Efficacy of Donated Milk in Early Nutrition of Preterm Infants: A Meta-Analysis

Background: Preterm birth is associated with an increased risk of many complications, which is a main public health problem worldwide with social and economic consequences. Human milk from breast feeding has been proved to be the optimal nutrition strategy for preterm infants when available. However, the lack of human milk from mothers makes formula widely used in clinical practice. In recent years, donated breast milk has gained popularity as an alternative choice which can provide human milk oligosaccharides and other bioactive substances. Objective: We aimed to conduct a systematic review and meta-analysis to evaluate the nutritional effects of donated breast milk on preterm infants compared with formula. Method: In the present study, we searched Medline, Web of Science, Embase, clinicaltrials.gov, the China national knowledge infrastructure, and the Cochrane central register of controlled trials for candidate randomized controlled trials (RCTs). Results: A total of 1390 patients were enrolled in 11 RCTs and meta-analysis results showed that donated breast milk is also more advantageous in reducing the incidence of necrotizing enterocolitis (NEC, RR = 0.67, 95% CI = 0.48 to 0.93, p = 0.02), reducing the duration of parenteral nutrition (MD = −2.39, 95% CI = −3.66 to −1.13, p = 0.0002) and the time of full enteral feeding (MD = −0.33, 95% CI = −3.23 to 2.57, p = 0.0002). In comparison, formula significantly promotes the growth of premature infants, including their weight gain (MD = −3.45, 95% CI = −3.68 to −3.21, p < 0.00001), head growth (MD = −0.07, 95% CI = −0.08 to −0.06, p < 0.00001) and body length (MD = −0.13, 95% CI = −0.15 to −0.11, p < 0.00001), and reduces the time it takes for premature infants to regain birth weight (MD = 6.60, 95% CI = 6.11 to 7.08, p < 0.00001. Conclusion: Compared with formula, donated breast milk could significantly reduce the incidence of NEC, the duration of parenteral nutrition, and the time of full enteral feeding. Adding fortifiers in donated milk could make it as effective as formula in promoting the physical growth of premature infants.

A Novel Volume-based Cone-beam Computed Tomographic Periapical Index

INTRODUCTION

The purpose of this study was to evaluate the variations in the volume of periapical lesions scored using a cone-beam computed tomographic periapical index (CBCTPAI) and to develop a new volume-based periapical index.

METHODS

Cone-beam computed tomographic images were obtained from InteleViewer (Intelerad Medical Systems Incorporated, Montreal, Canada). Teeth with a periapical radiolucency or with a history of endodontic treatment were included in this study. Using 3-dimensional medical imaging processing software (Mimics Research; Materialise NV, Leuven, Belgium), the maximum diameter of 273 periapical lesions and their corresponding CBCTPAI score was determined. The software was then used to determine the volume of the lesions using a semiautomatic segmentation technique.

RESULTS

There was a substantial variation in the volume for CBCTPAI scores 3, 4, and 5, which was demonstrated by the variance and range, thus making it difficult to use the current CBCTPAI as a method to predict volume and treatment outcomes. A new index, the cone-beam computed tomographic periapical volume index (CBCTPAVI), was developed using partition classification analysis. The results for the new index demonstrated high levels of sensitivity, specificity, precision, and area under the curve, all at 0.90 or more, except 1 sensitivity for CBCTPAVI 1 at 0.875. Overall, the accurate classification rate was 98.169%, and the root mean square error rate was low at 0.07.

CONCLUSIONS

The proposed CBCTPAVI will allow clinicians to classify lesions based on their true 3-dimensional size, accurately assess healing of lesions, and predict treatment outcomes.

Obsessive-compulsive symptoms in a normative Chinese sample of youth: prevalence, symptom dimensions, and factor structure of the Leyton Obsessional Inventory--Child Version

BACKGROUND

Chinese adolescents face life stresses from multiple sources, with higher levels of stress predictive of adolescent mental health outcomes, including in the area of obsessive-compulsive disorders (OCD). Valid assessment of OCD among this age group is therefore a critical need in China. This study aims to standardise the Chinese version of the Leyton short version scale for adolescents of secondary schools in order to assess this condition.

