = 0.004). For each OR and aOR above, p ≤ 0.05.

Conclusions

This secondary analysis identifies that the population along the central and eastern coastal regions, young males, and those of Indo-Guyanese descent might benefit from focused public health interventions on alcohol and cardiovascular risk in Guyana.

Recreation specialization and leisure satisfaction among long-distance running: an examination of the mediating role of place dependence and place identity

Introduction

Researchers extensively employed recreation specialization as a dependent variable or classification tool for investigating the relationship between leisure activities and sociological variables. This study challenged the conventional understanding by suggesting recreation specialization was more likely to be positively associated with leisure satisfaction through place dependence and place identity.

Methods

A total of 570 questionnaire responses were collected from participants engaged in long-distance running at West Lake. JASP 0.18.3.0 software was used to examine all hypotheses in the conceptual model.

Results

The findings provided support for the following: (1) Recreation specialization directly and positively influenced place dependence, place identity, and life satisfaction; (2) Place dependence was positively related to place identity, while both place dependence and place identity were positively associated with individuals' life satisfaction; (3) Place dependence and place identity mediated the impact of recreation specialization on life satisfaction, with place dependence partially explaining this mediation effect through place identity.

Discussion

These findings concluded with practical and academic implications of the study. Future research should also explore the underlying mechanisms linking recreation specialization and life satisfaction.

A conceptual framework for defining work disparities: A case of nurses in long term care

BackgroundIncreasing the recruitment and retention of nurses within long-term care (LTC) is a growing challenge faced by the healthcare community. Addressing this problem will require a greater understanding of the day-to-day experiences of nurses, including the disparities and unequal treatment experienced by this group of workers (e.g., pay parity, discrimination, and unfair job demands). However, while there is a need to better understand work disparities faced by nurses, a formalized definition and framework for examining work disparities do not exist within the literature.ObjectiveTo create a conceptual framework to define and analyze work disparities experienced by nurses in LTC.MethodsThis analysis was conducted in adherence to Podsakoff et al.'s four-stage series of recommendations. A partial survey of the literature and operationalizations of work disparities were analyzed to create a core list of attributes of work disparities among nurses in LTC. A definition and framework for classifying work disparities were then posited through a dialogic process and refined by testing on two studies.ResultsA definition of work disparities was posited and four categories of work disparities were identified: job security, work compensation, work opportunities, and workplace treatment. A matrix for classifying the variables of work disparities and comparator groups was refined.ConclusionWith the increasing recognition of unequal treatment of nurses in LTC, this framework can enable further research within this area to support and enhance opportunities for the retention and health of the LTC workforce.

Association between pain intensity and body composition in adults with chronic non-specific low back pain: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis evaluated the association between pain intensity and different body composition measures in adults suffering from chronic non-specific low back pain (CNLBP).

METHODS

A systematic literature search across five databases-PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library-was conducted. It identified observational studies published until January 2024. A meta-analysis was conducted incorporating a random-effects approach with Fisher's Z transformation. A critical appraisal of the included studies' quality was conducted.

RESULTS

Twenty-two studies were included. Of those, 20 were meta-analyzed, revealing positive, very weak correlations between pain intensity and body mass index (r = 0.11; 95% CI: 0.04 to 0.18), waist-hip ratio (r = 0.10; 95% CI: -0.14 to 0.34) and waist circumference (r = 0.09; 95% CI: -0.28 to 0.44). Not pooled study findings (e.g., hip circumference and body fat percentage) were narratively summarized, revealing 13 positive and four negative associations between pain intensity and body composition measures. Studies showed a substantial risk of bias due to unadjusted confounding factors and limited transferability of findings.

CONCLUSION

This systematic review and meta-analysis provided very low-quality evidence for a positive, very weak association between pain intensity and body composition measures in adults with overweight and obesity suffering from CNLBP. The included studies had a substantial risk of bias due to their observational and cross-sectional study designs, which prevents recommendations for clinical practice. Randomized controlled trials are needed to investigate the causal effect of interventions on body composition measures and pain intensity.

Is Kinesiophobia Associated With Quality of Life, Level of Physical Activity, and Function in Older Adults With Knee Osteoarthritis?

