Sample size determination and power analysis using the G*Power software

The impact of intradialytic elastic band exercise on physical and cognitive abilities in patients on maintenance hemodialysis: a randomized controlled trial

Exercise benefits patients on maintenance hemodialysis (MHD) by addressing complications and dysfunctions. Elastic band exercise is cost-effective, but its safety, efficacy, and feasibility during dialysis are not well-established. The aim of this study is to investigate the physical and mental effects of intradialytic elastic band exercise in patients on MHD. Sixty patients on MHD were randomly assigned to the exercise or control group (30 patients/group). The control group received routine hemodialysis care, whereas those in the exercise group performed intradialytic elastic band exercises for 0.5-2 h during hemodialysis three times a week for 12 weeks. Physical function (Short Physical Performance Battery [SPPB]), cognitive function (Montreal Cognitive Assessment [MoCA]), fatigue (14-item Fatigue Scale [FS-14]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and anxiety and depression (Hamilton Anxiety Rating Scale [HAMA]/Hamilton Depression Rating Scale [HAMD]) were assessed. The exercise group showed significant improvements in SPPB (p = 0.008) and MoCA (p < 0.001) scores compared to pre-intervention and control groups. FS-14 scores decreased significantly (p = 0.005). PSQI (p < 0.001) and HAMA (p < 0.001) scores improved post-intervention but not versus control. HAMD scores reduced significantly (p < 0.001). Satisfaction and recommendation scores were 9.57 and 9.71. In conclusions, intradialytic elastic band exercise improved physical and cognitive function and alleviated fatigue, sleep issues, depression, and anxiety in patients on MHD. With high compliance, no significant adverse events, and high patient satisfaction, it is recommended as a routine intervention during dialysis.

CYP2D6 polymorphism rs1065852 significantly increases the risk of type 2 diabetes

BACKGROUND

Genetic variations within the cytochrome P450 (CYP) gene family are significant determinants of type 2 diabetes mellitus (T2DM) susceptibility. This study aimed to investigate the association between CYP2C8 and CYP2D6 gene variants and the risk of T2DM.

METHODS

We conducted a case-control study involving 512 individuals with T2DM and 515 controls. Genotyping of CYP2C8 and CYP2D6 polymorphisms was performed using the Agena MassARRAY system. Logistic regression analysis was employed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs), thereby assessing the relationship between these genetic variants and T2DM risk. Additionally, multifactor dimensionality reduction (MDR) was utilized to assess the potential interaction effects of SNPs on T2DM risk.

RESULTS

The study found a strong correlation between rs1065852 and increased risk of T2DM in overall (A vs. G: OR = 1.22, 95% CI: 1.03-1.45, p = .024; AA vs. GG: OR = 1.46, 95% CI: 1.04-2.06, p = .031; AA-AG vs. GG: OR = 1.36, 95% CI: 1.04-1.79, p = .026; additive: OR = 1.21, 95% CI: 1.02-1.44, p = .027), males and age < 59 subgroups. However, there is no significant association between the CYP2C8 polymorphisms (rs1934953, rs1934951, rs2275620 and rs17110453) and T2DM risk. MDR analysis results showed that the best model was the one locus model (rs1065852, testing accuracy = 0.534; OR = 1.39; 95% CI: 1.05-1.85; p = .023; CVC = 10/10), indicating that rs1065852 is an independent risk factor for T2DM.

CONCLUSIONS

This study suggests that rs1065852 (CYP2D6) is an independent risk factor for T2DM. Further research is warranted to validate these results and explore their clinical implications.

Effect of 12-week fitness walking programme on sex hormone levels and risk factors for metabolic syndrome in postmenopausal women: A pilot study

BACKGROUND AND AIMS

Postmenopausal women are at a heightened risk of developing metabolic syndrome and therefore require targeted interventions. This study investigated the effects of a 12-week fitness walking (FW) programme on risk factors for metabolic syndrome and sex hormone levels in postmenopausal women. Our study hypothesised that FW would reduce the risk of metabolic syndrome in this population, with correlated changes in sex hormone levels.

METHODS AND RESULTS

Postmenopausal women were randomly assigned to FW (n = 15, age: 60.87 ± 5.73 years, body mass index (BMI): 23.58 ± 2.88 kg m-2) or control (CON) groups (n = 15, age: 60.40 ± 3.79 years, BMI: 24.97 ± 3.07 kg m-2). The FW group engaged in a 12-week FW programme (60 min/session, five times/week, 50%-60 % VO2max, aerobic training). The CON group maintained their usual lifestyle. After the intervention, the FW group exhibited decreased levels of triglycerides (TG), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP, P = 0.009) and waist circumference (WC), and increased high-density lipoprotein cholesterol (HDL-C, P = 0.001). The CON group demonstrated increased TG (P = 0.001), FBG, SBP, DBP and WC, and decreased HDL-C. Sex hormone-binding globulin (SHBG) was negatively correlated with TG and SBP in the CON group pre- and post-intervention. Among all participants, there was a significant negative correlation between SHBG and TG, BMI, and WC pre-intervention; only TG remained significantly correlated with SHBG post-intervention.

CONCLUSION

A 12-week FW training programme effectively controlled metabolic syndrome risk factors in postmenopausal women, and a significant relationship between metabolic syndrome risk factors and sex hormone levels was observed.

EEG responses to onset-edge and steady-state segments of continuous speech under selective auditory attention modulation

Electroencephalography (EEG) signals provide valuable insights into the neural mechanisms of speech perception. However, it still remains unclear how neural responses dynamically align with continuous speech under selective attention modulation in the complex auditory environments. This study examined the evoked and induced EEG responses, their correlations with speech features, and cortical distributions for the target and ignored speech in two-talker competing scenarios. Results showed that selective attention increased the evoked EEG power for the target speech compared to the ignored speech. In contrast, the induced power indicated no significant differences. Low-frequency EEG power and phase responses reliably indexed the target speech identification amid competing streams. Cortical distribution analyses revealed that the evoked power differences between the target and ignored speech were concentrated in the central and parietal cortices. Significant induced power differences between the target and ignored speech presented only at the onset-edge segments in the left temporal cortex. Comparisons between onset-edge and steady-state segments showed the evoked power differences in the right central and temporal cortices and the induced power differences in the frontal cortex for the ignored speech. No significant differences of the cortical distribution were observed between the onset-edge and steady-state segments for the target speech. These findings underscore the distinct contributions of the evoked and induced neural activities and their cortical distributions to selective auditory attention and segment-specific speech perception.

Time perception in shoulder dystocia management; a secondary analysis of the prospective cohort simulation SAFE study

OBJECTIVE

The aim of this study was to explore and quantify the potential improvement and retention of time perception in a simulated childbirth complicated by shoulder dystocia with use of high-fidelity simulation.

METHODS

This was a secondary analysis of the previously conducted prospective cohort SAFE study. Registered midwives and final year Midwifery students were invited to attend a one-day workshop in 6-monthly intervals at the University of Western Macedonia in Greece between October 2021-November 2022. There was a 30-minute initial assessment, a 30-minute theoretical and hands-on training, and a 30-minute post-training assessment on shoulder dystocia management. We identified the actual-time and the self-reported perceived-time of delivery at the start and end of each workshop and measured the difference between them to determine if there was any improvement and retention of time perception through consecutive workshops.

RESULTS

The baseline workshop recruited 101 participants with mean age of 26.7 ± 9.8 years (range:20-59), of which 53 participated at the 6 month and 33 at the 12 month workshop. There was a significant improvement in time perception by approximately 34.8 % at the end of the baseline workshop, which was retained after 6 and 12 months. 80.2 % of participants experienced a 'time-distortion effect' towards the same direction and felt that the simulated delivery lasted longer than the actual time recorded by the birthing simulator. Those who were more competent at the start of the baseline workshop demonstrated a better time perception.

CONCLUSIONS

The skill of time perception in shoulder dystocia can be improved and retained through simulation training.

Impact of a mineral enriched, fiber complex on glycaemic response and satiation in healthy adults: a double-blind, crossover intervention study

PURPOSE

To investigate the effects of a chromium-enriched glucomannan-fructooligosaccharide complex (SB) on glycaemic and insulin responses, satiation, and hunger biomarkers in healthy adults.

METHODS

Using a double-blind, placebo-controlled, randomised crossover design, we assessed the acute impact of a single 3 g SB dose in 16 healthy adults (BMI 18.5-24.9 kg/m2) during a modified oral glucose tolerance test. On separate days, participants consumed 50 g dextrose or 50 g dextrose with 3 g SB (SBD). Blood glucose and insulin were analysed over 2.5 h. Hunger, fullness, and desire to eat were assessed via visual analogue scales. Additionally, the impact of SB on gastric viscosity was assessed in vitro.

RESULTS

SBD intake significantly reduced the insulin concentration compared to dextrose alone at 45, 75, and 90 min post-intake. Additionally, SBD resulted in significantly greater fullness and a lower desire to eat at 75 min when compared to dextrose (p < 0.05). Although hunger increased over time for both interventions, SBD led to lower hunger, desire to eat, and food desire scores compared to dextrose at 150 min (p < 0.05). The viscosity of SB, even when combined with dextrose, was significantly higher compared to dextrose alone.

CONCLUSIONS

These novel findings suggest that SB can modulate insulin response and influence appetite regulation, highlighting its potential use in weight management strategies.

Photon-counting detector CT provides superior subsolid nodule characterization compared to same-day energy-integrating detector CT

PURPOSE

To investigate the image quality and the performance of photon-counting detector (PCD) CT compared to conventional energy-integrating detector (EID) CT in identifying subsolid nodule (SSN) characteristics.

MATERIALS AND METHODS

Participants with SSNs who underwent same-day EID CT and PCD CT between October 2023 and April 2024 were prospectively included. The 1.0 mm EID CT images and, subsequently, 1.0 mm, 0.4 mm, and 0.2 mm PCD CT images were reviewed to assess image noise and subjective image quality on a 5-point Likert scale. SSN characteristics, including lobulation, spiculation, pleural retraction, air cavities, intra-nodular vessel signs, internal vascular changes, and heterogeneous solid components, were evaluated. Additionally, a step-by-step observation and comparison method was used to determine the presence of any additional characteristics.

RESULTS

Forty-eight participants (mean age: 56 ± 11 years; 16 males) with 89 SSNs were included. PCD CT significantly reduced radiation dose when using matched scans (1.79 ± 0.39 vs 2.17 ± 0.57 mSv, p < 0.001). Compared to 1.0 mm EID CT, 1.0 mm PCD CT images exhibited significantly lower objective image noise and higher subjective image quality (all p < 0.001). Compared to EID CT, PCD CT demonstrated enhanced visualization of subtle characteristics, except for lobulation, with a 0.4 mm section thickness offering a favorable balance between ultra-high resolution and perceived image quality for radiologists.

CONCLUSION

PCD CT facilitated radiation dose reduction and outperformed conventional EID CT in terms of image quality and visualization of SSN characteristics.

