Is medical training solely to blame? Generational influences on the mental health of our medical trainees

INTRODUCTION

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

METHODS

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

RESULTS

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

DISCUSSION

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

Measuring teacher identity of physicians - a validation study of a questionnaire instrument

BACKGROUND

Teacher identity is defined as a continuum of a person's self-conviction ('Identity is something I have') and a context-dependent action ('Identity is something I do in a context') (Lankveld et al. 2021). It has been identified a relevant contributor to physicians' teaching commitment. In this study, we further improve the currently only existing questionnaire instrument (37 items) measuring physicians' teacher identity.

METHODS

Survey data on 147 clinicians at a German university hospital were (1) analyzed by confirmatory factor analysis (CFA). We tested (a) the model fits of the originally suggested scales and (b) potential for improvement of model fits by item reduction. As this could not reveal satisfactory fits for all scales, we (2) applied a principal axis factoring as an exploratory approach. Last, we combined findings from (1) and (2) with a theoretical item content discussion and suggest (3) reassembled scales which were again checked using CFA.

FINDINGS

(1a) Two scales from the original instrument were successfully confirmed. (1b) Some scales benefited from item reduction. (2) The exploratory analysis identified three factors that explained at least 5% variance. (3) By integrating confirmatory and exploratory findings with a content analysis of the items, we propose a partially rearranged questionnaire instrument, comprising seven scales: (1) Feeling intrinsic satisfaction from teaching; (2) Feeling responsibility to teach; (3) Exchange of teaching experience; (4) Identification and enjoyment of the teaching role; (5) Development of teaching; (6) Teaching self-concept of ability; (7) Desired rewards for teaching. Four items were kept as single items.

CONCLUSION

We suggest that when assessing teacher identity in physicians, all items should be constructed to allow for responses, even from physicians who are presently not actively involved in teaching. The scales benefited from categorizing items based on the continuum of teacher identity as outlined by van Lankveld et al. (2021).

COVID-19 clinical trial participation and awareness in Texas

The COVID-19 pandemic required the rapid development of COVID-19 vaccines and treatments, necessitating quick yet representative clinical trial enrollment to evaluate these preventive measures. However, misinformation around the COVID-19 pandemic and general concerns about clinical trial participation in the U.S. hindered clinical trial enrollment. This study assessed awareness of, willingness to participate in, and enrollment in COVID-19 vaccine and treatment clinical trials in Texas. A quota sample of 1,089 Texas residents was collected online from June - July 2022. Respondents were asked if they were aware of, willing to participate in, and had enrolled in clinical trials for COVID-19 vaccines or treatments. Overall, 45.8% of respondents reported being aware of clinical trials for COVID-19 treatments or vaccines, but only 21.7% knew how to enroll and only 13.2% had enrolled in a COVID-19 clinical trial. Respondents with bachelor's or graduate degrees were more likely to be aware of clinical trials, more likely to have enrolled in trials, and more willing to participate in treatment trials. Women were less willing to participate and less likely to have enrolled in COVID-19 clinical trials than men. Respondents aged 55 years and older were more willing to participate, but less likely to have enrolled in COVID-19 clinical trials than 18-to-24-year-olds. Common reasons given for not participating in clinical trials included concerns that COVID-19 treatments may not be safe, government distrust, and uncertainty about what clinical trial participation would entail. Substantial progress is needed to build community awareness and increase enrollment in clinical trials.

Methodological issues of retrospective surveys for measuring mortality of highly clustered diseases: case study of the 2014-16 Ebola outbreak in Bo District, Sierra Leone

BACKGROUND

There is a lack of empirical data on design effects (DEFF) for mortality rate for highly clustered data such as with Ebola virus disease (EVD), along with a lack of documentation of methodological limitations and operational utility of mortality estimated from cluster-sampled studies when the DEFF is high.

OBJECTIVES

The objectives of this paper are to report EVD mortality rate and DEFF estimates, and discuss the methodological limitations of cluster surveys when data are highly clustered such as during an EVD outbreak.

METHODS

We analysed the outputs of two independent population-based surveys conducted at the end of the 2014-2016 EVD outbreak in Bo District, Sierra Leone, in urban and rural areas. In each area, 35 clusters of 14 households were selected with probability proportional to population size. We collected information on morbidity, mortality and changes in household composition during the recall period (May 2014 to April 2015). Rates were calculated for all-cause, all-age, under-5 and EVD-specific mortality, respectively, by areas and overall. Crude and adjusted mortality rates were estimated using Poisson regression, accounting for the surveys sample weights and the clustered design.

RESULTS

Overall 980 households and 6,522 individuals participated in both surveys. A total of 64 deaths were reported, of which 20 were attributed to EVD. The crude and EVD-specific mortality rates were 0.35/10,000 person-days (95%CI: 0.23-0.52) and 0.12/10,000 person-days (95%CI: 0.05-0.32), respectively. The DEFF for EVD mortality was 5.53, and for non-EVD mortality, it was 1.53. DEFF for EVD-specific mortality was 6.18 in the rural area and 0.58 in the urban area. DEFF for non-EVD-specific mortality was 1.87 in the rural area and 0.44 in the urban area.

CONCLUSION

Our findings demonstrate a high degree of clustering; this contributed to imprecise mortality estimates, which have limited utility when assessing the impact of disease. We provide DEFF estimates that can inform future cluster surveys and discuss design improvements to mitigate the limitations of surveys for highly clustered data.

Uncovering heterogeneity in mental health changes among first-year medical students

INTRODUCTION

The initial year of medical school is linked to a decline in mental health. To assess mental health comprehensively, the dual-factor model posits the consideration of both psychopathology (e.g., depression) and positive mental health (e.g., well-being). Previous mental health research among medical students has primarily examined these two factors independently. This study uses the dual-factor approach for a deeper understanding of mental health changes during the first year of medical school.

METHODS

Students from eight German medical schools (N = 450) were surveyed three times (T0 = entering medical school, T1 = end of the first semester, T2 = end of the second semester) regarding depression (PHQ-9), well-being (subscale of FAHW-12), and general life satisfaction (German Single-Item Scale L1). Latent profile analysis was used to identify distinct mental health groups based on their combinations of psychopathology and positive mental health. We then analysed trajectories descriptively by examining the longitudinal stability and dynamics of mental health group membership during the first year of medical school.

RESULTS

We identified five mental health groups: (1) complete mental health, (2) moderately mentally healthy, (3) symptomatic but content, (4) vulnerable, and (5) troubled. The examination of change trajectories unveiled diverse paths pointing towards both recovery and deterioration. In comparison to the other groups, students belonging to the complete mental health group exhibited greater stability and a higher potential to recover after initial deteriorations in the first semester.

CONCLUSIONS

Our study uncovers distinct mental health trajectories in the first year of medical school, emphasizing the crucial role of initial mental health status. Our findings stress the diverse nature of mental health changes in medical students, underscoring the need for tailored prevention strategies. The implications for research and practice are discussed.

Perception of clinical teachers about their roles and current practice at affiliated hospitals of medical universities in China

Phenomenon: The increase in clinical and teaching workload has brought enormous pressure to clinical teachers. Clinical teachers play an extremely important role in the quality of higher medical education and the cultivation of medical talents. However, few studies have examined the attitudes and practices of clinical teachers regarding the role of teachers in China. This study aimed to investigate clinical teachers' perceptions about their roles and current practices at affiliated hospitals of medical universities in China. Approach: Responses from 312 Chinese clinical teachers were included in the analyses. The data were collected using the questionnaires of perception and practice regarding the role of teachers which consisted of 12 items rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), and scored by calculating the mean. The data were analyzed using the Statistical Package for Social Sciences, version 22.0 (IBM SPSS Corp). Findings: The mean score of perception of clinical teachers regarding the role of teachers was 4.51 (SD = 0.72), and the mean score of practice was 3.69 (SD = 1.17). Multivariable binary logistic regression model showed that undertaking very few/few clinical teaching workload, 'thinking it is my obligation to carry out teaching work seriously' and 'thinking it is my duty to train medical talents' were not only significant determinants of good perception but also good practice. Additionally, 'thinking hospital attached great importance to clinical teaching' was the significant determinant of good perception. Insights: Chinese clinical teachers demonstrate less positive perception and practice regarding the roles of teacher than clinical teachers in developed countries. Affiliated hospitals of medical universities should hold training sessions regularly and take targeted intervention measures to enhance clinical teachers' perception and practice regarding the roles of teacher.

Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study

BACKGROUND

Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group.

OBJECTIVE

To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia.

METHODS

An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants.

RESULTS

The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement.

CONCLUSIONS

These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.

Medical students' knowledge about human papillomavirus (HPV), HPV vaccine and head and neck cancer

The Human Papillomavirus (HPV) is a sexually transmitted infection that significantly affects the population worldwide. HPV preventive methods include vaccination, prophylactics, and education. Different types of cancers associated with HPV usually take years or decades to develop after infections, such as Head and Neck Cancer(HNC). Therefore, HPV prevention can be considered cancer prevention. A sample of medical students in Puerto Rico was evaluated to assess their knowledge about HPV, HPV vaccine, and HNC through two previously validated online questionnaires composed of 38 dichotomized questions, we measured HPV, HPV vaccination(HPVK), and HNC knowledge (HNCK). Out of 104 students surveyed, the mean HPVK score obtained was 20.07/26, SD = 3.86, while the mean score for HNCK was 6.37/12, SD = 1.78. Bidirectional stepwise regression showed study year and HPV Vaccine name had been the most influential variables on HPVK and HNCK. MS1 participants scored lower than MS2-MS4 participants, with no significant difference between MS2-MS4 scores. The results reveal knowledge gaps in HPV/HPV Vaccine and HNC among surveyed medical students. Our findings also suggest an association between knowledge of personal vaccination status, self-perceived risk, and how uncertainty in these factors may affect the medical students' understanding of HPV, HPV vaccination, and associated cancers.

Evaluating the effectiveness of an online curriculum on caring for transgender and nonbinary patients

BACKGROUND AND OBJECTIVES

 It is well established that provider lack of knowledge in the field of transgender and nonbinary health is as ignificant barrier to care and that training in this area is lacking. This study examined how family medicine residents' self-confidence and medical knowledge in providing gender-affirming care changed after completing a novel, online curriculum on transgender and nonbinary care.

METHODS

Thirty-nine family medicine residents were invited to complete the curriculum. Change inself-confidence was determined by the difference in scores on a Likert scale on a pre- and post-survey. Change in medical knowledge was assessed by examining the difference between pre- and post-test scores on a novel multiple-choice examination.

RESULTS

Only 7% of current residents agreed that their current training is adequate in order to provide comprehensive primary care to transgender and nonbinary people. After completion of the curriculum, 100% of participants felt at least somewhat confident providing primary care to transgender and nonbinary people, including hormone therapy. Average medical knowledge post-test scores trended higher than the pre-test results (mean (SD) at pre = 11.2 (1.4) vs post = 14.6 (2.8)).

CONCLUSIONS

An online, self-directed curriculum on caring for transgender and nonbinary patients in the primary care setting, including management of gender-affirming hormone therapy, has the potential to increase confidence and knowledge in this field, decreasing barriers to care for this population.

Clicks for credit: an analysis of healthcare professionals' social media use and potential for continuing professional development activities

BACKGROUND

Previous studies have examined social media habits and utilization patterns among various groups of healthcare professionals. However, very few studies have evaluated the use of social media to support continuing professional development activities. The goal of the 2023 Clinical Education Alliance social media survey was to explore how HCPs interact professionally with social media, describe utilization trends, and identify barriers to using social media to disseminate CPD content.

METHODS

We conducted an online anonymous, voluntary survey of healthcare professionals contained in the Clinical Education Alliance learner database from January to March 2023. The survey was distributed via email and all learners were invited to participate regardless of profession or specialty. This survey consisted of 16 questions and collected demographic information and social media utilization and habits of healthcare professionals.

RESULTS

Of the 2,615 healthcare professionals who completed the survey, 71.2% use social media. Most respondents were physicians (50.6%) practicing in an urban setting (59.6%) and have been practicing for more than 15 years (70.5%). The most widely used platform was Facebook (70.7%), but there were no significant differences among the different professions. Of the respondents who use social media, 44.5% used social media to access continuing professional development-certified activities. Surveyed learners preferred passive participation with social media content. Participant-reported concerns include issues with legitimacy of the information, privacy, time constraints, and institutional barriers.

DISCUSSION

As the continuing professional development community continues to evolve and seek new innovative strategies to reach healthcare professionals, the findings of this survey highlight the need to identify and enact social media-based strategies aimed to engage healthcare professionals and provide them with unbiased evidence-based education.

Knowledge about, attitudes toward and acceptance and predictors of intention to receive the mpox vaccine among cancer patients in China: A cross-sectional survey

This study aimed to investigate the knowledge about, attitudes toward, and acceptance and predictors of receiving the mpox vaccine among Chinese cancer patients. Patients were selected using a convenience sampling method. A web-based self-report questionnaire was developed to assess cancer patients' knowledge, attitudes, and acceptance regarding the mpox vaccine. Multivariate logistic regression analysis was used to determine predictors of acceptance of the mpox vaccine. A total of 805 cancer patients were included in this study, with a vaccine hesitancy rate of 27.08%. Approximately 66% of the patients' information about mpox and the vaccine came from the mass media, and there was a significant bias in the hesitant group's knowledge about mpox and the vaccine. Multivariable logistic regression analysis suggested that retirement; chemotherapy; the belief that the mpox vaccine could prevent disease, that vaccination should be compulsory when appropriate and that the mpox vaccine prevents mpox and reduces complications; the willingness to pay for the mpox vaccine; the willingness to recommend that friends and family receive the mpox vaccine; and the belief that the mpox vaccine should be distributed fairly and equitably were factors that promoted vaccination. The belief that mpox worsens tumor prognosis was a driving factor for vaccine hesitancy. This study investigated the knowledge of cancer patients about mpox and the vaccine, evaluated the acceptance and hesitancy rates of the mpox vaccine and examined the predictors of vaccination intention. We suggest that the government scientifically promote the vaccine and develop policies such as free vaccination and personalized vaccination to increase the awareness and acceptance rate of the mpox vaccine.

Association between friends' hesitancy and personal COVID-19 vaccine hesitancy among Chinese medical staff

COVID-19 vaccine hesitancy remains problematic among healthcare workers. Social network influences may shape vaccine decision-making, but few studies have examined this in this critical workforce. We assessed the relationship between friends' COVID-19 vaccination attitudes and personal hesitancy among Chinese healthcare personnel. In December 2022-January 2023, a cross-sectional online survey was conducted at a tertiary hospital in China using WeChat. Of the 1832 healthcare personnel who were invited to answer the structured questionnaire, 613 (33.5%) samples had valid data for data analysis. Logistic regression examined the association between friends' hesitancy and participants' own hesitancy, adjusting for confounders. Of 613 healthcare workers included, 266 (43.4%) were hesitant. Those with hesitant friends had 6.34 times higher adjusted odds of hesitating themselves versus those without hesitant friends (95% CI 2.97-13.52). Strong associations persisted across subgroups. Chinese healthcare workers' COVID-19 vaccination hesitancy was highly influenced by perceived friends' attitudes. Fostering pro-vaccine social norms through trusted peer networks could help promote vaccine acceptance in this critical workforce.

The Relationship between Burnout and Sense of School Belonging among the Resident Physicians in the Standardization Training in China

BACKGROUND

As an important part in medical training in graduate school, 33-month medical residency training could be a stressful period inducing burnout (i.e. emotional exhaustion, depersonalization, and low personal accomplishment). Despite that existing literature has found that sense of belonging may have merits for residents' well-being, it has remained unclear how sense of school belonging affects burnout and the potential moderators. To address this question, a cross-sectional survey has been conducted among the residents of the physicians standardized residency training program in China.

