From static web to metaverse: reinventing medical education in the post-pandemic era

The World Wide Web and the advancement of computer technology in the 1960s and 1990s respectively set the ground for a substantial and simultaneous change in many facets of our life, including medicine, health care, and medical education. The traditional didactic approach has shifted towards more dynamic and interactive methods, leveraging technologies such as simulation tools, virtual reality, and online platforms. At the forefront is the remarkable evolution that has revolutionized how medical knowledge is accessed, disseminated, and integrated into pedagogical practices. The COVID-19 pandemic also led to rapid and large-scale adoption of e-learning and digital resources in medical education because of widespread lockdowns, social distancing measures, and the closure of medical schools and healthcare training programs. This review paper examines the evolution of medical education from the Flexnerian era to the modern digital age, closely examining the influence of the evolving WWW and its shift from Education 1.0 to Education 4.0. This evolution has been further accentuated by the transition from the static landscapes of Web 2D to the immersive realms of Web 3D, especially considering the growing notion of the metaverse. The application of the metaverse is an interconnected, virtual shared space that includes virtual reality (VR), augmented reality (AR), and mixed reality (MR) to create a fertile ground for simulation-based training, collaborative learning, and experiential skill acquisition for competency development. This review includes the multifaceted applications of the metaverse in medical education, outlining both its benefits and challenges. Through insightful case studies and examples, it highlights the innovative potential of the metaverse as a platform for immersive learning experiences. Moreover, the review addresses the role of emerging technologies in shaping the post-pandemic future of medical education, ultimately culminating in a series of recommendations tailored for medical institutions aiming to successfully capitalize on revolutionary changes.

Health literacy & Chagas disease knowledge: A cross-sectional study in Southern Loja Province, Ecuador

Objective

Health literacy is associated with many patient outcomes. This study sought to determine the association between a person's level of health literacy and their knowledge about Chagas disease.

Methods

A cross-sectional survey was conducted with people living in two counties in rural Loja Province, Ecuador who attended a mobile health clinic. The communities in which the study was conducted are at high risk of Chagas disease and have limited access to both health care and educational resources. The Spanish version of Short Assessment for Health Literacy measured health literacy. The Chagas Disease Knowledge questionnaire measured knowledge of Chagas disease. T-tests and correlational analysis were used to assess associations.

Results

Overall 85 people participated in this study. A majority of the respondents were female (64.1%), and a plurality were married (40.7%) and had education less than secondary (40.7%). The average age of the sample was 44.31 ± 18.85. Health literacy levels and Chagas disease knowledge in the communities were low. About half of people had inadequate health literacy. No association between health literacy and Chagas knowledge was found.

Conclusion

Health literacy levels and Chagas disease knowledge were not found to be correlated. Explanations for the lack of association may include common causes of inadequate investment in Chagas disease education as well as neglect of health systems in rural Ecuador. Efforts to improve both health literacy and Chagas disease knowledge in poorer, rural areas of Ecuador are needed.

Innovation

This is the first study to assess relationships between health literacy and knowledge of Chagas disease in an uninfected population. For novel conditions, relationships between health literacy and disease knowledge should be investigated before communication campaigns are adapted.

The experiences of transgender and nonbinary adults in primary care: A systematic review

BACKGROUND

Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.

OBJECTIVES

This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.

RESULTS

Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.

CONCLUSION

This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.

Prevalence of pulmonary hypertension in children with obstructive sleep apnea living at high altitude

Introduction

The prevalence of obstructive sleep apnea (OSA) is 1-4 %. Some reports describe its association with pulmonary hypertension (PH), but its prevalence is unknown. No studies at high altitude have determined the relationship between OSA and PH. The aim of this study was to establish the prevalence of PH in children diagnosed with OSA living in a high-altitude city at 2640 m above sea level.

Methods

Children between 2 and 16 years of age referred to the Sleep Laboratory of the Fundación Neumológica Colombiana in Bogotá with a positive polysomnogram for OSA were included, and a two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate PH. Statistical analysis was performed using median, interquartile range, chi-squared test, and Kruskall-Wallis test.

Results

Of the 55 patients (n: 55), 63.6 % were male, with a median age of 6 years, 14 children (25.5 %) were overweight; 12 children (21.8 %) had mild OSA, 12 (21.8 %) had moderate OSA and 31 (56.4 %) severe OSA. In patients with severe OSA, the minimum saturation during events was 78 % with a desaturation index (DI) of 33.8/hour (p < 0.01). T90 and T85 increased proportionally with OSA severity (p < 0.05). Of the 55 patients with OSA, none had PH according to echocardiography; 4 patients (7.2 %) had pulmonary artery systolic pressure (PASP) at the upper limit of normal (ULN), and it was not related to a higher body mass index (BMI).

Conclusions

We found no association between OSA and PH in children with OSA at high altitude.

Color-reversible fluorescence tracking for the dynamic interaction of SO2 with Hg2+ in living cells

Mercury ion (Hg2+) is one of the most threatening substances to human health, and the mercury poisoning can damage physiological homeostasis severely in human, even cause death. Intriguingly, Sulfur dioxide (SO2), a gas signal molecule in human, can specifically interact with Hg2+ for relieving mercury poisoning. However, the dynamic interaction of Hg2+ with SO2 at the tempospatial level and the correlation between Hg2+ and SO2 in the pathological process of mercury poisoning are still elusive. Herein, we rationally designed a reversible and dual color fluorescent probe (CCS) for dynamically visualizing Hg2+ and SO2 and deciphering their interrelationship in mercury poisoning. CCS held good sensitivity, selectivity and reversibility to Hg2+ and SO2, that enabled CCS to specifically detect SO2 and Hg2+ via cyan fluorescence channel (centered around 485 nm) and red fluorescence channel (centered around 679 nm), respectively. Notably, the separate fluorescence signal changes of CCS realized the dynamic tracing of Hg2+ and SO2 in living cells, and presented the potential for exploring the correlation between SO2 and Hg2+ in mercury poisoning.