KEY POINTS

Question PCD CT, featuring ultra-high-resolution mode acquisition and a thinner reconstruction, has not been fully explored for characterizing SSNs. Findings Compared to EID CT, PCD CT was associated with lower objective image noise, higher subjective image quality, and superior SSN characterization. Clinical relevance PCD CT effectively reduced the radiation dose delivered to the patients and enabled more precise SSN characterization.

Noninvasive Evaluation of Prolonged-Release Pirfenidone in Compensated Liver Cirrhosis. ODISEA Study, a Randomised Trial

BACKGROUND

Advanced liver fibrosis (ALF) predicts an adverse prognosis in chronic liver disease. In addition to etiological treatment, a new approach to stop or reverse residual fibrosis is desirable.

OBJECTIVE

To assess the efficacy and safety of prolonged-release pirfenidone (PR-PFD) versus placebo in compensated cirrhosis.

METHODS

180 patients with ALF (F4) were randomly assigned to: placebo, 1200 mg/d, and 1800 mg/d PR-PFD, plus standardised care, for 24mo. Frequency of lab tests: (3mo), liver stiffness measurement (LSM), FibroTest, ultrasound (US) (6mo), and endoscopy (annually).

RESULTS

Fibrosis evolution estimated from LSM was significantly lower only in the 1200 compared to placebo and 1800 groups (24.2 ± 2.4 vs. 15.4 ± 2.4; 27.6 ± 2.4 vs. 24.6 ± 2.4; 24.4 ± 2.3 vs. 23.3 ± 2.3 kPa, respectively, p < 0.001), in intergroup analysis, meeting the primary endpoint. Fibrotest was significantly lower only in the 1200 mg/d group, compared to baseline values (0.86 ± 0.02 vs. 0.83 ± 0.02 units, p < 0.001). Liver function test (LFT's) also improved as well as Model for End-Stage Liver Disease (MELD) score and quality of life (QoL). Decompensations occurred in 19 patients: 12 ascites (more frequent in placebo, p = 0.003), 5 variceal bleeding, 4 encephalopathies, 4 hepatocarcinomas. Adverse events were mainly mild gastrointestinal (n = 35, 48 and 46, p = 0.010) and cutaneous (n = 12, 15, and 22, p = 0.0001) in placebo, 1200 and 1800 mg/day, respectively.

CONCLUSION

PR-PFD at a dose of 1200 mg significantly decreased non-invasive liver fibrosis markers at 24 months and induced improvement in LFT's, MELD, and QoL in compensated cirrhosis, without safety concerns.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01046474.

Relationship between cumulative peer risk and sense of security among adolescents: a moderated mediation model

Adolescents' sense of security is closely related to their ecological background. Previous studies have shown that single or minority risk factors in peer risk are crucial in adolescents' sense of security. Nevertheless, research into the collective influence of peer-related risk factors on a the sense of security among adolescents is scarce. Furthermore, the moderated mediation processes between cumulative peer risk and a sense of security in adolescents are poorly understood. Therefore, using a cumulative risk model, the present study examined the impact of cumulative peer risk on adolescents' sense of security. Furthermore, based on self-system theory and stress-buffering theory, we examined whether self-efficacy mediated the relationship between cumulative peer risk and adolescents' sense of security and whether perceived social support moderated the adverse effect of cumulative peer risk on adolescents' sense of security. A total of 3037 adolescents (mean age = 14.98 years, SD = 1.72) from three middle schools and two high schools in Henan province, China participated in this study. They completed a set of surveys evaluating demographic characteristics, peer-related risk factors (including peer rejection, peer alienation, peer acceptance, and peer support), self-efficacy, perceived social support, and adolescents' sense of security. Mediation analysis indicated that (a) cumulative peer risk significantly negatively predicted adolescents' sense of security; (b) cumulative peer risk significantly negatively predicted self-efficacy, which in turn reduced adolescents' sense of security; and moderated mediation analysis further demonstrated (c) That the first and second half of the mediation path were moderated differently by perceived social support. High perceived social support could enhance the positive effect of self-efficacy on adolescents' sense of security, but the protective role of perceived social support in adolescents' sense of security is limited, especially when adolescents are exposed to high cumulative peer risk. Taken together, the present study is the first to demonstrate the detrimental impact of cumulative peer risk on adolescents' sense of security, as well as the mediating role of self-efficacy and the moderating role of perceived social support. In addition, we discussed the implications of our findings on improving adolescents' sense of security.

Deep learning reconstruction improves computer-aided pulmonary nodule detection and measurement accuracy for ultra-low-dose chest CT

PURPOSE

To compare the image quality and pulmonary nodule detectability and measurement accuracy between deep learning reconstruction (DLR) and hybrid iterative reconstruction (HIR) of chest ultra-low-dose CT (ULDCT).

MATERIALS AND METHODS

Participants who underwent chest standard-dose CT (SDCT) followed by ULDCT from October 2020 to January 2022 were prospectively included. ULDCT images reconstructed with HIR and DLR were compared with SDCT images to evaluate image quality, nodule detection rate, and measurement accuracy using a commercially available deep learning-based nodule evaluation system. Wilcoxon signed-rank test was used to evaluate the percentage errors of nodule size and nodule volume between HIR and DLR images.

RESULTS

Eighty-four participants (54 ± 13 years; 26 men) were finally enrolled. The effective radiation doses of ULDCT and SDCT were 0.16 ± 0.02 mSv and 1.77 ± 0.67 mSv, respectively (P < 0.001). The mean ± standard deviation of the lung tissue noises was 61.4 ± 3.0 HU for SDCT, 61.5 ± 2.8 HU and 55.1 ± 3.4 HU for ULDCT reconstructed with HIR-Strong setting (HIR-Str) and DLR-Strong setting (DLR-Str), respectively (P < 0.001). A total of 535 nodules were detected. The nodule detection rates of ULDCT HIR-Str and ULDCT DLR-Str were 74.0% and 83.4%, respectively (P < 0.001). The absolute percentage error in nodule volume from that of SDCT was 19.5% in ULDCT HIR-Str versus 17.9% in ULDCT DLR-Str (P < 0.001).

CONCLUSION

Compared with HIR, DLR reduced image noise, increased nodule detection rate, and improved measurement accuracy of nodule volume at chest ULDCT.

CLINICAL TRIAL NUMBER

Not applicable.

A pre - post quasi-experimental study of team-based learning effectiveness for Vietnamese nursing students

BACKGROUND

Team-Based Learning (TBL) is a student-centered teaching strategy designed to improve problem-solving skills, knowledge, and practical abilities. Despite its increasing use in nursing education globally, limited research has explored its effectiveness in Vietnam. This study evaluates the impact of TBL on learning outcomes, accountability, preferences, satisfaction, engagement, perceptions, and attitudes of Vietnamese nursing students during the Nursing Care for Adults with Internal Medicine course.

METHODS

A quasi-experimental pre-post study was conducted with 186 fourth-year nursing students at a nursing faculty in Vietnam during the 2023-2024 academic year. TBL was implemented in the course, and data were collected using validated instruments, including the Individual Readiness Assurance Test (i-RAT), Team Readiness Assurance Test (t-RAT), Classroom Engagement Survey (CES), and Perceived Collective Efficacy (PCE) scale. Data were collected from January to April 2024 and analyzed using SPSS version 20.0.

RESULTS

The mean t-RAT scores significantly exceeded i-RAT scores, increasing from 8.17 to 9.68 (t = -19.507, p < 0.001), indicating improved group performance. Students' attitudes toward teamwork showed significant improvements across all dimensions, with higher post-TBL mean scores. CES and PCE scores also increased significantly post-TBL (31.37 ± 2.002 vs. 29.54 ± 2.186; t = -8.981, p < 0.001; 4.03 ± 0.488 vs. 3.64 ± 0.461, t = -8.667, p < 0.001). Additionally, students reported positive experiences with TBL, with average scores for accountability, preference, and satisfaction at 31.19 ± 2.975, 57.10 ± 5.279, and 36.54 ± 3.815, respectively.

CONCLUSIONS

TBL effectively enhances academic performance, teamwork attitudes, and group responsibility awareness among Vietnamese nursing students. This approach holds promise for improving nursing education in Vietnam, and educators are encouraged to expand its application to other universities and disciplines.

Practical guide to calculate sample size for chi-square test in biomedical research

In biomedical research, the calculation of sample size is a critical component of study design. Adequate sample size ensures the reliability of statistical tests, including the chi-square test. This manuscript outlines the use of an online sample size calculator for chi-square tests. The paper includes detailed explanations of the formulas used in the calculations and highlights the importance of power analysis in planning research studies. This tool is designed to assist and guide researchers in determining the optimal sample size for detecting statistically significant differences in categorical data. We describe the theory behind the chi-square test, the statistical principles involved in sample size calculation, and the specific methodology for using the sample size calculator. The calculator is freely available to use at https://hanif-shiny.shinyapps.io/chi-sq/ .

Association between sense of coherence and phasic heart rate variability under psychosocial stress conditions

The concept of sense of coherence (SOC) is fundamental in salutogenesis, with an enhanced SOC being conducive to health promotion. Nonetheless, the precise physiological mechanisms through which SOC responds to stress and influences health remain incompletely understood. This study aimed to compare the effects of varying SOC levels on the autonomic nervous system during psychosocial stress conditions, employing phasic heart rate variability (HRV) as a measure. Thirty healthy volunteers participated in the study and were categorized into low- and high-SOC groups according to their SOC scores. A speech preparation task served as the acute stressor, with HRV recorded for physiological assessment. HRV data were analyzed across three phases-baseline, stress, and recovery. Two-way repeated-measures analysis of variance revealed a statistically significant distinction in the root mean square of successive differences (RMSSD) values between the low- and high-SOC groups under stress conditions (p=0.026). In particular, the high-SOC group exhibited a significant increase in RMSSD values during the transition from the stress to recovery phase (p=0.020), whereas the low-SOC group displayed no significant change in RMSSD values (p=0.844). These findings suggest that individuals with low SOC may encounter challenges in effectively regulating the autonomic nervous system, potentially leading to slower recovery from stress.

Factors influencing undergraduate and newly graduated nursing students' competence and attitudes toward nursing research: a structural equation modeling analysis

BACKGROUND

Nursing research is integral to advancing evidence-based practice (EBP), providing the foundation for informed decision-making in the nursing profession. Moreover, nurse-led research plays a pivotal role in enhancing patient outcomes, underscoring the importance of cultivating robust research competencies among nursing students.

AIM

The study investigated the factors influencing attitudes toward nursing research and their impact on perceived competence in learning nursing research among undergraduate nursing students and newly graduated nursing students.

METHODS

A cross-sectional research design was employed, utilizing convenience sampling of 309 undergraduate and newly graduated nursing students from various universities and hospitals in Saudi Arabia. The Revised Attitudes Toward Research (R-ATR) and the Perceived Competence Scale (PCS) were employed to assess attitudes and perceived competence. The data were analyzed utilizing IBM SPSS version 27.0 and IBM SPSS AMOS version 24.0, using confirmatory factor analysis and structural equation modeling.