METHODS

Seven hundred (N = 700) resident physicians from different majors (i.e. clinical medicine, clinical Stomatology, and Chinese medicine) and grades have participated in the survey. Resident's sense of school belonging was assessed with the psychological sense of school membership scale (PSSM, mean = 45.12, SD = 11.14). Burnout was measured by the 22-item Maslach Burnout Inventory (MBI-HSS, mean = 65.80, SD = 15.89), including three subscales of emotional exhaustion, depersonalization, and personal accomplishment.

RESULTS

The results showed that over 80% of the residents reported moderate or high level of emotional exhaustion and reduced personal accomplishment during residency training. Meanwhile, higher level of sense of school belonging was associated with lower overall burnout (B = -0.722, p < 0.001), less emotional exhaustion, reduced depersonalization, and higher personal accomplishment. In particular, the benefits of sense of belonging seem more pronounced among female and those at earlier stage of residency. No interaction effect was found between sense of belonging and major, while those from Chinese medicine reported lower scores in overall burnout and the three dimensions.

CONCLUSIONS

Burnout was a prevalent issue among the resident physicians, and our findings confirmed the protective effects of sense of school belonging against burnout. Therefore, support service should be developed to cultivate resident's sense of school belonging and social connections, particularly for female and those at earlier stage of residency.

Health-related quality of life among adult patients with cancer in Uganda - a cross-sectional study

OBJECTIVES

The study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda.

METHODS

This cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue.

RESULTS

The mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life.

CONCLUSION

Improvement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.

The community nurse's role on the promotion of papillomavirus vaccination among young students: A study protocol

Vaccination is the principal strategy for primary prevention of infection by Human Papilloma Virus (HPV), which causes different pathological conditions, up to cancer, in both males and females. However, to date, knowledge among adolescents and their parents about the HPV vaccine is still low. The aim of this quasi-experimental, multicenter study is to assess the effectiveness of a digital educational intervention, conducted by a multidisciplinary health-care team including a Community Nurse, to increase adolescents' HPV vaccination uptake, their knowledge, self-efficacy, feelings and involvement in HPV vaccine decision-making, and parents' vaccination hesitancy. The study will be carried out among a population of students (and their parents), aged between 11 and 13, at secondary schools in Italy. Validated questionnaires will be administered to both students and parents at baseline (T0) and 3 months after a digital educational intervention (T1). The findings may be useful in evaluating and deepening a methodology for designing and implementing educational interventions, embedded in the school setting, that could promote the achievement of outcomes within the broader process of youth's health promotion.

Assessing readiness: the impact of an experiential learning entrustable professional activity-based residency preparatory course

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018-2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks - adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019-2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

COVID-19 pandemic and its impact on medical interns' mental health of public and private hospitals in Guadalajara

INTRODUCTION

Burnout syndrome is a global burden characterized by exhaustion, work detachment, and a sense of ineffectiveness. It affects millions of individuals worldwide, with a particularly high prevalence among medical students. Factors such as demanding education, exposure to suffering, and the COVID-19 pandemic have contributed to elevated stress levels. Addressing this issue is crucial due to its impact on well-being and health-care quality.

MATERIALS AND METHODS

This cross-sectional survey study assessed fear of COVID-19 and burnout levels among medical student interns in hospitals in Guadalajara, Jalisco. The study used validated scales and collected data from September 2021 to September 2022. A snowball sampling method was employed and a minimum sample size of 198 participants was calculated.

RESULTS

This study included 311 medical students (62.1% female and 37.9% male with a mean age of 23.51 ± 2.21 years). The majority were in their second semester of internship (60.5%) and from public hospitals (89.1%). Most students believed that the COVID-19 pandemic affected the quality of their internship (82.6%). Female students had higher personal burnout scores, while male students had higher work-related burnout scores. The mean score for fear of COVID-19 was 13.71 ± 6.28, with higher scores among women (p = 0.004) and those from public hospitals (p = 0.009). A positive weak correlation was found between COVID-19 scores and burnout subscales.

CONCLUSION

Our study emphasizes the significant impact of various factors on burnout levels among medical students and health-care professionals during the COVID-19 pandemic. Prolonged exposure to COVID-19 patients, reduced staffing, and increased workload contributed to burnout, affecting well-being and quality of care. Targeted interventions and resilience-building strategies are needed to mitigate burnout and promote well-being in health-care settings.

A survey into the utilization of probiotics and medicinal plants among individuals afflicted with gastrointestinal disorders in healthcare institutions in Saïda, Algeria

Aim: Functional gastrointestinal (GI) disorders are recognized as a major public health concern worldwide. These disorders involve persistent digestive symptoms indicative of digestive tract dysfunction.Materials and Methods: A survey examining the utilisation of probiotics and medicinal plants as supplementary treatments was conducted on 160 patients with GI disorders at healthcare institutions in Saïda from March to April 2023 using questionnaires that had been previously adapted and tested for reliability with Cronbach's alpha test. Raw data collected through the questionnaires were transferred to a database and analysed using SPSS software.Results: Overall, 49.38% of participants possessed knowledge of or actively utilised probiotics; such awareness was strongly associated with the participants' educational attainment (p = 0.029). The noteworthy probiotic supplements were Biocharbon (36.09%), Lactocil (15.38%), Smebiocta (13.61%), Ultrabiotic Adult (12.43%), Effidigest (12.43%), and Ultralevure (7.69%). During crisis, individuals tended to consume natural goods rich in probiotics, including yoghurt (13.26%) and fermented milk (8.60%), as well as foods rich in prebiotic fibre, including vegetables (18.99%), fruits (13.26%), wheat (9.67%), bran (7.52%), rye (6.81%), and oat flakes (6.45%). Additionally, 77.56% of patients used medicinal plants during crises, with Mentha spicata (12.2%), Thymus vulgaris (11.3%), Pimpinella anisum (8.5%), Cuminum cyminum (8.0%), Punica granatum (7.8%), Trachyspermum ammi (7.5%), and Senna acutifolia (7.0%) being the more commonly favoured options in phytotherapy. The main focus of these herbs was to alleviate bloating (57%), constipation (30.12%), and diarrhoea (12.87%) (p < 0.001). The most frequently utilised plant parts were leaves (47.30%), seeds (25.21%), and bark (13.21%). Most patients (82.91%) favoured infusion as their preferred consumption method, and approximately 85.43% believed in phytotherapy's ability to extend symptomatic relief.Conclusion: The understanding of probiotics is still in its infancy, whereas phytotherapy is more widely accepted by patients. Nonetheless, patients are open to the exploration of natural alternatives to conventional medicines.

Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan

Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.

Performance evaluation on vaccination rates monitoring report system of Shenzhen, China

To evaluate the performance of "Vaccination Rates Monitoring Report System" implemented by Shenzhen CDC, we conducted an analysis of the data quality and identify key areas for system improvement. Following evaluation guidelines provided by WHO and United States CDC, we established six evaluation attributes: representativeness, simplicity, acceptability, data reliability, stability and timeliness. In eastern, central and western regions of Shenzhen, we selected one district from each region, of which the local CDC and ten CHSCs under jurisdiction were chosen for evaluation. On-site inspections, questionnaires survey and interviews were utilized for data collection, while the Likert scale method was used for attributes rating evaluation. A total of 70 participants were surveyed, consisting of 60 CHSCs and 10 CDCs staff. The gender ratio was 1:2.5 (males to females), with the majority falling within the 25-34 age range (46%). Most participants held full-time positions (80%) and had more than 5 years of work experience (62%). The system achieved 100% coverage of all CHSCs and CDCs (100%). The cumulative percentage scores for the overall favorable options of simplicity, acceptability, data reliability, stability, and timeliness were 79%, 85%, 73%, 50%, and 71% respectively. The system operates normally with strong representativeness. Acceptability was rated as "good." Simplicity, data reliability, and system timeliness were rated as "average," while system stability was rated as "poor." Based on these survey results, developers should urgently investigate reasons for poor stability, particularly addressing concerns from CHSCs users. Additionally, the issues and shortcomings identified in other attributes should also be gradually improved.