METHODS

Stratified randomly selected adolescents were selected from four high schools located in Beijing, China. The Chinese version of the Leyton scale was administered to 3221 secondary school students aged between 12 and 18 years. A high response rate was achieved, with 3185 adolescents responding to the survey (98.5 percent). Exploratory factor analysis (EFA) extracted four factors from the scale: compulsive thoughts, concerns of cleanliness, lucky number, repetitiveness and repeated checking. The four-factor structures were confirmed using Confirmatory Factor Analysis (CFA).

RESULTS

Overall the four-factor structure had a good model fit and high levels of reliability for each individual dimension and reasonable content validity. Invariance analyses in unconstrained, factor loading, and error variance models demonstrated that the Leyton scale is invariant in relation to the presence or absence OCD, age and gender. Discriminant validity analysis demonstrated that the four-factor structure scale also had excellent ability to differentiate between OCD and non-OCD students, male and female students, and age groups.

LIMITATIONS

The dataset was a non-clinical sample of high school students, rather than a sample of individuals with OCD. Future research may examine symptom structure in clinical populations to assess whether this structure fits into both clinical and community population.

CONCLUSIONS

The structure derived from the Leyton short version scale in a non-clinical secondary school sample of adolescents, suggests that a four-factor solution can be utilised as a screening tool to assess adolescents׳ psychopathological symptoms in the area of OCD in mainland Chinese non-clinical secondary school students.

Dietary Patterns, Nutrition Knowledge, Lifestyle, and Health-Related Quality of Life: Associations with Anti-Hypertension Medication Adherence in a Sample of Australian Adults

INTRODUCTION

Poor anti-hypertension medication (AHT) adherence can increase disease costs and adverse outcomes. Hypertensive individuals who have a better nutrition knowledge may lead a healthier lifestyle, have a better health-related quality of life (HRQoL) and greater confidence to change behaviour. On this basis, they may have better treatment adherence.

AIM

To explore the association between the above-mentioned variables and AHT adherence in a group of Australian adults with high blood pressure (BP) in a cross-sectional clinical and community-based study.

METHODS

Adults with high BP (n = 270) completed a questionnaire including: food frequency questionnaire (FFQ), nutrition knowledge, HRQoL, self-efficacy of diet and exercise, lifestyle and AHT adherence sections. Bivariate analysis and hierarchical logistic regression were used to explore the data.

RESULTS

Three dietary patterns were identified from the FFQ, using factor and cluster analyses (Western, Snack and Alcohol, and Balanced). We observed that following a Western dietary pattern, having lower exercise self-efficacy and shorter sleep duration were more dominant in the poor AHT adherence individuals compared to their counterparts. A positive association was observed between self-efficacy and sleep duration with AHT adherence. A Western dietary pattern was prevalent in high BP participants which slightly reduced the likelihood of good adherence.

CONCLUSION

A healthier dietary pattern, better exercise self-efficacy and adequate sleep (more than six hours a night) may increase the likelihood of AHT adherence in individuals with high BP. Interventions focusing on improving these variables are required to confirm the findings of this study.

Dysbiosis of the Gut Microbiota and Kynurenine (Kyn) Pathway Activity as Potential Biomarkers in Patients with Major Depressive Disorder

With increasing attention paid to the concept of the microbiota-gut-brain axis, mounting evidence reveals that the gut microbiota is involved in a variety of neurological and psychiatric diseases. However, gut microbiota changes in major depressive disorder (MDD) patients and their association with disease mechanisms remain undefined. Fifty MDD patients and sixty healthy controls were recruited from the Shanghai Healthy Mental Center, China. Fecal samples were collected, and the compositional characteristics of the intestinal flora were determined in MDD patients by MiSeq sequencing. Venous blood was collected for the detection of plasma indoleamine-2,3-dioxygenase (Ido), kynurenine (Kyn) and tryptophan (Trp) levels. Stool samples of bacterial 16S sequencing was carried out. A total of 2,705,809 optimized sequences were obtained, with an average of 54,116 per sample. More unique OTUs were observed at the family, genus and species levels in the control group compared with the MDD cases. Further analysis showed significant changes in the α- and β-diversities and relative abundance levels of gut microbial entities in MDD patients, as well as elevated amounts of Ido and Kyn indicating Kyn pathway activation, KEGG bacterial 16S function prediction analysis shows a variety of amino acids and metabolic (including Ido, Trp and Kyn) changes in the body of patients with MDD. These may result in increased neurotoxic metabolites and reduced generation of serotonin in the disease process. These changed factors may potentially be utilized as biomarkers for MDD in the future, playing more important roles in the disease course.