RESULTS

Satisfaction with research skills significantly predicted research anxiety, while research participation, satisfaction with research skills, and college support were significant predictors of research usefulness and positive research predispositions. English proficiency level was the only demographic variable impacting nursing students' perceived competence.

CONCLUSIONS

The study underscores the intricate interplay between attitudes toward research and perceived competence among undergraduate and newly graduated nursing students. Targeted interventions promoting research skills, active participation, and college support are recommended to foster positive attitudes and competence among nursing students.

Nonregular Physical Activity and Handgrip Strength as Indicators of Fatigue and Psychological Distress in Cancer Survivors

BACKGROUND

Cancer survivors who do not engage in regular physical activity often experience persistent psychological distress and fatigue, which can significantly impact their quality of life. While handgrip strength (HGS) is recognized as an indicator of overall health and physical resilience, the combined role of HGS and physical inactivity in predicting psychological distress and fatigue in this population remains unclear. This study aimed to examine the relationships between self-reported physical inactivity, HGS, and psychological distress, specifically depressive symptoms, anxiety, and cancer-related fatigue (CRF), in physically inactive cancer survivors.

METHODS

This cross-sectional study included 42 physically inactive cancer survivors (mean age = 63.2 years, SD = 8.96) recruited from the Cancer Institute (IRCCS) in Bari, Italy. Physical inactivity was quantified based on self-reported weekly physical activity minutes, with all participants engaging in less than 150 min per week. The participants underwent HGS assessment and completed validated psychological measures, including the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2), and the Fatigue Severity Scale (FSS).

RESULTS

Bivariate correlations were examined via Spearman's rank correlation coefficients, and multiple linear regression analyses were performed to identify independent predictors of psychological distress and fatigue, adjusting for covariates such as age, sex, cancer type, and time since treatment completion. Both lower HGS and greater physical inactivity were significantly correlated with greater depressive symptoms (HGS: ρ = -0.524, p < 0.001; physical inactivity: ρ = -0.662, p < 0.001), greater fatigue severity (HGS: ρ = -0.599, p < 0.001; physical inactivity: ρ = -0.662, p < 0.001), and increased trait anxiety (HGS: ρ = -0.532, p < 0.001; physical inactivity: ρ = -0.701, p < 0.001). No significant associations were found between physical inactivity or HGS and state anxiety (p > 0.05). Multiple regression analyses confirmed that both HGS and physical inactivity independently predicted depressive symptoms (HGS: β = -0.435, p = 0.009; physical inactivity: β = -0.518, p = 0.002), trait anxiety (HGS: β = -0.313, p = 0.038; physical inactivity: β = -0.549, p < 0.001), and fatigue (HGS: β = -0.324, p = 0.033; physical inactivity: β = -0.565, p < 0.001), even after adjusting for covariates. Low physical activity and reduced muscle strength independently predict psychological distress and fatigue in cancer survivors.

CONCLUSIONS

These findings highlight the potential exacerbating role of physical inactivity in both physical and psychological vulnerability, underscoring the need for interventions promoting regular exercise. Integrating strength assessments and structured physical activity programs may be key strategies in survivorship care to improve mental well-being and overall quality of life.

Outcomes of a Risk-Stratified Protocol for Preventing Peristomal Skin Complications in Patients with an Ostomy: A Cohort Study

BACKGROUND/OBJECTIVES

Peristomal skin complications (PSCs) are common among patients with ostomies, significantly impacting quality of life and increasing healthcare utilization. This study aimed to evaluate the effects of the Dermamecum protocol, a risk-stratified educational intervention, on the prevention of PSCs, self-care improvements, health-related quality of life (HRQoL), and patient satisfaction over a 90-day follow-up period.

METHODS

This prospective cohort study included 305 patients stratified into three risk-based groups (green, yellow, and red paths) according to the Dermamecum protocol. Primary outcomes included PSC rates at 30, 60, and 90 days. Secondary outcomes included self-care scores, HRQoL, and patient satisfaction. Comparative analyses and trend assessments were performed across groups and time points. Temporal trends in PSCs were analyzed using Poisson regression.

RESULTS

Early PSC rates were 8.5% at 30 days, with late complications at 7.9% and 6.2% at 60 and 90 days, respectively. No significant differences in PSC rates were observed between paths. Self-care scores improved over time, with stability across groups and domains. HRQoL remained stable, with minor fluctuations in physical and mental components. Patient satisfaction was high across all paths. Poisson regression identified significant temporal trends in PSC rates, with higher risks at 30, 60, and 90 days compared to baseline. Age, BMI, and path assignment (lower risk for the green path) were significant predictors of PSCs.

CONCLUSIONS

The Dermamecum protocol effectively maintained low PSC rates, supported self-care, and sustained HRQoL and patient satisfaction. These findings highlight the value of risk-stratified, patient-centered interventions in ostomy care. Further studies are needed to validate these results and explore long-term outcomes.

Investigating the anticancer effect of purified rCec-B peptide in a DEN murine model: Insights into tumorigenesis prevention, bioavailability, and molecular mechanisms

BACKGROUND

Anticancer peptides (ACPs) are considered cancer therapeutic candidates through decreasing tumor cell proliferation, migration, and angiogenesis.

OBJECTIVES

Determine the therapeutic potential of purified recombinant cecropin-B (rCec-B) peptide in vivo on HCC murine model and its effect, particularly on the activation of apoptotic pathways.

METHODS

Intact mass analysis of rCec-B was confirmed using mass spectrometry, molecular docking on epidermal growth factor receptor (EGFR) apoptosis was studied, and an in vivo acute toxicity study, followed by establishing the HCC model using diethylnitrosamine (DEN) was performed. Biochemical, molecular, and immunohistochemical parameters were detected in serum and liver samples.

RESULTS

A molecular docking study on EGFR showed a predicted binding model of rCec-B as a ligand with a high binding affinity equal to -50.167 kcal/mol. The peptide showed remarkable safety in the studied high doses. The liver of the HCC untreated model had a distorted lobular pattern with minimal to mild nuclear atypia. In HCC treated with rCec-B, liver sections had periportal inflammation, hydropic degeneration with focal cholestasis, and apoptotic hepatocellular bodies. Molecular detection and immunohistochemical analysis showed an upregulation of the oncogenic marker, Bcl-2, and a downregulation of apoptotic markers (FAS, FAS-L, Cas-8, BAX, and BID) in the untreated DEN group. Treated groups had a significant increase in all the detected apoptotic markers.

CONCLUSION

This study sheds light on the potential rCec-B's role in suppressing HCC progression. Hence, this peptide could be considered a promising therapeutic drug alone or in combination with other drugs to alleviate HCC treatment.

Do mental or somatic diagnoses influence emotional response and perception of physician-assisted suicide in Germany? A vignette-based experiment

BACKGROUND

Physician-assisted suicide (PAS) is increasingly being legalized in a growing number of countries and is the focus of societal and ethical debates. However, there is limited knowledge regarding the perception and acceptance of PAS across different physical and mental health conditions. This study aimed to explore emotional responses, understanding, and willingness to support individuals with the wish for PAS.

METHODS

Participants from the general German population (N = 512) were presented with four case vignettes of PAS depicting individuals in an online study: one with cancer, one with depression, one with schizophrenia, and one healthy individual. Participants were asked to evaluate the emotional reactions elicited by the desire for PAS, the extent of their understanding of this wish, and their willingness to support each individual.

RESULTS

The study revealed significant differences in reactions to the case vignettes. Pro-social emotions were lowest and anger highest when considering the healthy individual. Participants demonstrated the greatest understanding and highest willingness to support the individual with cancer, while the least understanding and support were observed for the healthy person.

CONCLUSIONS

The differential levels of support for PAS across various conditions underscore the complex interplay between societal values, perceived quality of life, and ethical considerations, particularly when mental health is involved.

Effect of drama-education for alcohol/substance user on attitudes toward violence against women: randomized controlled design

BACKGROUND

Alcohol is an important risk factor for substance abuse and violence against women. Educating alcohol users has become important in preventing violence against women.

OBJECTIVES

The aim of this study is investigate the impact of creative drama education on the attitudes of male patients with alcohol and substance dependence towards violence against women.

METHODS

This study has a pre-test post-test parallel group randomized controlled design. This study as carried out at a treatment center for individuals with alcohol and substance addiction. The study was conducted with 35 male patients (Experimental group n = 18, Control group: n = 17) diagnosed with alcohol and substance addiction in a state hospital. Participants filled in the measurement tools before and after the training.

RESULTS

Post-intervention, the experimental group showed statistically significant improvements in total ISKEBE scores (Z = - 3.421, p = 0.001, Cohen's d = 1.44), as well as in the subdimensions of attitudes toward the body (Z = - 3.332, p = 0.001, d = 1.30) and identity (Z = - 3.075, p = 0.002, d = 1.18). No significant changes were observed in the control group (p > 0.05).

CONCLUSION

The findings suggest that creative drama education may have a beneficial effect on improving attitudes toward VAW among men with alcohol and substance use disorders. Further studies with larger and more diverse samples are recommended to confirm the generalizability and long-term impact of this approach.

CLINICAL TRIAL NUMBER

NCT05595759-10/23/2022.

Comparison of dried blood spot (DBS) and plasma HIV-1 viral load measurements using Roche COBAS AmpliPrep/COBAS TaqMan assay, Northwest Ethiopia

INTRODUCTION

Quantitative determination of HIV-1 viral load measurements using plasma samples has been widely applicable for prompt monitoring at baseline and following initiation of highly active antiretroviral therapy (HAART). However, improper mixing of whole blood with anticoagulants during plasma sample processing, as well as limited access to specialized health facilities might hinder HIV diagnosis services. Considering its higher stability and increased accessibility in areas with poor laboratory settings, the dried blood spot (DBS) sample might be a suitable alternative approach for periodic monitoring of HIV-1 viral load measurements. Thus, in this study, we aimed to compare the quantitative determination of HIV-1 RNA levels using plasma and DBS samples among people living with HIV in Northwest Ethiopia.

METHODS

An institutional-based analytical cross-sectional study was conducted from March to July 2020 using 48 paired plasma and DBS samples among people living with HIV at the HIV Treatment Center, Northwest Ethiopia. A total of four milliliters of venous blood was collected to harvest plasma and for DBS sample preparation. The HIV-1 RNA extraction, amplification, and quantification were performed using the Roche COBAS AmpliPrep/COBAS TaqMan version 2.0 assay. Data were managed and analyzed using SPSS version 26 software. Mean HIV-1 viral load measurements as well as the associations between plasma and DBS sample measurements were computed using a paired sample t-test and Pearson's correlation statistical tests, respectively. In addition, the level of agreement and the presence of proportional bias between sample measurements were performed using the Bland-Altman plot and linear regression models, respectively. A p-value of ≤ 0.05 with a 95% confidence interval was considered statistically significant.