BACKGROUND

Beyond knee pain itself, the fear of movement, also known as kinesiophobia, recently has been proposed as a potential factor contributing to disability and functional limitation in patients with knee osteoarthritis (OA). Nevertheless, the available evidence on the association of kinesiophobia with patient-reported outcome measures (PROMs) in knee OA remains limited.

QUESTIONS/PURPOSES

Among patients with nonoperatively treated knee OA, we asked: (1) Is kinesiophobia associated with decreased quality of life (QoL), functional outcomes, and physical activity? (2) What are the patient disease and psychosocial demographic factors associated with kinesiophobia?

METHODS

This was a multicenter, cross-sectional study of 406 general orthopaedic patients from two urban, referral-based tertiary hospitals in Singapore under a single healthcare group who received nonoperative treatment for knee OA. Between July 2020 and January 2022, a total of 1541 patients were treated for knee OA nonoperatively. Based on that, 60% (923) of patients were rejected due to refusal to participate in the study, 3% (52) of patients were enrolled but did not show up for their appointments for data collection, and a further 10% (160) had incomplete data sets, leaving 26% (406) for this study's analysis. The mean age of patients was 64 ± 8 years, 69% were women, and 81% were Chinese. The level of kinesiophobia in patients was measured using the Brief Fear of Movement scale, a validated 6-item questionnaire ranging from a score of 6 to 24 to measure kinesiophobia in OA, with higher scores representing higher levels of kinesiophobia. In terms of PROMs, the QoL and functional level of patients were measured using the QoL and activities of daily living (ADL) components of the widely validated 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12). The KOOS-12 is a questionnaire consisting of 12 items encompassing three domains (QoL, ADL, and pain), with each item ranging from 0 to 4 and higher scores representing worse outcomes. The University of California, Los Angeles (UCLA) Activity Scale was used to measure the level of physical activity in patients. The UCLA score is a descriptive 10-level activity scale ranging from a score of 1 to 10, with higher scores representing greater physical activity levels. A directed acyclic graph, which is a relationship map used to depict and visualize the confounders between the studied variables, was used to identify the confounders between kinesiophobia and PROMs (QoL, function, and physical activity). An ordinal regression model was used to explore: (1) the association between kinesiophobia (as measured using the Brief Fear of Movement scale) and PROMs (as measured using KOOS QoL, KOOS ADL, and the UCLA Activity Scale), adjusting for key confounders such as age, gender, pain, side of arthritis, OA duration/severity, and psychosocial factors (for example, depression, anxiety, and education levels), and (2) the association between kinesiophobia (Brief Fear of Movement scale) and various patient disease and psychosocial demographic factors.

RESULTS

After accounting for confounders, greater kinesiophobia (higher Brief Fear of Movement scores) was associated with lower QoL (KOOS QoL score adjusted IQR OR 0.69 [95% confidence interval (CI) 0.53 to 0.90]; p = 0.007) and lower physical activity (UCLA score adjusted IQR OR 0.68 [95% CI 0.52 to 0.90]; p = 0.007); however, there was no association between kinesiophobia and function (KOOS ADL score adjusted IQR OR 0.90 [95% CI 0.70 to 1.17]; p = 0.45). After adjusting for age, gender, OA duration, pain, and BMI, higher levels of anxiety (Patient Health Questionnaire 2 [PHQ-2] anxiety score adjusted OR 2.49 [95% CI 1.36 to 4.58]; p = 0.003) and depression (PHQ-2 depression score adjusted OR 3.38 [95% CI 1.73 to 6.62]; p < 0.001) were associated with higher levels of kinesiophobia. Education level, OA disease severity, side of arthritis (unilateral versus bilateral), and history of previous injury or surgery on the knee were not associated with kinesiophobia.

CONCLUSION

Clinicians should assess for kinesiophobia and other psychological comorbidities such as depression and anxiety at the point of initial evaluation and subsequent follow-up of knee OA with simple validated tools like the Brief Fear of Movement scale (kinesiophobia) in the clinic. This allows for clinicians to identify high-risk individuals and offer evidence-based treatment such as cognitive behavioral therapies with a multidisciplinary team, including a physical therapist and psychologist, to manage these psychological comorbidities and improve outcomes in patients with knee OA. While kinesiophobia was found to be associated with poorer QoL and physical activity, future studies including larger observational cohort studies should be conducted to determine causal and prognostic relationships between kinesiophobia and outcomes in knee OA.