Antigen specific vaccine hesitancy in pregnancy

BACKGROUND

Vaccinations in pregnancy are recommended for the potential benefits of preventing severe pertussis disease in newborns and for preventing the impact of influenza on the pregnant woman, her foetus in utero and, the newborn in the first six months of life. Published data in Australia suggested that coverage rates were sub-optimal so the reasons for this were reviewed.

METHODS

A cross-sectional survey of 1014 postnatal women, aged 18 years and older, who had given birth in the previous six months was undertaken on the Gold Coast in Queensland, Australia. Participants completed a brief questionnaire on provided smart tablets at public vaccination clinics or with a researcher by phone or via an on-line link.

RESULTS

Just over 85% of survey respondents received a pertussis booster with many of those not receiving vaccine having had it in a recent pregnancy. Only 36.7% of respondents had an influenza vaccine in pregnancy with key barriers being belief in influenza vaccine, seasonality of parturition and a lack of recommendation from the attending obstetric carers.

DISCUSSION

While maternal pertussis vaccine programs are a success, work needs to be done to improve the public perception of the risk benefit equation surrounding influenza vaccine in general, and particularly its use in pregnancy. Research is required into approaches to altering practitioner attitudes as well as how to alter public perceptions.

Short-term body weight fluctuations in older well-hydrated hospitalised patients

BACKGROUND

The usual daily weight fluctuations of well-hydrated older hospitalised people have not been documented internationally. To date, dehydration assessments based on a short-term body weight change defined as >2% have been drawn from healthy population data. The present pilot study aimed to describe usual body weight fluctuation at the same time of day over a 3-day time frame in well-hydrated older hospitalised adults.

METHODS

An observational study of non-acute inpatients (n = 10) admitted to a Geriatric and Rehabilitation Unit, aged ≥60 years, assessed as well-hydrated, mobile, non-amputee and without conditions that influenced fluid status, was conducted. Participants were weighed hourly over a 9-h period for 3 days. Food and fluid intake, clothing items added or removed, and urine and faecal output were recorded.

RESULTS

Weight fluctuation for each participant [mean (SD) 80.2 (4.2) years; male 60.0%, n = 10] over 3 days ranged from 1.1% to 3.6%. Over 3 days, 40.0% (4/10) of participants had weight fluctuations of >2% and 20% (2/10) had weight fluctuations of >3%. Time of weigh-in accounted for 99.8% of the variation in weight fluctuation (P < 0.05), with the lowest fluctuations observed when weights were compared at the same time each day (≤0.4 kg).

CONCLUSIONS

Weights recorded at the same time daily had the greatest accuracy. Given that the range 1.1-3.6% was within normal weight fluctuations for well-hydrated older hospitalised participants, the weight change indicative of dehydration remains to be established in this setting but appears greater than conventionally used figures.

Association between the gut microbiota and nonalcoholic fatty liver disease: A two-sample Mendelian randomization study

BACKGROUND

Increasing studies have shown that there is a significant association between gut microbiota and non-alcoholic fatty liver disease.

AIMS

To show the potential association between gut microbiota and non-alcoholic fatty liver disease, we performed a two-sample Mendelian randomization analysis.

METHODS

We analyzed summary statistics from genome-wide association studies of gut microbiota and non-alcoholic fatty liver disease and conducted Mendelian randomization studies to evaluate relationships between these factors.

RESULTS

Of the 211 gut microbiota taxa examined, the inverse variance weighted method identified Lactobacillaceae (OR = 0.83, 95% CI = 0.72 - 0.95, P = 0.007), Christensenellaceae (OR = 0.74, 95% CI = 0.59 - 0.92, P = 0.007), and Intestinibacter (OR = 0.85, 95% CI = 0.73 - 0.99, P = 0.035) were negatively correlated with non-alcoholic fatty liver disease. And Coriobacteriia (OR = 1.22, 95% CI = 1.01 - 1.42, P = 0.038), Actinomycetales (OR = 1.25, 95% CI = 1.02 - 1.53, P = 0.031), Oxalobacteraceae (OR = 1.10, 95% CI = 1.01 - 1.21, P = 0.036), Ruminococcaceae_UCG005 (OR = 1.18, 95% CI = 1.01 - 1.38, P = 0.033) are positively associated with non-alcoholic fatty liver disease.