RESULTS

Among 48 people living with HIV, more than half (64.6%) of them were females. The minimum and maximum age of the study participants was 12 and 58 years, respectively. The mean difference with standard deviation (SD) of sample measurements (DBS minus plasma) HIV-1 viral load was 0.66 ± 0.70 log copies/mL. In the current study, a strong association with a significant linear correlation (r = 0.796) (p < 0.001) was obtained from Pearson's correlation analysis among HIV-1 viral load measurements between DBS and plasma samples. Moreover, the Bland-Altman plot also depicted a high level of agreement between the sample measurements.

CONCLUSIONS

The findings of the current study suggested that DBS samples could be considered as an alternative approach for periodic monitoring of HIV-1 viral loads to scale-up the HIV diagnosis and treatment coverage, particularly in areas with limited laboratory settings due to minimal invasive blood collection, higher stability at room temperature or ease of transportation, and decentralized sample collection approaches.

Effects of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics in pediatric patients undergoing laparoscopic inguinal hernia repair

BACKGROUND

Laparoscopic inguinal hernia repair (LIHR) has the characteristics of a clear surgical field and short operation time, but it has high requirements for anesthesia. We investigated the impacts of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics of pediatric LIHR.

METHODS

This randomized, double-blind and controlled study included 310 pediatric patients accepting LIHR. Excluding those failed to meet the inclusion or met the exclusion criteria, 280 patients were enrolled and randomized into the control group (sevoflurane) and the low-dose remifentanil & sevoflurane (LRS), medium-dose remifentanil & sevoflurane (MRS) and high-dose remifentanil & sevoflurane (HRS) groups (0.10, 0.20 and 0.25 µg/kg). The Behavior Pain Scale (BPS) (main observation index), Ramsay Sedation Scale (RSS), and Paediatric Anaesthesia Emergence Delirium (PAED) scores were evaluated at 1 h (T4), 3 h (T5), 6 h (T6), 8 h (T7) and 12 h (T8) postoperatively. The dynamic process of BPS, RSS and PAED scores over time was evaluated by analyzing the changes in the area under the curve (AUC) of each score during T4-T8. The changes in mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) before the start of anesthesia (T0), 10-min after the start of surgery (T1), at the time of extubation (T2) and 30-min post-surgery (T3) and postoperative adverse reaction incidence were recorded.

RESULTS

Remifentanil & sevoflurane reduced postoperative BPS and PAED scores and increased RSS score in pediatric patients during T4-T8. The AUCBPS and AUCPAED in the LRS, MRS and HRS groups decreased as the remifentanil dose increased, and the AUCRSS increased as the remifentanil dose rose. During T0-T3, MAP, HR and SpO2 fluctuated greatly in the control group, but maintained good stability in the LRS, MRS and HRS groups, and the fluctuation in the HRS group was smaller. The HRS group had a lower adverse reaction incidence than the control and LRS groups.

CONCLUSIONS

Remifentanil & sevoflurane may have better effects on postoperative pain, sedation and agitation, and may be more conducive to stabilizing hemodynamics. Especially, 0.25 mg/kg remifentanil & sevoflurane have the best anesthetic effect and a low adverse reaction incidence.

The genetic technologies questionnaire in the Greek-speaking population: the moral judgement of the lay public

Introduction

Advancements in life sciences have significantly boosted biomedical capabilities. Genetic testing forecasts hereditary traits and disease susceptibility, while CRISPR/Cas allows permanent genome alterations. However, ethical considerations arise regarding the morality of these capabilities, particularly concerning the moral status, autonomy, and privacy of living beings. The lack of valid instruments to assess moral judgment in genetic technologies highlights the need for this study, aiming to translate and validate the "Genetic Technologies Questionnaire" (GTQ) and the short version of the "Conventional Technologies Questionnaire" (CTQ5) into Greek. As the full version of the GTQ with 30 questions could be too extensive for some studies, we also tested other versions: The short versions GTQ20-GR and GTQ5-GR which were already presented in the original study, as well as a version which included questions solely about humans (GTQ-H-GR) and is intended for use in human research and therapy, and the GTQ-Moral Status (GTQ-MS-GR), which included questions about genetic testing and gene editing in different living beings to investigate differences in moral status.

Methods

A cross-sectional study involved 250 participants who completed an online questionnaire, assessing internal consistency, structural validity, known-groups validity, floor/ceiling effects, and retest reliability (subset of 50 participants). Correlational analyses explored relationships with education, age, genetic knowledge, religiosity, and genetic testing experience. The study followed the STROBE checklist for reporting.

Results

The GTQ-GR (Cronbach's α = 0.929) and GTQ20-GR (α = 0.935) exhibit high reliability and stability in assessing moral judgment among lay people, whereas the GTQ5-GR (α = 0.866) and CTQ5-GR (α = 0.758) displayed some weaknesses. Participants tended to rate conventional technologies more favorably than genetic technologies, with genetic testing perceived more positively than genome editing. The two additional derived versions, GTQ-H-GR (α = 0.859) and GTQ-MS-GR (α = 0.787), also demonstrated solid psychometric characteristics.

Conclusion

The GTQ-GR is a valid and reliable questionnaire with strong psychometric properties and is now available in Greek.

Alveolar bone loss is associated with oral cancer: a case-control study

Background

A link between chronic inflammation and malignant transformation is evident in various cancer types. Periodontitis is the most common chronic inflammatory condition in oral medicine with a proven association with systemic diseases like diabetes. Although there is scant evidence of a potential link between periodontitis and oral cancer there is no proof for a correlation yet. We hypothesize that radiographic bone loss (RABL) as indicator of chronic periodontitis is associated with the occurrence of oral squamous cell carcinomas (OSCC).

Methods

206 orthopantomograms (OPTs) from a cohort of OSCC cases and controls without OSCC, both between the age of 40 and 70, were analyzed in this retrospective study. Radiographic oral health parameters like radiographic alveolar bone loss (RABL), remaining teeth as well as implants were analyzed and compared between the two groups. The analyses of the study were controlled for the impact of confounders such as diabetes, smoking of tobacco and age. Welch-test, Chi-Square-Test and a two-way Analysis of Covariance (ANCOVA) followed by a Bonferroni post-hoc test for multiple pairwise comparison were performed.

Results

Several statistically significant differences were identified between the two groups, with a greater than twofold prevalence of nicotine consumption among the OSCC group. Additionally, the OSCC cohort exhibited a mean age approximately 3.5 years higher and a lower number of remaining teeth compared to the control group. After eliminating the effect of these confounders, a significantly greater loss of bone mass was observed in the OSCC cohort in comparison to the control cohort.

Conclusion

In consideration of the confounders, patients with OSCC had more bone loss, compared to controls. These data indicate an association between periodontitis derived chronical inflammation and the malignant transformation of oral epithelium.

Efficacy of diabetes-specific partial meal replacement on glycemic and weight control in type 2 diabetes: A randomized controlled trial

AIMS

To evaluate the efficacy of a diabetes-specific formula (DSF)-based partial meal replacement (PMR) in improving glycemic control, weight, and underlying hormonal changes among participants with type 2 diabetes and overweight or obesity compared to dietary consultation.

MATERIALS AND METHODS

This 12-week, parallel randomized controlled trial was conducted at Hospital Canselor Tuanku Muhriz, National University of Malaysia, from February 2022 to March 2024. Adults aged 20-65 years with type 2 diabetes [haemoglobin A1c (HbA1c) ≥7.5%] and overweight or obesity were randomized into two groups: PMR with DSF (Metabolic+ Sauver) plus dietary consultation (treatment group) or dietary consultation alone (control group). The primary endpoint was mean change in HbA1c at week 12.

RESULTS

Among 156 participants (mean age 52.2 ± 9.7 years), 141 completed the 12-week intervention. The treatment group had a greater HbA1c reduction compared to controls (-0.83% vs. -0.19%; MD: -0.63%; 95% CI: -1.00, -0.27; p < 0.001). A significantly higher proportion of the treatment group participants (61.4%) achieved clinically significant HbA1c reduction (≥0.5%) compared to controls (42.3%, p = 0.023). Fasting glucose, insulin, and anthropometric measurements also significantly improved in the treatment group compared to controls. Subsample analysis on hormonal changes revealed significant improvements in adiponectin levels among the treatment group.

CONCLUSION

This study demonstrated that PMR with DSF significantly improved glycemic and weight management in participants with type 2 diabetes and overweight or obesity. Adiponectin levels increased in the treatment group, correlating with improved glycemic control. No adverse events were observed on liver and kidney profiles, highlighting its potential as a safe and effective approach for diabetes management.

Longitudinal associations between BMI, ideal-actual BMI gap, and body shape concern among young Chinese females

Objectives

Body shape concerns significantly impact young females' psychological wellbeing. This study aimed to estimate the short-term bidirectional relationships among BMI, ideal-actual BMI gap, and body shape concern across different BMI groups, and further explore their potential non-linear associations in young Chinese females.

Methods

We conducted a longitudinal study among Chinese females aged 18 to 30 in December 2023 (T1) and April 2024 (T2). Body mass index (BMI) was calculated using the formula: weight in kilograms divided by the square of height in meters, based on self-reported data. The body shape questionnaire 8-item version C (BSQ-8C) was adopted to measure levels of body shape concern. We utilized two-time-point cross-lagged panel models (CLPMs) to investigate temporal associations among BMI, ideal-actual BMI gap, and body shape concern, and used restricted cubic spline (RCS) fitted for multiple linear regressions to explore their potential non-linear relationships.

Results

A total of 688 young females were enrolled (mean age = 21.084, SD = 2.091). The percentages of underweight, normal, and overweight-obesity were 12.2%, 66.9%, and 20.9%, respectively. In the normal and overweight-obesity groups, the ideal BMI was significantly lower than the actual BMI at baseline. Among underweight females, 44.70% expressed a desire to further reduce their BMI. For all participants, the higher the BMI at T1, the smaller the ideal-actual BMI gap at T2, which means the more the ideal value of BMI was lower than its actual value at T2. In the normal BMI group, the ideal-actual BMI gap and body shape concern negatively predicted each other. A U-shaped correlation was observed between baseline body shape concern and BMI change in the overweight group.

Conclusion

Complex reciprocal effects of BMI, ideal-actual BMI gap, and body shape concern existed in different BMI groups. There is an urgent need for the whole society to pay more attention to the issue of body shape concern. In particular, health educators should organize programs to promote accurate weight perception among young women, and policymakers should enhance content regulation by restricting the promotion of extreme weight loss across media platforms. This approach would help avoid the negative impact of excessive concerns about body image on mental health.

Towards a Better Understanding of the Lived Experience of Carers of People With Bipolar Disorder: A Mixed-Methods Study

BACKGROUND

Caring for someone with Bipolar disorder (BD) is unique, and the severity and complexity of symptoms can overwhelm informal carers such as family, friends, and partners.

AIM

This study employed a concurrent mixed-methods model to investigate the lived experience of informal carers caring for those with BD in Australia.

METHODS

Participants (n = 46) answered an online survey containing standardised measures of quality of life and coping mechanisms as well as open-ended questions about their caring role challenges and support.