LEVEL OF EVIDENCE

Level III, prognostic study.

Unraveling the link between language barriers and cancer risk

PURPOSE

Clear patient communication with the physician is an integral aspect of cancer treatment and successful health outcomes. Previous research has shown improved cancer screening in cases of patient navigator assistance to limited English proficient patients, but no research has analyzed the relationship between language isolation and cancer incidence rates in the United States.

METHODS

Using state-level data from the United States Census Bureau and the National Cancer Institute, we analyzed the correlations between language isolation and age-adjusted incidence rates across 19 different invasive cancers.

RESULTS

A complex relationship between language isolation and cancer incidence rates was found. States such as California, New York, Texas, and New Jersey show high language isolate prevalence and elevated cancer incidence rates. Cancer subtype incidence rates varied between states, indicating the multifactorial importance of lifestyle, genetics, and environment in cancer. California had the highest language isolation ranking of 8.5% and elevated rates of ovarian (10.4/100,000) and stomach (9.1/100,000) cancers. New York, with the second-highest language isolation ranking of 7.6%, manifests a pronounced prevalence of ovarian (11.3/100,000) and stomach (10.9/100,000) cancers. Overall, positive correlations were observed between language isolation and ovarian/stomach cancers, while negative correlations were found with lung, kidney, melanoma, and colorectal cancers.

CONCLUSION

This study emphasizes the need to address language barriers and other social determinants of health in cancer prevention/control. Targeted interventions, such as culturally appropriate education, increased access to linguistically and culturally appropriate cancer screening, and language lessons, are crucial in improving health outcomes in linguistically diverse communities.

Food-based indexes and their association with dietary inflammation

Chronic inflammation is associated with an increased risk of noncommunicable diseases, prompting an intensified interest in the diet-disease relationship for modulating inflammation. Diet quality indexes are widely used to quantify dietary patterns. However, the optimal tool for assessing dietary quality in relation to chronic inflammation remains unclear. The objective of this study was to synthesize the literature on food-based diet quality indexes and their association with chronic inflammation. A systematic scoping review of scientific databases was conducted from inception to March 2024. Studies describing the development and validation of original dietary inflammatory indexes or assessed associations between established indexes and inflammatory biomarkers were included. Studies that predominantly focused on nutrient-based indexes were excluded. Forty-three food-based indexes, evaluated across 65 studies, were categorized into 4 distinct groups based on dietary patterns (n = 18), dietary guidelines (n = 14), dietary inflammatory potential (n = 6), and therapeutic diets (n = 5). Established indexes based on the Mediterranean diet and dietary guidelines were the most extensively utilized, demonstrating inverse associations with several inflammatory biomarkers across diverse populations. The Anti-Inflammatory Diet Index, Dietary Inflammation Score, and Empirical Dietary Inflammatory Index were identified as robust, empirically derived indexes to assess diet quality based on their inflammatory potential. The dietary composition of the evaluated indexes ranged from 4 to 28 dietary components, with fruits, vegetables, whole grains, and legumes consistently classified as favorable, whereas red/processed meats and added sugars were unfavorable. This scoping review identified several promising food-based indexes for assessing inflammation-related diet quality. Methodological variations and inconsistencies in algorithms underscore the need for further validation across diverse populations. Future research should consider the scoring methods, dietary composition, and validated inflammatory biomarkers when selecting indexes to evaluate diet-inflammation associations. Understanding the characteristics that underpin these indexes informs their application in nutrition research and clinical practice.

Emotions, coping and psychological flexibility in earthquake survivors: a cross-sectional study