CONCLUSIONS

Our study found that the abundance of certain strains was associated with the progression of nonalcoholic fatty liver disease.

The value of inter-professional education: a comparative study of dental technology students' perceptions across four countries

The ability to function as an effective member of a dental care team is a highly desirable--frequently mandated--attribute of dental technology (DT) graduates. Currently, there is little rigorous examination of how the learning of team-working skills might best be structured in a DT curriculum. This research compares DT curricula, and students' attitudes and perceptions regarding collaboration in practice, from four countries. Students (n=376) were invited to complete an education profile questionnaire, and the standardised measure--the shared learning scale. There were 196 (52%) responses. Students given opportunities to engage with others had better perceptions of inter-professional learning (IPL). Most believed that team-work and collaborative skills were best acquired by learning together with other dental care professionals, preferably sharing cases for real patients. Curricula should maximise opportunities for dental technology students to experience authentic IPL. Collaboration and team-work needs to be embedded through the whole undergraduate programme.

Arterial line versus venous line administration of low molecular weight heparin, enoxaparin for prevention of thrombosis in the extracorporeal blood circuit of patients on haemodialysis or haemodiafiltration: A randomized cross-over trial

STUDY OBJECTIVE

The objective of the study is to compare the anti-factor Xa (AXa) level in the blood, after arterial and venous line administration of equivalent doses of enoxaparin for prevention of thrombosis in the extracorporeal blood circuit.

DESIGN

The design of the study is a dual centre, prospective, open-labelled randomized crossover, 7 weeks trial.

SETTING

The setting of the study is on a patient on long-term haemodialysis (HD) or haemodiafiltration (HDF) using high-flux membrane.

PARTICIPANT

There were eight patients on HD and eight on HDF.

INTERVENTION

Participants were randomly assigned to receive enoxaparin either through the arterial line or venous line of extracorporeal blood circuit for an initial study interval of 2 weeks, followed by 2 weeks of alternate route administration. During the run-in period of 1 week and the follow-up period of 2 weeks, enoxaparin was administered through the arterial line.

OUTCOMES

The primary outcome measure was to compare AXa blood level 4 h after enoxaparin administration. The secondary outcome measures were manual compression time to stop bleeding from arteriovenous fistula, extracorporeal circuit clotting and systemic bleeding episodes.

RESULTS

The mean AXa blood level, 4 h after venous circuit administration (0.58 ± 0.21 (HD), 0.82 ± 0.29 (HDF)) of enoxaparin, was significantly greater than that after arterial administration of enoxaparin (0.39 ± 0.25 (HD), 0.39 ± 0.14 (HDF) U/mL), (P < 0.001).

CONCLUSION

In patients on HD or HDF, venous line administration of enoxaparin achieves greater 4 h blood AXa level compared with arterial line administration of equivalent dose. Based on this, we suggest a 25% or 50% reduction in the dose of venous line enoxaparin, compared with the dose administered through arterial line in patients receiving either HD or HDF, respectively.

A Group-Based Community Reinforcement Approach of Cognitive Behavioral Therapy Program to Improve Self-Care Behavior of Patients With Type 2 Diabetes

INTRODUCTION

This study evaluated a cognitive behavioral-based self-care intervention program on diabetes management in individuals with type 2 diabetes in Jiangsu Province, China. People with type 2 diabetes were recruited to a 6-month, prospective, intervention study.

METHODS

The intervention group (n = 296) received an intensive cognitive behavioral-based self-care intervention, including group activities, frequent blood glucose monitoring, nutritional counseling, diabetes-specific meal and a weekly progress report. The control group (n = 110) received diabetes education, including diet and physical activity instruction only. Assessment data was obtained at baseline, and after 12 and/or 24 weeks of intervention. The intention to treat method was used to assess the effectiveness of the intervention program.

RESULTS

The intervention group showed improved fasting blood glucose, HbA1c, systolic and diastolic blood pressures compared to the control group. The intervention group also had significantly improved knowledge and self-care behavior, and general health.

CONCLUSION

This study demonstrates that significant improvement in glycemic control and markers of cardiovascular health can occur in Chinese people with type 2 diabetes following a CBT-based intervention program that includes diabetes education, frequent blood glucose monitoring and daily use of a diabetes-specific meal plan, suggesting CBT is beneficial to improve health outcome in patients with type 2 diabetes.

MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis

Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.

Resilience Factors Important in Health-Related Quality of Life of Subjects With COPD

BACKGROUND

Common among patients with COPD is declining health-related quality of life (HRQOL). Although results of research identified some factors associated with HRQOL, resilience factors are yet to be fully investigated.

METHODS

This study examined resilience and demographic factors associated with HRQOL. Participants >40 y old were recruited from community health programs and hospitals in South East Queensland. Self-administered questionnaires were used to query subjects' HRQOL and levels of resilience. A decision tree examined the factors important to HRQOL in 159 subjects with COPD.

RESULTS

Factors of importance in the HRQOL of subjects with COPD were found in 3 domains of the St George Respiratory Questionnaire. Of importance on the breathlessness domain was marital status, defensive coping, coping, number of comorbidities, relationships, decision-making, self-esteem, self-efficacy, and professional support of health and well-being. Of the symptoms domain, self-efficacy, recruitment location, anxiety/depression, decision-making, self-esteem, coping, relationships, professional support of health and well-being, and risks were important. The cough domain found recruitment location, anxiety/depression, professional support of health and well-being, coping, and defensive coping to be important for subjects' HRQOL.

CONCLUSIONS

Resilience and confounding factors were of importance in the HRQOL of subjects with COPD. Thus, consultation with a medical professional, especially at discharge, who identifies, encourages, and approves of the patient's disease management abilities will enhance both resilience and HRQOL.

Caregiver resilience and patients with severe musculoskeletal traumatic injuries

AIMS

This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries.

METHODS

A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey.

RESULTS

Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden (β = -0.74, p = 0.008) and higher levels of patient physical health and function (β = -0.69, p = 0.003).

CONCLUSIONS

Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes.Implications for rehabilitationAfter 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function.The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden.Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community.Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health.

Systematic review of robotic ventral hernia repair with meta-analysis

BACKGROUND

Despite being one of the most common operations performed by general surgeons, there is a lack of consensus regarding the recommended approach for ventral hernia repair (VHR). Recent times have seen the rapid development of new techniques, such as robotic ventral hernia repair (RVHR). This systematic review and meta-analysis aims to evaluate the currently available evidence relating to RVHR, in comparison to open VHR (OVHR) and laparoscopic VHR (LVHR).

METHODS

A systematic search of the following databases was conducted: PubMed, Embase, Scopus and Web of Science. A meta-analysis was performed for the outcomes of length of stay (LOS), recurrence, operative time, intraoperative complications, wound complications, 30-day readmission, 30-day reoperation, mortality and costs.

RESULTS

A total of 39 studies met inclusion criteria. Overall, RVHR reduced LOS, intra-operative complications, wound complications and readmission compared to OVHR. Compared to LVHR, RVHR was associated with increased operative time and costs, with comparable clinical outcomes.

CONCLUSION

There is currently a lack of robust evidence to support the robotic approach in VHR. It does not demonstrate major benefits in comparison to LVHR, which is more affordable and accessible. Strong quality, long-term data is required to help with establishing a gold standard approach in VHR.

Effects of a formula with a probiotic Bifidobacterium lactis Supplement on the gut microbiota of low birth weight infants

PURPOSE

Low birth weight (LBW) infants have a less diverse gut microbiota, enriched in potential pathogens, which places them at high risk of systemic inflammation diseases. This study aimed to identify the differences in gut bacterial community structure between LBW infants who received probiotics and LBW infants who did not receive probiotics.

METHODS

Forty-one infants were allocated to the non-probiotic group (N group) and 56 infants to the probiotic group (P group), according to whether the formula they received contained a probiotic Bifidobacterium lactis. Gut bacterial composition was identified with sequencing of the 16S rRNA gene in fecal samples collected at 14 days after birth.

RESULTS

There was no significant difference between the alpha diversity of the two groups, while the beta diversity was significantly different (p < 0.05). Our results showed that Bifidobacterium and Lactobacillus (both p < 0.05) were enriched in the P group, while Veillonella, Dolosigranulum and Clostridium sensu stricto 1 (all p < 0.05) were enriched in the N group. Predicted metagenome function analysis revealed enhancement of fatty acids, peroxisome, starch, alanine, tyrosine and peroxisome pathways in the P group, and enhancement of plant pathogen, Salmonella and Helicobacter pylori infection pathways in the N group.