RESULTS

Carers reported mental health problems as the highest care-related burden and reported low perceived social support. However, a one-way MANOVA indicated no difference in these dimensions between carers of people with BD I and II. Reflexive thematic analysis revealed five superordinate themes relating to informal caregivers' challenges, coping strategies, and the support they need. The themes were: like a roller-coaster; carer mental health; complexities of the carer role and diagnosis; how to cope; and multifaceted support. The oscillation of symptoms and complexities of the caring role increased the burden on carers and created mental health challenges, requiring carers to use various coping strategies. Findings highlight the need for individualised, multimodal support for carers.

CONCLUSION

Carers need adequate and accessible support through strong partnerships with healthcare providers to improve their own quality of life and mental health and, in turn, those in their care.

The causal effect of workplace violence on mental health and work-related outcomes: a cross-sectional study using propensity score matching

INTRODUCTION

The prevalence of workplace violence in healthcare is 50-60%. While it has been linked to decreased job satisfaction, diminished quality of care, and economic burdens on healthcare systems, there are still major gaps. Previous studies ignored the Latin American perspective. Moreover, they neither offered causal evidence nor measured its impact on psychological outcomes. The objective was to evaluate the impact of workplace violence on psychological and work-related outcomes.

METHODS

A secondary analysis of Peru's 2016 National Healthcare Satisfaction Survey was conducted. This was a large-scale survey that used a stratified two-stage cluster sample design with a sample size of 5098 healthcare workers across all regions of Peru. Propensity score matching and Poisson regression models were used to assess the effect of self-reported workplace violence on outcomes, including depressive symptoms, burnout, sleep problems, work-life balance, and intention to quit.

RESULTS

Among 4,951 healthcare workers, workplace violence prevalence was 41.91% higher in physicians (47.4%) than nurses (37.8%). WV had a moderate effect on sleep problems (aPR: 2.06, 95% CI: 1.45 to 2.97) and depressive symptoms (aPR: 1.65, 95% CI: 1.47-1.86). It showed small to moderate effects on burnout dimensions and intention to quit (aPR: 1.26, 95% CI: 1.13-1.41). The impact on work-life balance was small to negligible.

CONCLUSIONS

Workplace violence affects 4 in 10 Peruvian healthcare workers and is associated with adverse psychological and work-related outcomes. These findings highlight the need for improved reporting systems, targeted interventions such as policy development and training programs, and ensure adequate reporting systems.

Effects of integrated exercise approach on total testosterone levels in eumenorrheic women: a randomized controlled trial

Testosterone modulated by exercise plays a pivotal role in maintaining the overall health of both males and females. Therefore, this study aimed to determine the effects of an integrated exercise approach on total testosterone levels during different phases of the menstrual cycle in eumenorrheic females. This was a two-armed parallel design, single-blinded, randomized controlled trial held from March 14, 2023, to February 21, 2024, in Aadil Hospital Defense Lahore. Forty eumenorrheic females within the age range of 20 to 40 years, with a BMI ranging from 18.5 to 24.9, who were able to maintain sitting balance without the need for upper limb support or who had a minimum score of 25 on the trunk control test were recruited for the study. They were then divided into 2 groups using a random table generator and concealed envelope allocation. The treatment group was given an exercise plan 3 times per week for 16 weeks along with an awareness program for menstrual hygiene and maintaining an active lifestyle, while the control group was given an awareness program to maintain menstrual hygiene and an active lifestyle along with a recommendation to walk for 30 min 3 times a week for 16 weeks. The testosterone levels were calculated pre-intervention, mid-intervention, and post-intervention. Mixed model ANOVA was used for within- and between-group analyses. The data were analyzed using SPSS v21. The educational backgrounds of the participants were diverse, with 17.5% having completed matric, 47.5% holding a bachelor's degree, and 17.5% having a master's degree or PhD. Regarding occupation, 35% were students, 32.5% were housewives, and 32.5% were working professionals. Marital status varied, with 37.5% married, 45% unmarried, and 17.5% divorced. Total testosterone levels (ng/dl) were measured at different menstrual cycles for the experimental and control groups. During the follicular phase, the experimental group showed pre-exercise levels of 25.80 ± 2.57 (95% CI: 24.24-27.35) and post-intervention levels within 15 min of exercise of 33.04 ± 8.67 (95% CI: 28.85-37.23). In the mid-cycle phase, the pre-exercise level was 36.48 ± 2.80 (95% CI: 33.47-37.48), and the post-intervention level was 40.80 ± 7.12 (95% CI: 37.15-44.46). The luteal phase showed pre-exercise levels of 31.10 ± 3.44 (95% CI: 29.90-34.31) and post-intervention levels within 15 min of exercise of 34.97 ± 5.60 (95% CI: 31.95-38.00). Compared with the experimental group, the control group exhibited consistent testosterone levels with minor variations across all phases. The mixed model ANOVA results for the between-group effect were highly significant, with p = 0.00 and an effect size of 0.99. Integrated exercise leads to an increase in testosterone levels in females immediately after exercise, which decreases below pre-exercise levels within 24 h of exercise, with the testosterone level peaking in the mid-cycle phase of the menstrual cycle. This immediate increase in testosterone levels can lead to increased strength, cognition and sexual functions in females.Trial registration number. This clinical trial was submitted by Dr. Rabiya Noor on clinicaltrials.gov for registration with ID: NCT05460741 first posted on 31/05/2022, last updated on 03/04/2024, and last verified on 29/04/2024.

Clinical Features, Outcomes, and Antifungal Susceptibility Profiles of Invasive Candida Infections in a Tertiary Care Hospital in China

Purpose

Given the increasing incidence of invasive Candida infection worldwide, particularly among immunocompromised and critically ill patients, we aimed to assess the distribution of Candida species as well as their clinical features and responses to common antifungal agents through a retrospective analysis of patient data in a Chinese traditional medicine hospital.

Patients and Methods

In this retrospective single-center study, we analyzed data from 301 patients with invasive Candida infection at our hospital between 2020 and 2022, We report the clinical characteristics, species distribution, and in-vitro susceptibility profiles of Candida isolates to eight antifungal agents. Logistic regression analysis was employed for multivariate assessments to analysis the correlation between clinical symptoms and prognosis. Kaplan-Meier survival analysis was used for survival analysis.

Results

Candida albicans was the most prevalent species (38.9%, 117/301), followed by C. tropicalis (28.2%, 85/301) and C. glabrata (22.9%, 69/301). Age, department of admission, underlying disease, and presence of risk factors differed significantly among patients with different Candida infections. Kaplan-Meier survival analysis showed that C. krusei infection was associated with a higher seven-day mortality than other Candida spp. infections. Multivariate logistic regression analyses showed that age, presence of sepsis, insertion of the central venous catheter, and administration of total parenteral nutrition were independent predictors of mortality. C. tropicalis was most resistant to azoles, with 36.26% of the strains being fluconazole-resistant, 35.16% being non-wild type to itraconazole, and 34.52% being non-wild type to voriconazole. Non-susceptibility to echinocandins was found in 11 C. glabrata strains (10.39%, 3.90%, and 1.30% of isolates for caspofungin, micafungin, and anidulafungin, respectively).

Conclusion

Our findings underscore the need for close monitoring of azole resistance in C. tropicalis and echinocandin resistance in C. glabrata, and highlight age, sepsis, CVC insertion, and parenteral nutrition as key predictors of mortality in invasive Candida infections.

Characterization of gut dysbiosis and intestinal barrier dysfunction in patients with metabolic dysfunction-associated steatotic liver disease and chronic kidney disease: a comparative study

The mechanistic role of gut microbiota in metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) is increasingly recognized. Despite their close association, comparative data regarding gut dysbiosis in these disorders are limited. This study included 22 healthy controls and 180 patients (90 MASLD, 60 CKD, and 30 both diseases with sex- and age-matched). Fecal bacterial 16 S ribosomal RNA sequencing and butyryl-CoA: acetate CoA transferase (BCoAT) gene expression were analyzed. Plasma intestinal fatty acid binding protein (I-FABP), representing intestinal barrier dysfunction, was assessed using the ELISA method. Our data showed that alpha and beta diversities of gut microbiota differed between MASLD and healthy controls. However, only beta diversities were different between CKD and healthy individuals. The MASLD and CKD groups displayed fewer SCFA-producing genera, particularly Bifidobacterium, than healthy controls. Fecal BCoAT levels were inversely correlated with eGFR and I-FABP levels. Patients with CKD had significantly enriched pathogenic bacteria, reduced BCoAT, and increased I-FABP levels versus MASLD. Combining significant bacterial genera discriminated MASLD from CKD with high diagnostic accuracy (AUC of 0.90). Among patients with both diseases, gut microbial alterations showed mixed characteristics of MASLD and CKD. These data highlighted the shared and distinct gut dysbiosis and related biomarkers, which could provide a better understanding of MASLD and CKD pathogenesis.

German validation of three ethics questionnaires: Consequentialist scale, ethical standards of judgment questionnaire, and revised ethics position questionnaire

INTRODUCTION

The Consequentialist Scale (CS) and the Ethical Standards of Judgment Questionnaire (ESJQ) are instruments developed to evaluate the extent of moral reasoning in relation to the two pivotal factors that appear to influence moral decision-making: the degree of harm or benefit produced by the action in question and the consistency of the action with moral norms. In other words, they assess the propensity to utilitarian versus deontological moral reasoning. In contrast, the Ethical Position Questionnaire (EPQ-5) conceptualizes ethical idealism and ethical relativism as meaning-independent, orthogonal dimensions. This study aimed to assess the psychometric properties of German versions of the three mentioned scales in a sample of native German speakers.

METHODS

A convenience sample of 263 participants completed the online survey. Analyses included internal consistency, structural validity, construct validity through the known-groups method, retest-reliability with a subgroup of n = 102, and floor and ceiling effects. This study used the STROBE checklist.

RESULTS

The CS and EPQ-5 showed strong psychometric properties without any noticeable weaknesses. In contrast, the ESJQ displayed significant shortcomings across all analyses, with low internal consistency and poor results in both item analysis and confirmatory factor analysis. The results indicated that deontology, formalism, and idealism were positively correlated with age, while only idealism correlated significantly with gender, with females scoring higher on the idealism scale. A positive correlation was observed between deontology and formalism with religiosity. With regard to personality, deontology and idealism demonstrated a positive correlation with conscientiousness, whereas utilitarianism exhibited a negative correlation with conscientiousness. A positive correlation between consequentialism and openness was also identified, while a negative correlation between formalism and agreeableness was evident.

CONCLUSION

The German versions of the CS and EPQ-5 are reliable and valid instruments for measuring the propensity toward utilitarian and deontological approaches, as well as ethical idealism and relativism. The scales, therefore, serve as invaluable tools for research, training, and professional practice, facilitating comprehension of the aspects of conscious reflection on ethical dilemmas in practice and of responsible action. The ESJQ, however, did not perform well psychometrically in the German translation, as its internal consistency is questionable.