Ghanaian women's experience of intimate partner violence (IPV) during group antenatal care: a brief report from a cluster randomised controlled trial

Intimate partner violence (IPV) impacts women of reproductive age globally and can lead to significant negative consequences during pregnancy. This study describes an exploratory aim of a cluster randomised controlled trial designed to assess the outcomes of Group Antenatal Care (ANC) in Ghana. The purpose was to understand the effect of a healthy relationship Group ANC module on experiences of IPV and safety planning as well as to explore the relationship between self-efficacy on the experiences of IPV and safety planning. Data were collected at baseline and at 11-14 months postpartum (post). Survey measures captured reported experiences of violence, self-efficacy, and safety. The chi-square test was used to compare baseline and post scores, and a logistic regression was performed to ascertain the effects of self-efficacy on the experiences of IPV in both groups. The sample included 1,751 participants, of whom 27.9% reported IPV at baseline. Between baseline and postpartum, there was a small increase in reported emotional (6.2% vs. 4.6%) and sexual (5.4% vs. 3.2%) violence in the intervention group compared to the control group. Logistic regression demonstrated that an increasing self-efficacy score was associated with an increased likelihood of experiencing IPV. There were no changes in safety knowledge. This study found higher rates of reported sexual and emotional violence post-intervention among the intervention group. Group ANC may be just one part of a portfolio of interventions needed to address IPV at all socio-ecological levels.Paper ContextMain findings: There was no reduction in experiences of intimate partner violence or increases in safety planning among Ghanaian pregnant women participating in a Group Antenatal Care session focused on healthy relationships and safety planning.Added knowledge: Group Antenatal Care has been identified as an effective modality for providing antenatal care and facilitating conversations about sensitive topics such as intimate partner violence and safety. However, this study highlights the importance of developing multifaceted approaches to decrease the risk of intimate partner violence among women, especially during the critical times of pregnancy and postpartum.Global health impact for policy and action: Effective global health action and policy must extend beyond educational efforts, incorporating multifaceted strategies that include healthcare provider training, robust community engagement, and legislation aimed at preventing intimate partner violence, with a special focus on safeguarding the well-being of women during pregnancy and the postpartum period.

Assessing the determinants of influenza and COVID-19 vaccine co-administration decisions in the elderly

This research examines the low rate of co-administration of influenza and COVID-19 vaccines among seniors aged 65 and older in Korea, despite recommendations from authorities and academia worldwide. The study aimed to understand the influence of general characteristics and health beliefs on the vaccination choices of seniors, who were categorized into four groups based on their vaccination status: influenza only, COVID-19 only, both, or neither. A total of 400 participants, aged 65 and above, were selected through proportional stratified random sampling from five major Korean regions for a survey conducted between November 24th and December 15th, 2023. The results indicated no significant differences in general characteristics across these groups. However, regarding the health beliefs showed significant differences in perceived susceptibility and self-efficacy between the influenza-only and co-administration groups. Higher levels of perceived susceptibility and self-efficacy were associated with choosing co-administration. Contrary to previous studies focusing on safety concerns as a primary factor in vaccine hesitancy, this study highlights the role of individual health-related beliefs, particularly perceived susceptibility and self-efficacy, as critical in influencing the decision for co-administration among the elderly in Korea.

Association between health literacy with stress, anxiety and depression in multiple sclerosis patients: A cross sectional analytical study

OBJECTIVE

Multiple sclerosis is one of the diseases of the central nervous system, which causes numerous physical and mental problems. Since stress, anxiety and depression are effective in various dimensions of chronic diseases management and considering that health literacy plays a decisive role in the quality of life of these patients. Therefore, this study was conducted with the aim of determining the association between health literacy and stress, anxiety and depression.

MATERIALS AND METHODS

The current research is a cross-sectional analytical study that was conducted with the participation of 164 patient's from the MS society of Jahrom city with convenience sampling. The data collection tool was the health literacy questionnaire of multiple sclerosis patients and a 21-question stress, anxiety and depression questionnaire. SPSS - 21 software, descriptive statistics and spearman and chi-square tests were used to analyze the data.

RESULTS

The findings showed that the majority of patients had a borderline health literacy (53.7%). 43.3% of patients had adequate level of health literacy. Also, the findings showed that the stress, anxiety and depression levels of the majority of patients were moderate. Spearman's test showed that there is a negative and significant correlation between health literacy and stress in multiple sclerosis patients (p=0.03) (r=-0.37). While there was no significant correlation between health literacy and anxiety and depression of patients.

CONCLUSION

The findings showed that with the increase in the health literacy, the rate of stress in patient's decreases.

Network analysis of smoking-related sleep characteristics in Chinese adults

The associations between multiple sleep characteristics and smoking behavior are inconsistent, and it is unclear which sleep characteristics are most crucial for tobacco prevention. This study aimed to explore the associations between smoking status/intensity and multiple sleep characteristics and to identify the potential core domain of smoking-related sleep using network analysis. Data were obtained from a survey of cancer-related risk factors among Chinese adults. Logistic regression models were used to quantify the associations between sleep characteristics and smoking status/intensity. Network analyses were employed to identify the core sleep characteristics. A total of 5,228 participants with a median age of 44 years old were included in the study. Current smoking was significantly positively associated with long nap time, difficulty falling asleep, late bedtime, getting up after 7 am, and waking up earlier than expected. There was significant positive association between current smoking and short sleep duration in young adults under 45 years old. Late bedtime and getting up after 7 am were only associated with current heavy smoking, but not current light smoking. Network analyses showed that multiple smoking-related sleep characteristics were interconnected, with difficulty falling asleep and late bedtime as central characteristics in the network. The study found that the associations between sleep characteristics and smoking varied by age and smoking intensity and highlights the potential benefits of sleep health promotion in smoking cessation, with a particular focus on difficulty falling asleep and late bedtime.

Health-care-seeking behaviour in patients with hypertension: experience from a dedicated hypertension centre in Bangladesh

Objective: The study aimed to assess health-seeking behaviour (HSB) and associated factors among hypertensive patients in Bangladesh.Methods: This cross-sectional study was conducted in the Hypertension & Research Centre, Rangpur, Bangladesh, between January 2022 and June 2022. A total of 497 hypertensive adults were recruited consecutively. A pre-tested structured questionnaire was deployed by the research team for data collection. Multivariable logistic regression analysis was used to explore the predictors of HSB.Results: The mean age of the hypertensive patients was 52 ± 11 (SD) years. Most of them were aged between 51 and 60 years (33%), female (55%), came from rural areas (57%), and belonged to middle socioeconomic class (68%). One-fourth of the patients (27%) had chosen informal healthcare providers for their first consultation. Fear of stroke (244, 45%), headache (170, 36%), and neck pain (81, 17%) were the three most common compelling causes of their visit to the hypertension centre. Age (aOR 0.78, 95% CI 0.68 - 0.89), male sex (aOR: 1.79, 95% CI 1.05 - 3.10), living in semi-urban (aOR 4.68, 95% CI 1.45 - 15.10) and rural area (aOR 1.68, 95% CI 1.01 - 2.80), farmers as occupation (aOR: 3.24, 95%CI: 1.31 - 8.06) and belonging to lower social economic class (aOR 4.24, 95% CI 1.68 - 10.69) were predictors of visiting informal providers of hypertensive patient. One-fourth of the hypertensive patients received consultation from informal healthcare providers.Conclusions: Raising awareness among patients and proper referral to specialised hypertension centres could promulgate the patients towards appropriate behaviour.