CONCLUSIONS

Probiotic supplement in formula may affect the composition, stability and function of LBW infants' gut microbiota. LBW infants who receive probiotic intervention may benefit from gut microbiota that contains more beneficial bacteria.

Obsessive-compulsive symptoms and personal disposition, family coherence and school environment in Chinese adolescents: a resilience approach

BACKGROUND

Risk factors of adolescents with obsessive-compulsive symptoms (OC) have been extensively examined, but protective resilience factors have not been explored, particularly in Chinese adolescents.

AIM

This study aimed to investigate the association of resilience factors with the occurrence of OC and its symptoms in Chinese adolescents.

METHOD

This study consisted of two phases. The first phase used a cross-sectional design involving a stratified clustered non-clinical sample of 3185 secondary school students. A clinical interview procedure was then employed to diagnose OC in students who had a Leyton Obsessional Inventory 'yes' score of ≥15. The second phase used a case-control study design to analyse the relationship between resilience factors and OC in a matched sample of 288 adolescents with diagnosed OC relative to 246 healthy adolescents.

RESULTS

Low personal disposition scores in self-fulfilment, flexibility and self-esteem, and low peer relation scores in the school environment were associated with a higher probability of having OC. Canonical correlation analysis indicated that OC symptoms were significantly associated with personal dispositions, poor peer relationships and maladaptive social life, but not to family coherence.

LIMITATIONS

The study is not prospective in nature, so the causal relationship between OC occurrence and resilience factors cannot be confirmed. Second, the use of self-report instruments in personal disposition, family coherence, and school environment may be a source of error.

CONCLUSIONS

Resilience factors at both the personal disposition and school environment levels are important predictors of OC symptoms and caseness. Future studies using prospective designs are needed to confirm these relationships.

Mediating Role of Rumination and Negative Affect in the Effect of Mind-Wandering on Symptoms in Patients With Obsessive-Compulsive Disorder

To explore the relationship between negative affect, mind-wandering, rumination and obsessive-compulsive symptoms, 100 patients with obsessive-compulsive disorder and 100 healthy controls were assessed using the Obsessive-Compulsive Inventory, the Beck Anxiety Inventory, the Beck Depression Inventory, the Mind Wandering Scale and the Ruminative Response Scale. The results show that (i) patients diagnosed with obsessive-compulsive disorder displayed higher obsessive-compulsive symptoms, negative affect, mind-wandering and rumination compared with healthy controls; (ii) negative affect, mind-wandering and rumination were positively correlated with the severity of obsessive-compulsive symptoms; (iii) mind-wandering predicted the severity of obsessive-compulsive symptoms (both directly and indirectly); (iv) rumination and negative affect mediated the relationship between mind-wandering and obsessive-compulsive symptoms. The results preliminarily reveal the relationship between mind-wandering and psychopathological obsessive-compulsive symptoms, providing a reference for exploring novel psychological treatments for obsessive-compulsive disorder.

Smoking in Australian university students and its association with socio‐demographic factors, stress, health status, coping strategies, and attitude

Purpose

This study aims to evaluate the prevalence of smoking amongst university students in Brisbane, Australia and associated risk factors.

Design/methodology/approach

A cross‐sectional design was used for the study. A sample of 2,414 university students aged 18‐30 was examined to estimate the prevalence of tobacco use. Smoking was measured by means of an online survey that inquired about current tobacco use, socio‐demographic characteristics, self‐rated physical and mental health status and attitudes toward smoking.

Findings

The prevalence of tobacco use was 24.9 per cent among male students, 16.6 per cent among female students and 18.8 per cent overall. Low to medium level stress is a strong predictor of smoking in male students. Age and income are significantly related to smoking in female students. For both male and female students, disengagement coping strategies to deal with stressors, feeling not bothered by exposure to smoking, and knowledge of the effect of smoking on health were found to be independently related to smoking.

Research limitations/implications

Factors associated with an increased probability of tobacco smoking were: stress in male students, disengagement coping strategies and holding approval attitudes toward smoking, acceptance of exposure to smoking, and poor knowledge of the effect of smoking on health in both male and female students. It is recommended that active coping strategies, such as exercise and social participation, are the most effective ways of enabling students to cope with smoking cessation and other stressors.