Earthquakes may play a role in the development of several psychological distresses or psychopathologies. Nevertheless, protective factors such as positive emotions, psychological flexibility, and coping mechanisms may be helpful for earthquake survivors in coping. On the other hand, the role of both positive and negative emotions of earthquake survivors in psychological flexibility and coping remains elusive. Accordingly, this study aimed to examine the relationship between emotions, coping, and psychological flexibility levels of earthquake survivors considering positive and negative emotions together. A total of 330 adult participants of the cross-sectional study completed the Participant Information Form, Perceived Ability to Cope with Trauma (PACT), Psychological Flexibility (PF), and Positive-Negative Affect Schedule (PANAS) scales. Participants were aged between 20 and 68 years (Mean ± SD = 42.42 + 12.88). It was determined that as the PACT levels increased, the PF and negative emotion levels increased yet positive emotion levels decreased. As the PF levels increased, the negative emotion levels increased yet the positive emotion levels decreased (p < 0.01). According to the established model, it was concluded that the PACT was related to positive-negative emotion levels and values, being in the moment, and dissociation sub-dimensions of PF were unrelated to contextual self and acceptance (p > 0.05). In conclusion, positive-negative emotions and PF were found to have a mediating role in the coping of earthquake survivors. Mental health professionals may contribute to increasing PACT in earthquake survivors through interventions aimed at maintaining positive emotions, recognizing negative emotions, and increasing PF.

Age of onset of cannabis use and substance use problems: A systematic review of prospective studies

BACKGROUND

The association between the age of cannabis use (CU) onset and substance use (SU) problems has been extensively studied, yet findings remain inconsistent.

AIMS

This systematic review aimed to examine prospective studies on the association between age of CU onset and later SU problems, controlling for key individual, social, and SU-related risk factors.

METHODS

PsycINFO, Web of Science and PubMed were searched for studies published between January 2000 and December 2024. Studies were included if they: 1) were prospective; 2) measured CU onset during adolescence; 3) measured CU or SU problems after CU onset, 4) examined whole plant or phytocannabinoids. Studies were excluded if they exclusively focused on high-risk samples. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies-of Interventions tool. The review was registered with PROSPERO, number CRD42022332092.

RESULTS

Sixteen studies met eligibility criteria. Earlier age of CU onset was associated with CU disorder (CUD) and CU negative consequences, with mixed findings for other SU problems (e.g., alcohol). CU frequency accounted for a significant portion of the risk for CU negative consequences, but the association with CUD remained independent of frequency. Only one study had low risk of bias, while seven had some concerns, and eight had a high or very high risk of bias.

CONCLUSIONS

Findings suggest that early age of CU onset is a specific risk factor in the development of CUD, but not other SU problems. Prevention approaches should aim to delay the onset and reduce the frequency of CU among youth to reduce risk of the development of CUD.

The association between health literacy and unmet medical needs by gender

OBJECTIVES

Understanding the factors influencing unmet medical needs (UMN) is crucial for developing effective interventions. This study aims to investigate the association between health literacy (HL) and UMN by gender.

STUDY DESIGN

Quantitative survey analysis.

METHODS

We used data from the 2021 Korea Health Panel (KHP) with 10,073 participants. Variable of interest was HL, measured using the HLS-EU-Q16, and the dependent variable was an UMN, measured based on respondents' self-reported experiences of unmet medical needs due to financial or non-financial reasons over the past 12 months. First, the UMN experience was investigated, and then the reason for the occurrence was investigate. Multiple logistic regression was used to assess the association between HL and UMN after adjusted.

RESULTS

UMN rates with problematic and inadequate HL were 12.7 % and 12.5 %, respectively, for males; and 14.3 % and 13.2 %, respectively, for females. HL was significantly associated with UMN among both male and female participants, with adjusted odds ratios of 1.37 and 1.85, respectively; and 1.46 and 1.50, respectively, for problematic and inadequate HL. The odds ratio of UMN was associated with low HL in the groups under 30 years of age for both men and women. The UMN odds ratio was also associated with high academic achievement and the non-exercise group with low HL.

CONCLUSION

Low HL is associated with a higher likelihood of UMN. These findings emphasize the importance of improving HL to reduce the occurrence of UMN, warranting further research in this area.

North Carolina's FarmsSHARE: Farmers, Food Hubs, And Community-Based Organizations Sustain Healthy Food Programs

The North Carolina FarmsSHARE program distributes healthy, locally sourced food to low-income households across nearly 100 counties in the state through the Department of Agriculture's Local Food Purchase Assistance Cooperative Agreement. In this article, we present insights from a cross-sectional survey of stakeholders who were involved in implementing the program. We explore measures of satisfaction, perceived value, economic impact, quality of food, and community relationships within each stakeholder group (farmers, food hubs, and community-based organizations). We also discuss FarmsSHARE's impact on local farms, businesses, and food systems. In 2024, FarmsSHARE connected 217 local farms, 16 food hubs, and 117 community-based organizations that worked together to distribute more than 72,000 healthy food boxes. Our findings suggest that FarmsSHARE is strengthening collaborations and local food systems, specifically through partnerships with farms owned by members of racial and ethnic minority groups, and improving access to nutritionally tailored healthy food boxes for low-income households. These insights can be used to guide efforts to integrate local food within the Food Is Medicine paradigm to address nutrition insecurity and promote more equitable food systems within communities.