A New Short-Term Assessment Condition for Evaluating Nonfunctional Electromyographic Activity of Masseter Muscle During Wakefulness

BACKGROUND

Awake bruxism involves masticatory muscle activity during wakefulness, potentially leading to clinical concerns. Accurate electromyography (EMG) assessment is challenging with brief durations.

OBJECTIVE

To establish a reliable, short-term measure for nonfunctional masseter muscle activity during wakefulness.

METHODS

Thirty-four healthy participants completed the Oral Behavior Checklist (OBC) and were assessed with an EMG logger (FLA-500-SD) across three sessions. On Day 1, participants performed four tasks (reading, bead-grabbing, video watching and math) for 15 min each in random order. On Day 2, scheduled at least 1 week later, tasks were repeated in a different sequence. On Day 3, participants underwent a 7-h continuous EMG recording during daily activities while maintaining activity diaries. Main outcomes included the mean number of EMG bursts per hour, burst duration, burst peak value relative to maximum voluntary contraction (%MVC) and integral value (μV.s, %MVC.s).

RESULTS

Participants (mean age: 28.0 ± 3.1) scored low on AB likelihood per partial OBC results, contrasting with EMG activity levels. Significant differences in EMG parameters were noted across tasks, with consistent values between Days 1 and 2. The reading, video, and math tasks showed strongest correlations with long-term EMG measurements (rs = 0.62-0.66, p < 0.001). Reading task demonstrated high test-retest reliability (ICC > 0.9), with the highest specificity (100%) and positive predictive value, though sensitivity was limited compared with long-term AB measures.

CONCLUSIONS

EMG measurements during a 15-min reading task may correspond to prolonged monitoring, suggesting the potential for short-task EMG assessments in practice. Integrating such assessments might enhance diagnostic accuracy, although judgement remains essential.

Divalent metal ions enhance bone regeneration through modulation of nervous systems and metabolic pathways

The divalent metal cations promote new bone formation through modulation of sensory and sympathetic nervous systems (SNS) activities. In addition, acetylcholine (Ach), as a chief neurotransmitter released by the parasympathetic nervous system (PNS), also affects bone remodeling, so it is of worth to investigate if the divalent cations influence PNS activity. Of note, these cations are key co-enzymes modulating glucose metabolism. Aerobic glycolysis rather than oxidative phosphorylation favors osteogenesis of mesenchymal stem cells (MSCs), so it is of interest to study the effects of these cations on glucose metabolic pathway. Prior to biological function assessment, the tolerance limits of the divalent metal cations (Mg2+, Zn2+, and Ca2+) and their combinations were profiled. In terms of direct effects, these divalent cations potentially enhanced migration and adhesion capability of MSCs through upregulating Tgf-β1 and Integrin-β1 levels. Interestingly, the divalent cations alone did not influence osteogenesis and aerobic glycolysis of undifferentiated MSCs. However, once the osteogenic differentiation of MSCs was initiated by neurotransmitters or osteogenic differentiation medium, the osteogenesis of MSCs could be significantly promoted by the divalent cations, which was accompanied by the improved aerobic glycolysis. In terms of indirect effects, the divalent cations significantly upregulated levels of sensory nerve derived CGRP, PNS produced choline acetyltransferase and type H vessels, while significantly tuned down sympathetic activity in the defect zone in rats, thereby contributing to significantly increased bone formation relative to the control group. Together, the divalent cations favor bone regeneration via modulation of sensory-autonomic nervous systems and promotion of aerobic glycolysis-driven osteogenesis of MSCs after osteogenic initiation by neurotransmitters.

Gender differences in the prevalence and psychopathological mechanisms of internet addiction among Iranians aged 18 to 24: A nationwide study

BACKGROUND

The rapid advancement of technology has revolutionized interaction, learning, and entertainment but also led to Internet addiction, characterized by excessive internet use causing impairment or distress.

OBJECTIVE

The study explores gender differences in prevalence, risk factors, and clinical aspects of Internet addiction among Iranian youth, highlighting cultural and societal influences.

METHODS

A nationwide sample of 3149 individuals aged 18 to 24 was categorized into two groups: those with Internet addiction (n = 1040) and those without (n = 2109). Participants completed the Childhood Trauma Questionnaire-28, Dissociative Experiences Scale (DES), Difficulties in Emotion Regulation Scale (DERS), and Internet Addiction Test (IAT). Data analyses were conducted using SPSS software version 26, with a significance level set at <0.05.

RESULTS

Overall prevalence of Internet addiction was found to be 33 %, with a higher incidence in males (63.3 %) compared to females (36.7 %) (χ2 = 13.28, p = 0.001). In men, the severity of Internet addiction was significantly linked to emotional abuse (β = 0.20, p˂0.001), DES (β = 0.39, p˂0.001), and DERS (β = 0.16, p˂0.001) (F(3, 654) = 89.85, p˂0.001, R2 = 0.29); while in women, it was associated with emotional abuse (β = 0.18, p˂0.001) and dissociative experiences (β = 0.16, p˂0.001) (F(2, 379) = 13.70, p˂0.001, R2 = 0.06). The DES partially mediated the relationship between emotional abuse and IAT scores in both genders, whereas DERS only did so in males.

CONCLUSIONS

The study suggests Internet addiction as a maladaptive coping mechanism for early emotional abuse, highlighting the need for prevention programs and emotion regulation interventions. Future research should consider longitudinal effects and cultural influences.

The Impact of Alpha-Neurofeedback Training on Gastric Slow Wave Activity and Heart Rate Variability in Humans

INTRODUCTION

Neuromodulation of cortical brain regions associated with the gut-brain axis may have the potential to modulate gastric function. Previous studies have shown phase-amplitude coupling between the electroencephalogram (EEG) alpha band frequency of the insula (Ins) and gastric slow wave (GSW) activity. This study investigated the first evidence of alpha band EEG-neurofeedback (EEG-NF) training to explore its effects on GSW activity and heart rate variability (HRV).

METHODS

A randomized crossover design was employed with 20 healthy participants attending two separate sessions [active-training: uptraining left posterior Insula (LPIns) and active-control: uptraining primary visual cortex (PVC Brodmann area 17)] following the baseline recording period. A 5-min water loading test (5WLT) was conducted following the EEG-NF sessions. Finally, a post EEG-NF/5WL period was also recorded. Participants were blinded to the training program, and the sessions were randomized and conducted at least 48 h apart. Electrocardiogram (ECG), EEG, and electrogastrogram (EGG) data were recorded throughout theexperiment. In addition, the duration of successful NF training was also extracted. Correlation analysis was performed to assess the relationships between outcome variables.

RESULTS

Pearson correlation coefficient analysis revealed a significant relationship between the duration of successful NF training and HRV metrics (RMSSD: r = 0.59; p = 0.005, SI: r = -0.59; p = 0.006) in the LPIns training group and EGG-gastric rhythm index (r = -0.40; p = 0.028) in the PVC training group. Moreover, the duration of successful LPIns NF correlated with EEG activity of the infraslow band over the left anterior Ins (r = 0.45; p = 0.043), slow band over the right posterior Ins (r = -0.5; p = 0.022), and beta band over the left (r = 0.44; p = 0.04) and right anterior Ins (r = 0.45; p = 0.04). Significant correlations were also observed between LPIns NF duration and connectivity in the beta and gamma bands between cortical regions of interest.

CONCLUSION

The alpha band EEG-NF training of LPIns demonstrated significant association with HRV, and EEG (activity and functional connectivity)measures and did not show a negative correlation with Gastric Alimetry Rhythm Index (GA-RI) following the 5WLT as in the PVC training group. These findings underscore the importance of considering the duration of successful NF as an important variable when evaluating NF training efficacy in future studies.

Foot tissue stress in chronic ankle instability during the stance phase of cutting

Lower limb biomechanics of chronic ankle instability (CAI) individuals has been widely investigated, but few have evaluated the internal foot mechanics in CAI. This study evaluated bone and soft tissue stress in CAI contrasted with copers and non-injured participants during a cutting task. Integrating scanned 3D foot shapes and free-form deformation, sixty-six personalized finite element foot models were developed. Computed Achilles tendon forces and measured regional plantar pressure were applied as boundary loading conditions for simulation. It was observed that the primary group differences in foot stress occurred during midstance and heel-off phases of the cutting task. Specifically, healthy individuals had significantly higher stress in the talus and soft tissue around the talus compared to CAI participants. In contrast, CAI participants had significantly higher stress in the cuneiforms and lateral forefoot bones during mid-stance and push-off phases. CAI participants appeared to adopt a protective strategy by transferring greater force to the lateral forefoot at the heel-off phase while lowering stress around the talus, which may be associated with pain relief near the ankle. These findings suggest further attention should be placed on internal stress in CAI at the push-off phase with implications for long-term foot adaptation.

Dose-Response Relationship Between Perceived Control and Depression in Patients With Chronic Heart Failure: A Multicenter and Cross-sectional Study

BACKGROUND

Little is known regarding the relationship between perceived control and depression in patients with chronic heart failure (CHF), particularly in terms of their dose-response relationship.

OBJECTIVE

The aim of this study was to explore this relationship based on linear and nonlinear hypotheses and potential subgroup differences in patients with CHF.

METHODS

A total of 308 patients with CHF were included in the study. Data on perceived control, depression, and relevant covariates, such as gender, age, New York Heart Association classification, and comorbidity burden, were collected. Logistic regression, Spearman correlation, and restricted cubic spline analysis were used for data analysis.

RESULTS

Compared with the patients in the first quartiles of perceived control scores (0-16), those in the other 3 quartiles had a lower risk of depression (odds ratios of 0.29, 0.21, and 0.20, respectively; P < .05). Furthermore, a negative correlation between perceived control and depression ( r = -0.317, P < .01) was observed. The restricted cubic spline analysis revealed an "L-shaped" curve relationship between perceived control and the presence of depression ( P for nonlinear < .01). Compared with patients with a perceived control within the 5th percentile (10 scores), as the perceived control increased, the risk of depression rapidly decreased from "1" until it reached a threshold (20 scores) and stabilized. This trend remained consistent across the subgroups grouped by gender, age, New York Heart Association classification, and comorbidity burden.

CONCLUSIONS

Interventions targeting perceived control may hold valuable implications for reducing the risk of depression in patients with CHF, particularly those who have not yet reached the threshold.

Application of visual feedback and AR-enhanced wheelchair skill training

PURPOSE

Manual wheelchair users with spinal cord injury (SCI) face challenges in wheelchair skill training (WSTr) due to the complexity of learning advanced skills and limited access to rehabilitation services. This review aims to summarize existing WSTr methods for individuals with SCI/disabilities and propose the use of Augmented Reality (AR)-enhanced Immediate Visual Feedback (ARe-IVF) learning modules for wheelie and curbing skill training.

METHODS

The proposed ARe-IVF learning modules will incorporate AR-enhanced visual feedback, allowing users to visualize spatial and temporal aspects of wheelchair skills and assess their performance through computer vision technology. These modules are designed to tailor the learning experience to each user's SCI level, age, gender, body height, and weight. Key features of the ARe-IVF modules include verbal cues, computer graphic indications, and AR-enhanced feedback to support skill acquisition.