Practical implications

Future initiatives may need to focus on increasing the environmental supports to assist students to actively cope with life stressors, In addition, the implementation of health education programmes, which are designed to modify behaviour via a change in attitudes and beliefs in university, should be examined.

Originality/value

The association between cigarette smoking and morbidity and quality of life among university students is not well documented in Australia. The contribution of this paper is to increase understanding of the association between smoking and life stressors, coping strategies, attitudes and knowledge about the effects of smoking on health in Australia university students.

Relationship between moderate to late preterm, diet types and developmental delay in less-developed rural China

Aim: To measure the development of moderate to late preterm children by Ages and Stages Questionnaires (ASQ) and explore the relationship between moderate to late preterm, diet types and development delay in less-developed rural China.Methods: Data were collected from a cross-sectional community-based survey, which recruited 1748 children aged 1-59 months in eight counties of China. Caregivers of these children completed the Chinese version of ASQ-3 (ASQ-C) while physical examination and questionnaires on socio-demographic characteristics were conducted. Multivariate logistic regressions were used to analyze the association between moderate to late preterm and suspected developmental delay, as well as the association between diet types and suspected developmental delay. Consumption of certain food types was compared between moderate to late preterm and full-term children.Results: The prevalence of suspected overall developmental delay was 31.3% in the moderate to the late preterm group, compared with 21.6% in the full-term group. Moderate to late preterm birth was not associated with total suspected developmental delay and developmental delay in all the domains of ASQ, except for fine motor (OR = 2.43 95% C.I.: 1.04-5.56). The intake of vegetables and fruits had a protective influence on developmental delay in fine motor function, and moderate to late preterm children had lower relative consumption of fruits and vegetables than full-term children.Conclusion: Moderate to late preterm children in rural China showed an increased likelihood of developmental delay in fine motor function. Future interventions to improve the intake of vegetables and fruits in moderate to late preterm children are recommended.

Associations between meeting 24-hour movement guidelines and myopia among school-aged children: A cross-sectional study

BACKGROUND

The Canadian 24-hour movement behavior (24-HMB) guidelines recommend an adequate level of physical activity (PA), a limited amount of screen time (ST), and a sufficient sleep duration (SLP) to promote the healthy development of children. Although the positive effects of adhering to the 24-HMB guidelines have been established for several health parameters, less is known about how adherence to the 24-HMB guidelines relates to the myopia risk (i.e., inability to see distant objects properly). Thus, this study investigated associations between meeting 24-HMB guidelines and myopia risk in school-aged children.

METHOD

Using a questionnaire survey, this cross-sectional study was conducted among parents of school-aged children (5-13 years) in China from 15th September to 15th October 2022, with a total of 1423 respondents with complete data for analysis. Parents reported their child's time spent in moderate-to-vigorous-intensity physical activity (MVPA), SLP, and ST. Multiple logistic regression analyses were performed to examine the associations between measures of PA, ST, and SLP alone and in combination, and the occurrence of myopia.

RESULTS

A relatively low percentage of the children being included in the current study (4.92%) met all 24-HMB guidelines, while 32.46% had myopia. Girls had a significantly higher risk of myopia compared to boys (OR = 1.3, 1.002 to 1.68, p = 0.049). Children of parents without myopia had a lower risk of myopia (OR = 0.45, 0.34-0.59, p < 0.001). Children who lived in urban areas (OR = 1.83, 95% CI 1.33 to 2.52, p < 0.001) or towns (OR = 1.60, 1.03 to 2.47, p = 0.04) had a significantly higher risk of myopia compared to those living in rural areas. Meeting SLP guidelines (OR = 0.50, 95% CI 0.31 to 0.82, p < 0.01), meeting ST + SLP guidelines (OR = 0.47, 95% CI 0.32-0.69, <0.001), and meeting all three guidelines were associated with significantly lower risk of myopia (OR = 0.40, 95% CI 0.20-0.82, p = 0.01). Meeting more 24-HMB guidelines was associated with a reduced risk of myopia.

CONCLUSIONS

Our data suggest that adhering to SLP, ST + SLP, and ST + SLP + PA guidelines is associated with the risk of myopia. Future research investigating dose-response associations, and potential mechanisms, is necessary to achieve a more nuanced understanding of the observed associations.