Association between sleep duration, depression and breast cancer in the United States: a national health and nutrition examination survey analysis 2009-2018

OBJECTIVE

Breast cancer is the most common cancer in women, threatening both physical and mental health. The epidemiological evidence for association between sleep duration, depression and breast cancer is inconsistent. The aim of this study was to determine the association between them and build machine-learning algorithms to predict breast cancer.

METHODS

A total of 1,789 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the study, and 263 breast cancer patients were identified. Sleep duration was collected using a standardized questionnaire, and the Nine-item Patient Health Questionnaire (PHQ-9) was used to assess depression. Logistic regression yielded multivariable-adjusted breast cancer odds ratios (OR) and 95% confidence intervals (CI) for sleep duration and depression. Then, six machine learning algorithms, including AdaBoost, random forest, Boost tree, artificial neural network, limit gradient enhancement and support vector machine, were used to predict the development of breast cancer and find out the best algorithm.

RESULTS

Body mass index (BMI), race and smoking were statistically different between breast cancer and non-breast cancer groups. Participants with depression were associated with breast cancer (OR = 1.99, 95%CI: 1.55-3.51). Compared with 7-9h of sleep, the ORs for <7 and >9 h of sleep were 1.25 (95% CI: 0.85-1.37) and 1.05 (95% CI: 0.95-1.15), respectively. The AdaBoost model outperformed other machine learning algorithms and predicted well for breast cancer, with an area under curve (AUC) of 0.84 (95%CI: 0.81-0.87).

CONCLUSIONS

No significant association was observed between sleep duration and breast cancer, and participants with depression were associated with an increased risk for breast cancer. This finding provides new clues into the relationship between breast cancer and depression and sleep duration, and provides potential evidence for subsequent studies of pathological mechanisms.

Rural residence and health-related quality of life in a sample of Spain perimenopausal women

BACKGROUND

The prevalence and severity of perimenopausal symptoms are typically associated with multiple factors, including demographic characteristics. The sociodemographic characteristics of women living in rural areas differ from those residing in urban areas, and it has been suggested that these differences could potentially influence the prevalence of symptoms experienced during perimenopause.

OBJECTIVES

To evaluate if perimenopausal women living in Spanish rural areas have a higher prevalence of perimenopausal symptoms and assess their influence on health-related quality of life.

METHODS

A cross-sectional study was conducted in a sample of 270 perimenopausal women residing in rural and urban areas. The participants completed the Cervantes Scale Short Version and Beck Depression Inventory 2.

RESULTS

Perimenopausal women in rural areas reported a higher incidence of perimenopausal symptoms and a lower perception of health-related quality of life compared to those in urban areas, as evidenced by higher scores on the total Cervantes Scale Short Version scale (33.2 (±16.2) vs. 26.4 (±18.1), p = .001). No differences in the Beck Depression Inventory 2 score were detected.

CONCLUSIONS

Perimenopausal women residing in rural areas of Spain reported a higher prevalence of perimenopausal symptoms and experienced a poorer Health-Related Quality of Life compared to those living in urban areas of Spain.

Evaluation of the current situation and quality of neonatal hearing screening from hearing screening practitioners' perspective: a cross-sectional study

BACKGROUND

In recent years, neonatal hearing screening (NHS) has gained rapid traction in both developed and developing nations. However, the efficacy of these efforts depends on comprehensive standardization across all screening facets. This study aimed to assess the status and quality of NHS by investigating the knowledge, attitudes, beliefs, and practices of hearing screening practitioners regarding NHS.

METHODS

A cross-sectional survey was conducted, and an online questionnaire based on the knowledge-attitude/belief (A/B)-practice model was distributed to all NHS practitioners in Luzhou, western China. Valid questionnaires were examined and uniformly graded.

RESULTS

A total of 63 valid questionnaires were collected. The practitioners were mainly female (96.83%), with nursing backgrounds (63.49%), and undergraduate degrees (66.67%). Most had ≤5 years of experience (74.60%) and had junior/intermediate titles (93.65%). The NHS within the Luzhou area started in 2006 with provincial institutions, expanding to 42 institutions by 2022. Statistically significant correlations were observed between the A/B score and the conducting years of each NHS institution (p < .05) as well as between the Knowledge (K) and Practice (P) scores (p < .01). No significant correlation was found between the K score, P score, A/B score, and working years of practitioners (p > .05), or in the total score of NHS institutions at different levels or in different counties by one-way ANOVA (p > .05).

CONCLUSIONS

It has been 17 years since the first medical institution in Luzhou launched NHS, and the overall performance of practitioners from different institutions has been consistent in terms of their knowledge, attitudes, or level of practice. However, there is room for further improvement in both the professional development of individuals and aspects related to work, such as health education and long-term follow-up.

Patients' and caregivers' perspectives of the atopic dermatitis journey

BACKGROUND

Understanding the patient journey is important to optimize care for patients with atopic dermatitis (AD) and overcome challenges in diagnosis and management.

OBJECTIVE

To explore patient and caregiver perspectives regarding their experience with AD.

METHODS

Patients and caregivers of patients with AD completed a pre-meeting survey and were invited to join an advisory board meeting in their country (China, Hong Kong, Ireland, Japan and Lebanon) to discuss the survey results. Data were analyzed descriptively.

RESULTS

The survey included 31 participants (patients and caregivers) from Hong Kong (n = 7), China (n = 7), Ireland (n = 6), Japan (n = 6) and Lebanon (n = 5). The most challenging factors in the AD journey were management of symptoms before a confirmed diagnosis (68%), sudden recurrence of flares or worsening of symptoms (68%) and lifestyle changes (52%). In terms of overall AD management, 35% of participants indicated that AD was managed well, 23% had a clear treatment plan and 19% were generally satisfied with disease management. A collaborative relationship with healthcare professionals was favored.

CONCLUSION

A holistic assessment of AD includes understanding patient and caregiver preferences, needs, experiences and disease perceptions. Addressing the identified gaps may improve the management of AD.

The effect of the COVID-19 pandemic on the mental health of obstetrics and gynaecology trainees: a world-wide literature review

BACKGROUND

Coronavirus (COVID-19) pandemic has affected the training and wellbeing of obstetrics and gynaecology (O&G) trainees. The aim of this review is to offer a worldwide overview on its' impact on the mental health of O&G trainees, so that measures can be put into place to better support trainees during the transition back to the 'new normal'.

METHODS

Key search terms used on PubMed and Google Scholar databases include: mental health, COVID-19, O&G, trainees, residents.

RESULTS

Fifteen articles (cumulative number of respondents = 3230) were identified, of which eight employed validated questionnaires (n = 1807 respondents), while non-validated questionnaires were used in seven (n = 1423 respondents). Studies showed that COVID-19 appeared to exert more of a negative impact on females and on senior trainees' mental health, while protective factors included marriage/partner and having had children. Validated and non-validated questionnaires suggested that trainees were exposed to high levels of anxiety and depression. Their mental health was also affected by insomnia, stress, burnout and fear of passing on the virus.

DISCUSSION

This review analyses the global impact of COVID-19 on O&G trainees' mental health, showing a pervasive negative effect linked to fear of the virus. Limited psychological support has led to prolonged issues, hindering patient safety and increasing sick leave. The study underscores the urgency of comprehensive support, particularly in female-dominated fields. Addressing these challenges is crucial for future pandemics, highlighting the need to learn from past mistakes and prioritise mental health resources for trainee well-being during and beyond pandemics.

Sexual function and pelvic floor function in men with systemic sclerosis compared to healthy controls: a cross-sectional study

OBJECTIVES

This cross-sectional study aimed to compare the sexual function (SF) and pelvic floor function of men with systemic sclerosis (SSc) with age-matched healthy controls (HC) and to identify the implications of clinical features on SF.