RESULTS

The anticipated outcomes of the ARe-IVF modules include improved safety and effectiveness in WSTr by providing intuitive and concise guidance for key movements in wheelie and curbing maneuvers. Additionally, these modules offer an accessible alternative WSTr method for manual wheelchair users, caregivers, and rehabilitation therapists, with potential applications in Rehabilitation Centers, Hospitals, or home settings.

CONCLUSION

The ARe-IVF learning modules present an innovative approach to WSTr for manual wheelchair users with SCI, so that the modules provide promising learning outcomes through tailored, AR-supported feedback. This approach may empower wheelchair users to develop advanced skills with increased safety and confidence, ultimately improving rehabilitation outcomes and expanding training accessibility.

Proteomic signatures and predictive modeling of cadmium-associated anxiety in middle-aged and elderly populations: an environmental exposure association study

BACKGROUND

Emerging evidence implicates environmental contaminants such as cadmium (Cd) as modifiable risk factors for anxiety. Despite growing recognition of heavy metal toxicity in neuropsychiatric disorders, the molecular mechanisms linking environmental exposure to anxiety pathogenesis remain poorly understood.

METHODS

Based on the established cohort of individuals with cognitive impairment in cadmium-contaminated areas, this cross-sectional association study enrolled 50 middle-aged and elderly hospitalized patients from these regions, adhering to the STROBE guidelines. Blood concentrations of cadmium (Cd), lead (Pb), and mercury (Hg) were analyzed in relation to anxiety severity assessed via the Hamilton Anxiety Rating Scale (HAMA). Plasma proteomic profiling was performed using data-independent acquisition (DIA) quantitative technology with an LC-MS/MS platform (timsTOF Pro, Bruker Daltonics), systematically characterizing 2,531 proteins across all samples. Machine learning techniques, specifically XGBoost and LASSO, were employed to identify biomarkers that were subsequently validated through mediation analysis and animal experiments, allowing for the screening of key protein signatures. Finally, clinical variables were integrated to construct a comprehensive model, which was then thoroughly evaluated.

RESULTS

Anxious individuals exhibited significantly higher blood Cd levels than controls (β = 0.50, 95% CI: 0.07-0.93, p < 0.01), with anxiety positively correlating with depression (r = 0.62, p = 0.003) and inversely with ApoE3 genotype prevalence. Proteomics identified 120 differentially expressed proteins in anxious patients, enriched in oxidative phosphorylation and neurodegenerative pathways. CCDC126 emerged as a cadmium-associated biomarker, validated in rat models exposed to Cd. Combining CCDC126, blood Cd, Pb, and hypertension, a clinical prediction model achieved robust discrimination (AUC = 0.80, validation cohort).

CONCLUSIONS

This first integrative environmental-proteomic study highlights cadmium's synergistic role in anxiety pathophysiology and psychiatric comorbidity. The predictive model offers translatable potential for early risk stratification, while CCDC126 provides mechanistic insights for targeted interventions in populations exposed to environmental pollutants.

Neuroinflammatory Biomarkers and Their Associations With Cognitive, Affective, and Functional Outcomes 3 to 12 Months After a Traumatic Brain Injury: A Pilot Study

BACKGROUND

Neuroinflammation is an important feature of traumatic brain injury (TBI) that remains poorly understood in the 3- to 12-month period post-TBI.

OBJECTIVE

The purpose of our pilot study was to examine the relationships between biomarkers of neuroinflammation and functional outcomes in TBI patients 3 to 12 months postinjury.

METHODS

TBI patients ( n =  36) 3 to 12 months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. The Disability Rating Scale, Satisfaction with Life Scale, NIH Toolbox Sorting Working Memory, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep assessments were performed. Multiple plasma biomarkers were assayed. Analysis of variance was used to compare between-group results. Linear regression was performed to analyze relationships between biomarkers and outcomes.

RESULTS

Brain-derived neurotrophic factor concentrations were higher as postinjury time interval increased and were associated with cognitive battery outcomes. S-100β and glial fibrillary acidic protein were associated with anxiety score and hospital length of stay; S-100β was also associated with depression. Interleukin 6 was associated with cognitive function score and time since injury.

CONCLUSIONS

We found S-100β, glial fibrillary acidic protein, Interleukin 6, and brain-derived neurotrophic factor to play a larger role in the TBI recovery period than other biomarkers examined. Clinicians should continue to monitor for symptoms post-TBI, as the neuroinflammatory process continues to persist even into the later rehabilitation stage.

Current landscape of dyslipidemia-related randomized clinical trials registered on the International Clinical Trials Registry Platform

Introduction

This study elucidates the characteristics of randomized clinical trials (RCTs) related to dyslipidemia that are registered on the International Clinical Trials Registry Platform (ICTRP) to better identify research hotspots, address existing gaps, and improve clinical trial designs.

Methods

This cross-sectional study included dyslipidemia-related RCTs registered on the ICTRP up to 13 August 2024. We evaluated the relevant characteristics of these RCTs and reviewed their publication status after enrollment using PubMed.

Results

A total of 2,410 dyslipidemia-related RCTs were analyzed. The number of registered RCTs sharply increased in 2005 (N = 125). The majority of the RCTs included adults (91.4%), with a median sample size of 93 (50-229), and 92.9% of these trials had no sex-based enrollment restrictions. Few RCTs focused on participants aged ≤18 years (2.8%), those aged 19-44 years (3.4%), or exclusively women (2.8%). Medication (83.1%) was the most common type of intervention. Efficacy and safety outcomes were predominant (81.5%), while only 0.7% of the RCTs specified treatment adherence as a primary outcome. The RCTs involving adults had larger sample sizes (median 100.0 [50, 245] vs. 56.0 [27, 108], p = 0.047) and lower proportions of natural medicine and extracts (26.6% vs. 33.6%, p < 0.001) compared to age-specific RCTs. After enrollment, the 7-year cumulative publication rate was 20.8%.

Conclusions

High-quality RCTs involving younger participants, women, and adherence-related outcomes were lacking. Researchers should prioritize exploring novel therapeutic strategies to improve trial publication rates.

Impact of Comorbidities on the Prevalence and Recovery Outcomes in Elderly Patients With Neck of Femur Fractures

Background Neck of femur (NOF) fractures are a major cause of morbidity and mortality in the elderly, with incidence rising due to the aging population. The presence of comorbidities in elderly patients can increase the risk of complications and extend recovery time. Understanding how these health conditions influence recovery is crucial for improving patient outcomes. The high mortality rates and functional decline linked to NOF fractures emphasize the need for tailored treatment strategies. Objective To examine how comorbidities affect the prevalence, recovery outcomes, and overall prognosis of neck of femur fractures in elderly trauma patients. Materials and methods A retrospective cohort study was conducted at the Orthopedic Department of Mardan Medical Complex, Pakistan, between December 2023 and March 2025. The study focused on elderly patients (aged ≥65 years) diagnosed with neck of femur (NOF) fractures. Data were extracted from patient medical records, including demographic information, comorbidities, medical history, and recovery outcomes. Statistical analyses, such as descriptive statistics, chi-square tests, and correlation analyses, were performed to investigate the relationships between comorbidities and all studied variables. Additionally, data visualizations, including boxplots, barplots, and heatmaps, were utilized to further explore the associations between comorbidities and all studied variables. Results The study population consisted of 163 patients, with 70.55% males (115 patients) and 29.45% females (48 patients). The mean age was 80.23 ± 9.02 years. Anemia had the highest prevalence, affecting 71.77% (117 patients), followed by hypertension in 60.12% (98 patients), diabetes in 57.05% (93 patients), and cardiovascular disease in 55.21% (90 patients). Postoperative complications were common, with hyperglycemia (31.90%, 52 patients), deep vein thrombosis (18.40%, 30 patients), and heart failure (12.88%, 21 patients) being the most frequent. Comorbidities such as anemia, diabetes, and cardiovascular diseases were strongly associated with longer hospital stays, delayed surgery, extended rehabilitation periods, and reduced follow-up care compliance. Additionally, a significant correlation was found between the number of comorbidities and higher pain levels, particularly in patients with anemia and diabetes. Conclusion Comorbidities notably impair recovery in elderly patients with NOF fractures, with anemia, hypertension, diabetes, and cardiovascular diseases contributing to delayed recovery, complications, and higher healthcare costs. Early intervention, personalized treatment plans, and targeted rehabilitation are crucial to improve outcomes. This study highlights the importance of thorough preoperative assessments and ongoing management of chronic conditions in this patient population.

Prevalence, knowledge, and awareness of needle stick injuries among nursing students in Palestine and associated factors

BACKGROUND

Student nurses are vulnerable to blood-borne infections from needle stick injuries (NSIs) during clinical training. To stay safe from the threats, they; must comprehend every facet of NSIs. The study's objectives were to determine the level; of knowledge among student nurses about NSIs and to examine their prevalence and; prevention strategies in Palestine.

METHODS

A descriptive, cross-sectional design was employed on a sample of 449 student nurses through an online anonymous survey between February 20, 2024, and March 20, 2024. The three questionnaire parts assessed the demographics of the students, the nurses' knowledge of NSIs, their exposure to NSIs, and their use of preventative measures. The data; were analyzed using SPSS Version 26.

RESULTS

A total of 449 students answered the questionnaire; 345 (76.8 %) were female and their average age was 21.08 (SD = 2.47) years. Out of ten, the average score for total knowledge was 7.04 (SD = 1.51). Nearly 105 students (23.4 %) reported having been exposed to NSIs at least once and most of them were junior students 67 (63.8 %). Of these, 69.5 % happened in open hospital units, while the technique of withdrawing blood caused 41.9 % of NSIs, and 67.6 % of students didn't report the incident of injury.

CONCLUSION

Training programs are necessary to reduce the risk of blood-borne disease transmission and improve workplace safety for nursing students. Clinical nursing administrators should create practical plans to lower the incidence of NSIs.

Latent profiles of psychosocial adaptation in hospitalized persons with stroke and their association with coping styles and illness uncertainty: A cross-sectional study

OBJECTIVE

Current studies on psychosocial adaptation of persons with stroke mainly focused on the overall level and ignored its heterogeneity. The aim of the current study was to identify the latent profiles of psychosocial adaptation of persons with stroke and further explore their association with coping styles and illness uncertainty.

METHODS

A total of 361 hospitalized persons with stroke were recruited at two affiliated hospitals of a medical university in southeastern China from October 2023 to March 2024. Latent profile analysis was used to identify latent profiles of psychosocial adaptation of persons with stroke.