Timing of diagnostic workups in Chinese population with recurrent pregnancy loss: a cross-sectional study

BACKGROUND

There are no specific guidelines regarding the definition, diagnostic workup and treatment of recurrent pregnancy loss (RPL) in China at present. Whether the diagnostic workup should occur after two or three or more pregnancy losses in the Chinese population is not clear.

METHODS

This cross-sectional study collected data from January 2017 to December 2022 from the RPL Clinic at Shengjing Hospital, affiliated with China Medical University. The results of diagnostic tests for evidence-based and possible risk factors of RPL,which is defined as two or more failed clinical pregnancies, were collected. The data collected include parental chromosomal karyotypes, immune factors (anticardiolipin antibody, anti-β2-glycoprotein I antibody, lupus anticoagulants, and antinuclear antibodies), endocrine factors (polycystic ovary syndrome, thyroid dysfunction, hyperprolactinemia, obesity, and glucose abnormalities), anatomical factors (uterine malformations, endometrial polyps, intrauterine adhesions, uterine fibroids or adenomyosis), coagulation factors (thrombelastogram, antithrombin III, and homocysteine levels) and other factors (vitamin D levels, MTHFR polymorphisms and ultrasound indices of endometrial receptivity). All these data were compared between patients with two or three or more pregnancy losses.

RESULTS

Among all 785 patients with RPL, the rates of abnormal anatomical factors (40.96% versus 32.94%, P = 0.021, OR 1.41, (95% Cl 1.05-1.89)), endometrial polyps (6.21% versus 3.06%, P = 0.034, OR 2.10, (95% Cl 1.04-4.23)) and obesity (13.76% versus 5.59%, P < 0.0001, OR 2.69, (95% Cl 1.62-4.49)) were significantly higher in people with three or more pregnancy losses than in people with two pregnancy losses. The rates of other diagnostic tests were not statistically significant between the two groups.

CONCLUSION

Based on the high rate of abnormal test results in the Chinese RPL population, our findings may provide evidence for patients in our area begin routine etiological screening after two pregnancy losses.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03561766, 18/5/2018.

Prescribing preoperative weight loss prior to major non-bariatric surgery for patients with elevated weight: a national provider survey (PREPARE provider survey)

Background

The surgical patient with obesity presents several challenges in intraoperative and postoperative care. We designed this cross-sectional survey to assess surgeon willingness to prescribe preoperative very low energy diets (VLEDs) and practice patterns in prescribing preoperative weight loss interventions for patients with obesity undergoing non-bariatric abdominal surgery.

Methods and findings

We conducted a cross-sectional survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery, reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies and utilizing non-probability convenience sampling. The primary outcome was willingness to prescribe preoperative VLED to obese patients undergoing major non-bariatric abdominal surgery for both benign and malignant indications. We created a multivariable proportional odds model to identify factors associated with willingness to prescribe VLEDs. A total of 78 participants completed and returned the survey (response rate 10.9%; mean age 43.54 ± 8.13 years; 48.72% female). Most surgeons (79.5%) felt that obesity significantly impacted the technical difficulty of their operations. We identified a disconnect between those surgeons who were willing prescribe VLEDs vs. those who actually prescribed them (78.2% vs. 30.8%, respectively). Approximately half of the surgeons reported being unfamiliar with VLEDs. Regression analysis identified practicing in academic institutions was associated with increased willingness to prescribe [odds ratio (OR) 3.71, 95% confidence intervals (CI) 1.01-13.7, p < 0.01].

Conclusion

Although the majority of surgeons feel that obesity adversely impacts perioperative care, only one-third routinely discuss preoperative VLEDs with their patients. Opportunities to increase awareness and evaluate the impact of VLEDs on patient outcomes remain high.