MATERIAL AND METHOD

Twenty SSc males and 20 HC aged 18-70 years completed eleven questionnaires assessing SF [International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire (MSHQ)]; sexual quality of life: Sexual Quality of Life Questionnaire-Male (SQoL-M); pelvic floor function: Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), fatigue, depression, physical fitness, functional disability, and quality of life. Clinical data were collected.

RESULTS

Significantly worse SF was observed in patients (median IIEF erectile function 12 in SSc versus 29 in HC, p < 0.001), with 70% reporting erectile dysfunction (ED) compared to 15% in HC. However, no significant difference was observed regarding pelvic floor function (median PFIQ7 8.8 in SSc versus 7.0 in HC, p = 0.141). Impaired SF was associated with higher disease activity, increased systemic inflammation, more pronounced fatigue, reduced physical fitness, severe depression, impaired overall quality of life, dyspepsia, and arthralgias (p < 0.05 for all).

CONCLUSIONS

Sexual dysfunction is highly prevalent in our SSc patients, whereas pelvic floor dysfunction is unlikely to be associated with these problems.

Prevalence and knowledge of polycystic ovary syndrome (PCOS) and health-related practices among women of Syria: a cross-sectional study

Polycystic Ovarian Syndrome (PCOS) is a prevalent metabolic and hormonal disorder affecting women of reproductive age. Limited data exists on Syrian women's PCOS awareness and health behaviors. This study aimed to gauge PCOS prevalence, knowledge, awareness, and health-related practices among Syrian women. A cross-sectional online survey was conducted from 11 February to 27 October 2022, targeting Syrian women aged 18-45. Collaborators from specific medical universities distributed a questionnaire adapted from a Malaysian paper through social media platforms. Out of 1840 surveyed Syrian women, 64.2% were aged 21-29, and 69.6% held bachelor's degrees. Those with a bachelor's degree exhibited the highest mean knowledge score (12.86), and women previously diagnosed with PCOS had a higher mean knowledge score (13.74) than those without. Approximately 27.4% were confirmed PCOS cases, and 38.9% had possible cases. Women with PCOS were 3.41 times more likely to possess knowledge about the condition. The findings suggest a moderate level of PCOS knowledge and health-related practices among Syrian women, emphasizing the need for increased awareness. Consistent local PCOS screening programs, in collaboration with obstetrics and gynecology professionals, are crucial for improving understanding and clinical symptom recognition of this condition among Syrian women.

The prevalence of functional dyspepsia using Rome IV questionnaire among chronic kidney disease patients

Background: Symptoms of dyspepsia are usually encountered by chronic kidney disease patients. Abdominal discomfort is commonly seen in CKD patients with no other causes of organic affection. Aim: to determine the prevalence of functional dyspepsia in CKD patients, and which subtype is predominant in them. Materials and patients: This observational study included 150 CKD patients. Clinical and laboratory data were recorded for every patient. All the patients were interviewed using the ROME IV questionnaire of functional dyspepsia. Patients fulfilling criteria for functional dyspepsia were exposed to upper GI endoscopy. Results: Overall, 73 (48.7%) of CKD patients were males and 77 (51.3%) were females with mean age of (45.71 ± 9.59) and mean BMI (26.58 ± 5.39). The frequency of functional dyspepsia among CKD patients was determined to be 14.7% (22 out of 150 patients). Among those affected by functional dyspepsia, the most prevalent subtype was found to be Epigastric Pain Syndrome (EPS), accounting for 59% (13 out of 22 cases). The most common predictor of FD in CKD patients was chronic HCV infection, hemodialysis, stage of CKD and eGFR as revealed by Univariate regression analysis. Conclusion: The prevalence of FD amongst CKD patients is 14.7% with EPS the predominant subtype. Male patients, HCV patients, patients with higher CKD stages and highly impaired eGFR (low eGFR) are more probable to have FD.

Patient preferences for treatment attributes in moderate-to-severe atopic dermatitis: a discrete choice experiment

Purpose: Evidence on treatment preferences of patients with moderate-to-severe atopic dermatitis (AD) in the United States (US) is limited and an assessment of treatment preferences in this group is warranted.Materials and methods: An online discrete choice experiment survey was conducted (June 2023) among US adults with self-reported moderate-to-severe AD or experience with systemic therapy who had inadequate response to topical treatments. Preference weights estimated from conditional logistic regression models were used to calculate willingness to trade off and attributes' relative importance (RI).Results: Participants (N = 300; mean age: 45 years; 70% females; 52% systemic therapy experienced) preferred treatments with higher efficacy, lower risk of adverse events (AEs), and less frequent blood tests (p < .05). Treatment attributes, from high to low RI, were itch control (38%), risk of cancer (23%), risk of respiratory infections (18%), risk of heart problems (11%), sustained improvement in skin appearance (5%), blood test frequency (3%), and frequency and mode of administration (2%); together, AE attributes accounted for more than half of the RI.Conclusions: Participants preferred AD treatments that maximize itch control while minimizing AE risks, whereas mode of administration had little impact on preferences. Understanding patients' preferences may help improve shared decision-making, potentially leading to enhanced patient satisfaction with treatment, increased engagement, and better clinical outcomes.

Assessment of the knowledge and attitudes of the Iranian medical faculty toward plagiarism

This study is among the few investigations that assesses knowledge and attitudes of faculty members of medical sciences universities regarding plagiarism. This investigation focused on the relationship between personal factors and knowledge and attitudes toward plagiarism among Iranian faculty members of medical sciences affiliated with the Ministry of Health. This descriptive cross-sectional study was performed on 247 participants using demographic questionnaires that collected data on attitudes toward plagiarism and knowledge of plagiarism. The questionnaires were uploaded on Porsline. The subjects were provided with the purpose of the study, informed consent, and the link to the questionnaire through WhatsApp. The mean scores of knowledge variables and different domains of attitude were calculated, and then, the obtained averages were compared in terms of age, gender, and participation in ethics workshop using univariate tests. Finally, the MANCOVA was used considering five dimensions of the questionnaire to assess attitude, as multiple response variables, and independent variables, including gender and participation in the ethics workshop and control of knowledge and age. The mean age of the subjects in this study was 38.9 ± 8.4. 79.4% of the participants were women. Overall, 79.8% of people participated in ethics workshops, of whom 78% were women, and 86.5% were men. The mean score of knowledge in men and women was 1.35 ± 0.19 and 1.56. ± 0.24, respectively, which was higher in women than men (PV <0.001). The mean score of total attitudes was 3.19 ± 0.46. There was a high level of knowledge of plagiarism and positive attitudes toward plagiarism avoidance or prevention among participants in this study, which may spread to students, and help to promote integrity in the educational and clinical environment in Iran.

Menopausal symptoms and the awareness of menopausal-related information in low-income mid-aged women from Guayaquil, Ecuador

OBJECTIVE

To assess menopausal symptoms and determine awareness of menopausal related information in mid-aged women.

METHODS

This was a cross-sectional study in which 140 women aged 40 to 60 years from Guayaquil, Ecuador were surveyed with the short 10-item Cervantes Scale (CS-10) and a questionnaire containing personal data and questions assessing awareness of menopause related information.

RESULTS

The mean age of the sample was 48.0 ± 5.6 years. More than half of surveyed women had low education and non-urban residency, none were on menopausal hormone therapy, 33.6% had hypertension, 35% were postmenopausal, 78.6% had an increased body mass index (overweight/obese) and 92.9% had abdominal obesity (waist > 88 cm). The average CS-10 score was 15.3 ± 9.0 with a median of 14.0. The three most frequent menopausal symptoms were muscle-joint pain (75.0%), changes in skin texture (74.3%) and vaginal dryness (71.4%). Regarding awareness of information related to the menopause, it was found that 98.6% of women had no idea about what the menopause is and the average age of its onset. Interestingly, although 61.4% knew that during the menopause there is weight gain, 57.9% were sedentary. Married, postmenopausal, older and less educated women presented higher mean total CS-10 scores. Contrarily, those with less awareness of menopause related information present lower scores.