RESULTS

Three different profiles of psychosocial adaptation of persons with stroke were identified: good adaptation group (with the lowest item mean scores of the dimensions, accounted for 32.4 %), moderate adaptation-poor social environment group (with moderate item mean scores of the dimensions and with a high score in the social environment dimension, accounted for 51.5 %) and poor adaptation group (with the highest item mean scores of the dimensions, accounted for 16.1 %). Living status (OR = 0.20, p = 0.018; OR = 7.72, p < 0.001), per capita monthly household income (OR = 13.32, p = 0.015; OR = 13.08, p = 0.003; OR = 5.11, p = 0.038), medical payment methods (OR = 5.74, p = 0.015), mRS (OR = 0.37, p = 0.015), confrontation (OR = 0.77, p = 0.010), ambiguity (OR = 1.26, p < 0.001; OR = 1.22, p = 0.014) and complexity (OR = 1.15, p = 0.045) were associated with different profiles of psychosocial adaptation.

CONCLUSIONS

Nearly two-thirds of the persons with stroke exhibited moderate psychosocial adaptation or poor psychosocial adaptation, which needs further improvement. Healthcare providers need to adopt individualized approaches to improve their level of psychosocial adaptation in practice.

Can protrusive movements during TMJ arthrocentesis improve final results?

This study aimed to evaluate and compare the efficacy of single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for the management of disk displacement without reduction (DDwoR). A total of thirty-six patients diagnosed with DDwoR were randomly and blindly assigned to two treatment groups (N = 18 each): Group 1 underwent TMJ arthrocentesis using a concentric needle-cannula system with protrusive movements, while Group 2 received TMJ arthrocentesis with a concentric needle-cannula system but without protrusive movements. The following variables were recorded and compared between the groups: maximal interincisal distance (MID - mm), patient pain perception (visual analogue scale - VAS [0-10]), and operation duration (OP - minutes). Patients in Group 1 exhibited significantly greater MID values after 1 year compared to Group 2 (p<0.001). Both techniques of TMJ arthrocentesis significantly reduced pain perception, with no significant difference between the groups. Additionally, no significant difference in OP was observed between the groups. TMJ arthrocentesis, with or without protrusive movements, significantly improves maximal interincisal distance. However, the inclusion of protrusive movements led to a greater final MID, though it did not significantly impact other measured variables. This suggests a potential benefit of incorporating protrusive movements in TMJ arthrocentesis.

Effect of an online program based on the transtheoretical model to promote physical activity and healthy eating habits in adolescents

BACKGROUND

Promoting health at early ages favors long-term healthy habits and the use of information and communication technologies (ICTs) for educational purposes, and theoretical models of behavioral change such as the transtheoretical model (TTM) seem to improve behaviors related to physical activity (PA) and eating. The aim was to analyze the effect of an educational program implemented through ICTs on the PA level and food consumption frequency of Mexican adolescents considering the stages of change of adolescents and in general.

MATERIAL AND METHODS

A 22-week randomized controlled trial was conducted in 175 adolescents of both sexes. Two groups received an educational intervention with different approaches: (1) according to the stage of change (EGC) and (2) in a general way (EGG). PA level, food consumption frequency, and stage of change were evaluated before, during, and after the intervention. A three-factor analysis of variance test was performed to know the differences of all variables, between groups and measurements. The effect size was determined using partial Eta squared.

RESULTS

EGC increased the frequency of food recommended for daily consumption toward the middle of the intervention and decreased the intake of boxed cereals, sweet food, and pastries at the end of the intervention. Although not significantly, EGC showed an upward trend in the level of PA and a downward trend on the intake of food not recommended for daily consumption.

CONCLUSION

An online program based on TTM to promote PA and healthy eating habits on adolescents is effective when the stage of current behavior change is considered.

Association between Sarcopenic Obesity and Changes in Skeletal Muscle Mass and Quality in Patients with Stroke Who Undergo Convalescent Rehabilitation

Introduction

Sarcopenic obesity substantially affects the recovery of physical function in patients with stroke. However, few studies have investigated the relationship between changes in skeletal muscle mass (SMM) and skeletal muscle quality (SMQ) and sarcopenic obesity diagnosed using the Japanese Working Group on Sarcopenic Obesity (JWGS) diagnostic criteria in patients with stroke who undergo rehabilitation. Therefore, this study aimed to investigate the relationship between sarcopenic obesity and changes in SMM and SMQ in patients with stroke who undergo rehabilitation.

Methods

Patients with stroke admitted to a rehabilitation ward in a single center in Japan were enrolled in this retrospective cohort study. The inclusion criteria were age 40-75 years and hospitalization for rehabilitation therapy due to stroke. The exclusion criteria were length of hospital stay <14 days and missing clinical data. Data were collected from medical records. Classification of sarcopenic obesity was based on the JWGS diagnostic criteria. The outcomes were the change in SMM and phase angle (PhA) from admission to discharge. Multiple regression analysis was used to investigate the relationship between sarcopenic obesity and changes in SMM and PhA after adjustment for confounding factors.

Results

A total of 173 patients were analyzed. 8 patients (3 male and 5 female) were diagnosed with sarcopenic obesity using the JWGS criteria. Multiple regression analysis revealed that sarcopenic obesity was negatively associated with changes in SMM (β: -0.281, 95% confidence interval [CI]: -0.449 to -0.113, p < 0.001) and PhA (β: -0.189, 95% CI: -0.367 to -0.010, p = 0.038).

Conclusions

Sarcopenic obesity is negatively associated with changes in SMM and SMQ in patients with stroke who undergo rehabilitation, highlighting the importance of evaluating sarcopenic obesity in patients with stroke from an early stage.

Assessing healthcare simulation facilitation using a competency-based tool derived from practice in low-resource settings

INTRODUCTION

The worldwide expansion in healthcare simulation training includes accelerated uptake in low-resource settings. Until recently, no framework has specifically delineated the competencies underpinning effective facilitation practice in low-resource settings. We describe the development of the Facilitation Behavioural Assessment Tool for simulation facilitation training and report reliability in scoring facilitation performance. This tool was informed by healthcare simulation facilitation practice in low-resource settings.

METHODS

The tool has 32 facilitation competencies, organised across three performance categories (techniques, artistry and values) and a three-point scale is used for scoring. Following a short, self-directed online training module, participants scored three videos that depicted facilitation performance at three levels. Videos were presented in a random order. Intraclass correlations and internal consistency with Cronbach's α were calculated. A random intercepts 3 × 3 linear mixed model assessed discrimination across the three levels of facilitation performance and the influence of previous facilitation on scoring.

RESULTS

In total, 104 participants from 29 countries completed rater training and scored at least one video. The inter-rater reliability was 0.73 (95%CI 0.66-0.79) and 0.89 (95%CI 0.85-0.92) for the intraclass correlation coefficient 2 and intraclass correlation coefficient 2k, respectively. Cronbach's α was 0.84 (95%CI 0.79-0.89) for the positive video; 0.84 (95%CI 0.78-0.88) for the mixed video; and 0.91(95%CI 0.87-0.93) for the negative video. Previous simulation facilitation experience did not affect the ability to distinguish between the videos meaningfully, but novice facilitators scored facilitation behaviours higher for mixed and negative videos compared with participants with intermediate and high levels of experience.

DISCUSSION

Our study shows that suitable reliability and internal consistency can be achieved when using the Facilitation Behavioural Assessment Tool. We recommend using the tool to support learning conversations for simulation faculty development in low-resource settings.

Modeling of demoralization in breast cancer

Objective

This study aimed at identifying correlates of demoralization in breast cancer.

Materials and methods

Information was obtained from outpatients with breast cancer at the Oncology Clinic of a university-affiliated hospital in the United States, using reliable and valid scales, and from the participants' medical records on demographic and social characteristics, location, type, and stage of cancer, whether it was a re-occurrence or first time diagnosed, type of cancer treatment, medications being used, history of mental disorder, functional impairment, perceived stress, perceived social support, resilience, subjective incompetence, demoralization, and depression. Demoralization was measured with the Demoralization Scale. Bivariable and multivariable analyses were conducted with demoralization as the dependent variable.

Results

Demoralization correlated positively with functional impairment, perceived stress, depression, and subjective incompetence, and negatively with months since diagnosed with breast cancer, perceived social support, resilience, and quality of life. Forward stepwise regression conducted without depression in the regression equation identified emotional wellbeing subscale of quality of life, resilience, subjective incompetence, perceived social support, and functional impairment as significant. After forced entry of depression, perceived social support and mild depression ceased to be significant, leaving only moderate and severe depression as significant. Perceived stress did not enter any of the regression models.

Conclusion

Early detection of demoralization and of the co-occurrence of depression and demoralization are essential for promoting the well-being of patients with breast cancer. Psychotherapy should focus on strengthening the modifiable negative correlates of demoralization, countering the modifiable positive correlates, and preventing the co-occurrence of demoralization and depression.

Effect of treadmill walking on cardiometabolic risk factors and liver function markers in older adults with MASLD: a randomized controlled trial

BACKGROUND

Regular walking has been reported to improve metabolically-associated steatotic liver disease (MASLD) by altering the metabolic environment. However, no studies to date have focused on older individuals in both conditions. Therefore, this study aimed to investigate the effects of a 12-week walking intervention on metabolic syndrome risk factors, liver function indicators, and liver ultrasound findings in older adults with both metabolic syndrome and MASLD.

METHODS

A total of 66 participants aged 65-85 years had average ages, heights, and weights of 75.3 ± 5.8 years, 159.3 ± 9.3 cm, and 68.6 ± 6.8 kg, respectively. The participants resided in four senior living communities, and their diets were uniform. The participants from two facilities were assigned to the control group (CON, n = 33), whereas those from the other two facilities were allocated to the treadmill walking program group (WPG, n = 33). Each group comprised 13 males and 20 females. The intervention consisted of a low- to moderate-intensity walking program, conducted for 30 min per day, 6 days per week, totaling 180 min per week. The total daily calorie expenditure was recorded based on the values calculated from the treadmill. The walking intensity was adjusted by modifying the treadmill incline according to each participant's heart rate corresponding to their maximal oxygen consumption (VO₂max). The exercise intensity was set at 50% on Mondays and Fridays, 60% on Tuesdays and Thursdays, and 70% on Wednesdays and Saturdays. Sundays were designated as rest days.

RESULTS

Although there were no significant differences in caloric intake between the groups, the WPG exhibited a 52.5% increase in physical activity levels (p < 0.001), resulting in significant reductions in body weight (-10.2%), fat mass (-17.2%), and abdominal fat (-4.8%). The WPG showed a 16.1% increase in VO₂max, along with significant reductions in systolic blood pressure (-9.6%) and blood glucose (-16.9%), as well as notable improvements in lipid profiles (p < 0.001). The WPG also demonstrated significant reductions in aspartate aminotransferase (-40%), alanine aminotransferase (-23.5%), total protein (-14.4%), albumin (-8.1%), bilirubin (-17.6%), and liver ultrasound scores (-31.8%), with all changes showing significant intergroup differences (p < 0.001).

CONCLUSIONS

Along with a consistent diet, a 12-week walk has been shown to induce significant changes in the body composition and cardiometabolic factors of older adults, as well as notable improvements in liver function markers and imaging findings.

TRIAL REGISTRATION

This study was registered with the Clinical Research Information Service of the Korea Centers for Disease Control and Prevention under Clinical Trials KCT0010079 on 26/12/2024.