Validation and normalization of the General Health Questionnaire 30 in parents with primary school children in China

OBJECTIVES

Parenting can be a stressful experience. Higher levels of parenting stress are predictive of parents' negative appraisal of children's behavior, the use of physical discipline, and poor child outcomes across a variety of domains. Assessment of parenting depression is needed in China. This study aims to standardize the Chinese version of the General Health Questionnaire (GHQ-30) for parents of primary school children.

METHOD

Stratified randomly selected parents of primary school children were selected from the cities of Nanjing and Shenyang in China. The Chinese version of the General Health Questionnaire 30 was administered to 7615 parents of primary school students aged between 8 and 12 years. A high response rate was achieved, with 6672 parents (88%) responding to the survey.

RESULTS

Exploratory factor analysis with a 5-factor solution showed that 5 factors were extracted from the scale, namely, depression, anxiety, inadequate coping, social dysfunctioning, and sleep disturbance. The 5-factor structures were confirmed by using confirmatory factor analysis (CFA). Overall, the 5-factor structure had a high level of reliability for each individual dimension. Confirmatory factor analysis showed that the 5-factor structure abstracted from this study had a good model fit.

CONCLUSIONS

The 5-factor structure derived from the present sample of parents, with good model fit in the CFA analysis, suggests that a 5-factor solution can be used to assess parent psychopathological symptoms in mainland Chinese parents of primary school children.

The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis

Recently, the benefits of cognitive behavioral therapy (CBT)-based interventions for patients with hypertension have been recognized, but there has been no systematic review that has comprehensively analyzed the efficacy of CBT on health outcomes in this population. We aimed to explore the therapeutic effect of CBT-based interventions on hypertension patients through a meta-analysis. Relevant randomized controlled trials (RCTs) were obtained by searching electronic databases. The primary outcomes were physiological indicators (blood pressure, blood lipid profile). Secondary outcomes were psychological indicators (anxiety, depression), and the quality of sleep. Stata version 15.0 software was used to analyze the results. A total of 15 RCTs were included. The main analysis revealed that CBT-based interventions reduced systolic pressure: -8.67 (95% CI: -10.67 to -6.67, P = 0.000); diastolic pressure: -5.82 (95% CI: -7.82 to -3.81, P = 0.000); total cholesterol levels: -0.43 (95% CI: -0.76 to -0.10, P = 0.010); depressive symptoms: -3.13 (95% CI: -4.02 to -2.24, P = 0.000); anxiety symptoms: -3.63 (95% CI: -4.40 to -2.87, P = 0.000); and improved quality of sleep: -2.93 (95% CI: -4.40 to -1.47, P = 0.000). Additionally, the results of subgroup analysis indicated that long-term group-based CBT-based interventions were particularly beneficial for blood pressure management in hypertension patients. CBT-based interventions are effective in reducing systolic pressure, diastolic pressure, total cholesterol levels, anxiety symptoms, depressive symptoms, and improving quality of sleep in hypertension patients.

Comparison in executive function in Chinese preterm and full-term infants at eight months

Executive function (EF) is increasingly recognized as being responsible for adverse developmental outcomes in preterm-born infants. Several perinatal factors may lead to poor EF development in infancy, and the deficits in EF can be identified in infants as young as eight months. A prospective cohort study was designed to study the EF in Chinese preterm infants and examine the relationship between EF in preterm infants and maternal factors during perinatal period. A total of 88 preterm infants and 88 full-term infants were followed from birth to eight months (corrected age). Cup Task and Planning Test was applied to assess the EF of infants, and the Bayley Scale of Infant Development (BSID-III) was used to evaluate cognitive (MDI) and motor abilities (PDI) of infants. In comparison with full-term infants, the preterm infants performed more poorly on all measures of EF including working memory, inhibition to prepotent responses, inhibition to distraction, and planning, and the differences remained after controlling the MDI and PDI. Anemia and selenium deficiency in mothers during pregnancy contributed to the differences in EF performance. However, maternal depression, hypertension, and diabetes during pregnancy were not related to the EF deficits in preterm infants. Future research should focus on the prevention of anemia and selenium deficiency during pregnancy and whether supplementing selenium in mothers during pregnancy can prevent further deterioration and the development of adverse outcomes of their offspring.

Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries

OBJECTIVES

To explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.

DESIGN

This is a cross-sectional, proof-of-concept study.

SETTINGS AND PARTICIPANTS

We analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child's survival.

RESULTS

We found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.

CONCLUSION

Our findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.