CONCLUSION

In this low-income mid-aged female sample there was a high rate of non-awareness regarding information related to the menopause, including an unhealthy cardiometabolic profile. There is a need for educational programs aimed to increase awareness in this high-risk population in relation to the surveyed aspects in order to improve their health status and prevent chronic conditions.

Co-creation of injury prevention measures for competitive adolescent distance runners: knowledge, behavior, and needs of athletes and coaches enrolled on England Athletics' Youth Talent Programme

This study assessed the knowledge, behavior, and needs of competitive adolescent (16-18 years) distance runners and distance running coaches enrolled as part of England Athletics' Youth Talent Programme in relation to the prevention of running-related injury (RRI). Two online surveys were developed and distributed to the distance runners (survey one) and coaches (survey two). Both surveys included sections related to: (1) current knowledge; (2) current behavior; (3) need and support for RRI prevention measures; and (4) possible content and form of RRI prevention measures. A total of 39 distance runners (36% of total possible sample) completed survey 1, and 29 coaches (32% of total possible sample) completed survey 2. Key findings included that the majority of distance runners and coaches: (1) agreed that it is 'very important' to try to prevent RRI; (2) are currently implementing something in practice (e.g., strength training) to prevent RRI; and (3) view the creation of RRI prevention measures as an important initiative. Differences between distance runners and coaches were identified in relation to their understanding of the most common causes of RRI. Interestingly, distance runners identified a modifiable cause of RRI (i.e., too much training) as the most common cause of RRI, while coaches selected a non-modifiable cause of RRI (i.e., growth and maturation). These key findings were supplemented by competitive adolescent runners and distance running coaches detailing their delivery preferences for such RRI prevention measures. Results from this study will help inform subsequent steps of the larger co-creation process, with an emphasis on developing multifaceted and context-specific RRI prevention measures that are deemed to be feasible and acceptable for real-world implementation.

Strategies to mitigate moral distress as reported by eldercare professionals

Eldercare workers experience higher levels of moral distress than other health and social care service workers. Moral distress is a psychological response to a morally challenging event. Very little is known about moral distress in the context of eldercare and about the mechanisms of preventing or mitigating moral distress. This qualitative study was conducted as part of the "Ensuring the availability of staff and the attractiveness of the sector in eldercareservices" project in Finland in 2021. The data were from 39 semi-structured interviews. This qualitative interview data were examined using two-stage content analysis. The key finding of this study, as reported by eldercare professionals, is that strategies to mitigate moral distress can be found at all organizational levels : organizational, workplace and individual. The tools that emerged from the interviews fell into four main categories:) organizational support and education 2) peer support 3) improving self-care and competence and 4) defending patients. The main identified categories confirmed the earlier findings but the qualitative, rich research interview data provided new insights into a little-studied topic: mitigating moral distress in eldercare. The main conclusion is that, in order to mitigate moral distress, ethical competence needs to be strengthened at all organizational levels.

Real world insights for psoriasis: the association of severity of skin lesions with work productivity, medical consumption costs and quality of life

BACKGROUND

Psoriasis is a prevalent, chronic skin disease with a potential impact on work productivity, medical consumption costs, and quality of life. The influence of the extent of skin lesions on these outcomes is not well known.

OBJECTIVE

We determined associations of self-reported skin lesions with self-reported work productivity, medical consumption costs, and health-related quality of life in respondents with psoriasis.

METHODS

In this cross-sectional study, we included respondents with self-reported psoriasis in the Netherlands in an online questionnaire. We assessed the self-reported percentage body surface area (BSA) of psoriasis lesions. We used validated instruments to assess work productivity (WPAI-PsO), medical consumption costs (iMCQ), and health-related quality of life (EQ-5D-5L and the DLQI). We used ordinal logistic regression to associate BSA categories >1% versus 0-1% with outcomes adjusted for multiple confounders.

RESULTS

We included 501 respondents with a mean age of 43 ± 12 years; 64% were men. Median BSA was 2% (interquartile range 1-5%). A higher BSA was associated with higher overall work impairment due to psoriasis (common odds ratio [cOR] 2.44, 95% confidence interval [CI] 1.40-4.29; n = 205), higher medical consumption costs (cOR 2.06, 95% CI 1.45-2.94) and lower health-related quality of life. Associations were strongest with a BSA cutoff of 0% or 1% compared to 2% or higher categories.

DISCUSSION

In our study, having few to no lesions in psoriasis was associated with lower overall work impairment due to psoriasis, lower medical consumption costs, and higher health-related quality of life.

Survey of general practitioners' awareness, practice and perception of social prescribing across Europe

BACKGROUND

Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, and perception of SP among GPs across Europe remains unclear.

OBJECTIVES

To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region.

METHODS

An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions.

RESULTS

Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries.

CONCLUSION

Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.

Daylight quality: high-transmittance glass versus low transmittance glass - effects on daylight quality, health, comfort and energy consumption

Introduction: This study investigated the health effects of two different architectural glass types: A two-layered low-iron high transmittance glass and a three-layered low energy glass with lower transmittance. The study investigated how these glass types affected daylight conditions in 72 residential apartments, as well as health and satisfaction of the residents.Methods: The study installed high transmittance glass (light transmittance LT:0.82) in 36 apartments and low transmittance (LT:0.74) in 36 identical apartments. The study then analyzed the light transmittance of each glass type in the laboratory and analyzed the indoor environmental quality (IEQ) in eight representative apartments before and after renovation. Self-reported questionnaires were handed out and collected before and after renovation.Results: The results showed that the glass types differed significantly in measured daylight transmittance. The two-layered high transmittance glass transmitted 15% more visual light (380-750 nm) and 20% more light in the spectral range (460-480 nm), stimulating ipRGCs and circadian rhythm, when compared to three-layered low energy glass. In addition, significant differences were observed in the UV-B spectrum (280-315 nm). While two-layered high transmittance glass transmitted UV-B, three-layered low transmittance glass did not. During the 12-month study period, residents in apartments with three-layered low energy glass reported more difficulties sleeping (p = 0.05), higher satisfaction with daylight (p = 0.03) and higher satisfaction with ventilation (p = 0.04). Residents in apartments with three-layered low energy glass experienced fewer days with too cold indoor temperatures (p = 0.02), compared to residents with two-layered low-iron glass. The results of energy consumption for heating showed that two-layered low-iron glass reduced the energy consumption by 11.0%, while three-layered low energy glass reduced the energy consumption by 9.4%, compared to the year prior to renovation.Conclusion: The results contribute to a discussion about potential energy savings on one hand and potential non-energy benefits, such as daylight quality, overall health, and total economy/life cycle assessment of the built environment on the other hand. The results suggest further research performed in randomized large-scale studies.

Real-life clinical practice in Spain in the setting of new drug availability for ITP treatment. A Delphi-based Spanish expert panel consensus

Immune thrombocytopenia (ITP) is a common autoimmune hematological disorder. Despite this, diagnosis is still challenging due to clinical heterogeneity and the lack of a specific diagnostic test. New findings in the pathology and the availability of new drugs have led to the development of different guidelines worldwide. In the present study, the Delphi methodology has been used to get a consensus on the management of adult patients with ITP in Spain and to help in decision-making. The Delphi questionnaire has been designed by a scientific ad hoc committee and has been divided into 13 topics, with a total of 127 items, covering the maximum possible scenarios for the management of ITP. As a result of the study, a total consensus of 81% has been reached. It is concluded that this Delphi consensus provides practical recommendations on topics related to diagnosis and management of ITP patients to help doctors to improve outcomes. Some aspects remain unclear, without consensus among the experts. Thus, more advances are needed to optimize ITP management.

Health-related quality of life in patients with generalized pustular psoriasis - a Swedish register study

BACKGROUND

Real-world data on health-related quality of life (HRQoL) in generalized pustular psoriasis (GPP) are scarce and studies have been restricted in terms of instruments used for assessments.

OBJECTIVE

To assess generic and dermatology-specific HRQoL of patients with GPP compared with patients with plaque psoriasis using real-world data from the Swedish National Register for Systemic Treatment of Psoriasis.

METHODS

Cross-sectional data from 2006 to 2021 including 7041 individuals with plaque psoriasis without GPP and 80 patients with GPP, of which 19% also had plaque psoriasis. Total scores for the EuroQol-5 Dimensions (EQ-5D) and Dermatology Life Quality Index (DLQI), as well as degree of severity within the instruments' dimensions/questions, were compared between patient groups.

RESULTS

EQ-5D scores were significantly (p < .01) lower (worse) in patients with GPP (mean [standard deviation (SD)] 0.613 [0.346]) vs. patients with plaque psoriasis (mean [SD] 0.715 [0.274]), indicating lower generic HRQoL of patients with GPP. Significantly (p < .01) higher (worse) total DLQI scores were observed for patients with GPP (mean [SD] 10.6 [8.9]) compared with patients with plaque psoriasis (mean [SD] 7.7 [7.1]), with proportionally more patients with GPP having severe (20% vs. 16%) and very severe (17% vs. 8%) problems. The worsened scores for GPP vs. plaque psoriasis were consistent across EQ-5D dimensions and DLQI questions.

CONCLUSIONS

Individuals with GPP have a considerable impairment in both generic and dermatology-specific HRQoL. The HRQoL was significantly worse in individuals with GPP compared to individuals with plaque psoriasis. The significant HRQoL impairment of GPP shows the potential value of better healthcare interventions for this multisystem disease.

A cluster analysis of reasons behind fear of birth among women in Sweden

BACKGROUND

Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth.

METHODS

A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women's background variables.

RESULTS

A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping.

CONCLUSIONS

Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.

Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician-gynecologists

OBJECTIVE

While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN).

METHODS

A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models.

RESULTS

The survey was distributed to 556 anesthesiology and 662 obstetrics-gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician-gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001).

CONCLUSIONS

ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

How I maximised my training during the COVID-19 pandemic

The COVID-19 pandemic was declared in March 2020 and London maternity units were among the first in the United Kingdom to report maternal infection and vertical transmission. To manage resources, over half of all Obstetrics and Gynaecology trainees were redeployed to support front-line specialities such as Core Medicine and Accident and Emergency. The vignettes in this article illustrate how three trainees maximised their limited training opportunities in the face of exceptional disruption, lack of surgical training opportunities and workload pressures.

Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies

Introduction. Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary; however, the final decision of which medication to administer to a patient is made independently by paramedics. This study sought to describe the clinical decision-making process of prehospital behavioral emergencies when paramedics consider chemical restraints, and determine the factors associated with choosing specific medications to administer. Methods. Paramedics from a Midwest County in the United States were surveyed in November of 2019. The survey consisted of two open-ended questions, measuring paramedics' clinical decision-making process and factors that they considered when selecting a medication. An immersion-crystallization approach was used to analyze the interviews. Results. There was a 53% (79/149) response rate. Six themes emerged regarding the paramedics' decisions to use medication for cases involving patients with behavioral emergencies: safety of the patients and paramedics; inability to use calming techniques; severity of the behavioral emergency; inability to assess the patient due to presentation; etiology of the behavioral episode; and other factors, such as age, size, and weight of the patient. Six themes emerged regarding factors paramedics considered when choosing which medication to use in behavioral emergencies: etiology of the behavioral emergency, patient presentation, the patient's history, the patient's age, desired effect and intended outcome of the medication, and other factors. Conclusion. This study suggests there are several factors, such as safety and the etiology of the behavioral emergency, that contributed to paramedics' decision-making. The results of this study could help Emergency Medical Services administrators in revising behavioral emergency protocols.

Development and Validation of the Self-efficacy Questionnaire in multiple sclerosis patients

OBJECTIVE

Self-efficacy is one of the factors affecting on the quality of life and adjustment to the chronic diseases such as multiple sclerosis. Self-efficacy is the individual's belief that they have the ability to overcome challenges presented to them. The current study aimed to develop and validate of selfefficacy questionnaire in Iranian MS patients.

MATERIALS AND METHODS

This is a methodological study that was performed in three phases. In the first phase, the concept of self-efficacy was defined through qualitative content analysis approach. In the second phase, early items of questionnaire was generated according to findings of the first phase. In the final phase, validation of the developed questionnaire were evaluated using face, content and construct validity as well as reliability.

RESULTS

In exploratory factor analysis, four subscales including: adherence to medication regimens (5 items), social performance control (4 items), symptom management (4 items) and maintain independence and activity (5 items) were extracted by Eigen value above one and factor load above 0.3. Internal consistency and stability of the developed questionnaire confirmed with 0.91 and 0.88 respectively that indicated acceptable reliability.

CONCLUSIONS

The 18-item developed questionnaire is valid and reliable for measurement of self-efficacy of Iranian MS patients.

E-cigarette use reasons and associated e-cigarette use dependence among college students: A longitudinal examination

OBJECTIVE

Previous studies have established an understanding of reasons for e-cigarette use and associated e-cigarette use patterns such as use frequency, yet the critical extension to associated e-cigarette dependence outcome remains under-researched. This study used longitudinal data to examine whether the reasons for e-cigarette use predict a higher/lower level of e-cigarette dependence.

METHODS

This study recruited college students who were current e-cigarette users from Fall 2019 to Fall 2020 (four semesters) at three public universities in the Midwest and South of the U.S. Those who participated for at least two semesters were included (N = 366). Data were collected using a structured questionnaire. E-cigarette use dependence was assessed using the Penn State Electronic Cigarette Dependence Index. A linear mixed model with a random intercept and a random slope was conducted to examine the longitudinal association between reasons for e-cigarette use and dependence, controlling for demographics and other covariates.

RESULTS

Participants who used e-cigarettes for relaxation (β = 0.63, p < 0.05) and due to their good taste (β = 0.63, p < 0.05) had a higher level of e-cigarette dependence. Participants using e-cigarettes for experimental purposes had a lower level of e-cigarette dependence (β = -1.21, p < 0.01).

CONCLUSIONS

These findings highlight the importance of addressing e-cigarette use reasons and their relationship to e-cigarette dependence. Prevention and intervention efforts aimed at developing more effective strategies should consider the various e-cigarette use reasons associated with dependence risks, such as enhancing awareness of the use dependence risk related to good taste of e-cigarettes and use for relaxation, as well as incorporating early screenings for use.

Heterogeneity in the co-occurrence of depression and anxiety among adolescents: Results of latent profile analysis

BACKGROUND

Depression and anxiety co-occur frequently and there is heterogeneity in the co-occurrence of such symptoms; however, few previous studies investigated the heterogeneity based on person-centered perspectives in adolescents. The primary aim of our study was to explore it using latent profile analysis (LPA), a person-centered statistical approach.

METHOD

The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to examine depression and anxiety symptoms in 7422 Chinese adolescents from 23 primary and secondary schools. To investigate latent profiles and assess profile validity, we employed Latent Profile Analysis (LPA), multinomial logistic regression, and analysis of variance.

RESULTS

A three-profile model was suggested as the optimum: low (69.9 %), moderate (21.6 %), and high depression/anxiety (8.5 %). Female with higher negative cognitive bias and higher emotional regulation difficulty are more likely to be categorized in the high depression/anxiety group. Internet addiction, academic "Lying flat" and involution are significantly and positively linked with the severity of anxiety and depression.

LIMITATIONS

Reliance on self-reported measures may lead to response bias; the cross-sectional design limits our ability to study how symptom profiles and category membership change over time.

CONCLUSIONS

Three latent profiles of the co-occurrence of depression and anxiety presented a parallel pattern, which serves as a poignant reminder of the imperative need to identify Chinese adolescents who may be at elevated risk for depression and/or anxiety, and promoting intervention that are meticulously tailored to address the unique symptom presentations of each individual.