Fish intake and mercury exposure in young children

Fish consumption is one of the main sources of mercury (Hg) exposure, but few studies have examined Hg exposure from fish consumption among children. This study aimed to assess the frequency of fish intake and associations with Hg and other element concentrations among 700 three-year-old children from the New Hampshire Birth Cohort Study. Usual fish intake was derived from a validated food frequency questionnaire (Block Questionnaire for ages 2-7) and toenail element concentrations were determined using ICP-MS. Multiple linear regression analysis was used to assess the association between fish intake and toenail element concentrations. A mixture analysis, using Weighted quantile sum (WQS) regression, was used to estimate the relative contribution of fish consumption to element exposures. Twenty-three percent of children were reported to consume at least one fish meal/week on average during the previous 6 months. In adjusted linear regression models, children with any type of fish consumption versus no consumption had 108% (95% confidence interval (CI: 68%, 153%)) higher toenail Hg concentrations. To a lesser extent, children consuming "other fish (not fried) including tuna" and "fried fish or fish sticks" had 120% (95% CI: 82%, 164%), and 23% (95% CI: 2%, 51%) higher toenail concentrations, respectively, than those consuming no fish. Using WQS regression, Hg was the element most strongly related to fish consumption. Fish intake among young children was related to Hg exposure even at low levels of consumption. Future studies will need to determine the health consequences of this exposure.

Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile.

Methods

The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child.

Conclusions

This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.

Racial, Age, and Regional Disparities in Maternal Mortality in the USA, 1999-2020

BACKGROUND

The health and well-being of mothers are essential for a thriving and prosperous society, yet maternal mortality remains a pressing public health problem in the USA. We aimed to examine the US trends in maternal mortality from 1999 to 2020 based on age, race/ethnicity, and census region.

METHODS

Data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research were used to identify maternal mortality cases. Temporal trends were analyzed using Joinpoint regression. Annual percentage changes, average annual percentage changes, and 95% confidence intervals were calculated.

RESULTS

The maternal mortality rate in the USA increased from 1999 to 2013, but has stabilized since then until 2020 (APC =  - 0.1; 95% CI: - 7.4, 2.9). However, there have been recent increases among Hispanics at a rate of 2.8% per year (95% CI: 1.6, 4.0) from 1999 to 2020. The rates stabilized among non-Hispanic Whites (APC =  - 0.7; 95% CI: - 8.1, 3.2) and non-Hispanic Blacks (APC =  - 0.7; 95% CI: - 14.7, 3.0). Maternal mortality rates increased among women aged 15-24 years at a rate of 3.3% per year (95% CI: 2.4, 4.2) since 1999, among women aged 25-44 years at a rate of 22.5% per year (95% CI: 5.4, 34.7), and among women aged 35-44 years at a rate of 4% per year (95% CI: 2.7, 5.3). Regional disparities existed, with rising rates in the West at a rate of 13.0% per year (95% CI: 4.3, 38.4), and stable rates in the Northeast (APC = 0.7; 95% CI: - 3.4, 2.8), Midwest (APC =  - 1.8; 95% CI: - 23.4, 4.2), and South (APC =  - 1.7; 95% CI: - 7.5, 1.7).

CONCLUSIONS

While maternal mortality rates in the USA have stabilized since 2013, our analysis reveals significant disparities by race, age, and region. Therefore, it is essential to prioritize efforts to improve maternal health outcomes across all population subgroups to achieve equitable maternal health outcomes for all women.

Associations between paediatric obesity, chemical mixtures and environmental factors, in a national cross-sectional study of Canadian children

BACKGROUND

Whilst single chemical exposures are suspected to be obesogenic, the combined role of chemical mixtures in paediatric obesity is not well understood.

OBJECTIVES

We aimed to evaluate the potential associations between chemical mixtures and obesity in a population-based sample of Canadian children.

METHODS

We ascertained biomonitoring and health data for children aged 3-11 from the cross-sectional Canadian Health Measures Survey from 2007 to 2019. Several chemicals of interest were measured in blood or urine and paediatric obesity was defined based on measured anthropometrics. Using quantile-based G computational analysis, we quantified the effects of three chemical mixtures selected a priori. Models were adjusted for sociodemographic and environmental factors identified through a directed acyclic graph. Results are presented through adjusted relative risks (RR) with 95% confidence intervals (95% CI).

RESULTS

We included 9147 children. Of these, 24.1% were overweight or obese. Exposure to the mixture of bisphenol A, acrylamide, glycidamide, metals, parabens and arsenic increased the risk of childhood overweight or obesity by 45% (95% CI 1.09, 1.93), obesity by 109% (95% CI 1.27, 3.42) and central obesity by 82% (95% CI 1.30, 2.56).

CONCLUSIONS

Our findings support the role of early childhood chemical exposures in paediatric obesity and the potential combined effects of chemicals.

Maternal gluten, cereal, and dietary fiber intake during pregnancy and lactation and the risk of islet autoimmunity and type 1 diabetes in the child

BACKGROUND & AIMS

Maternal gluten intake in relation to child's risk of type 1 diabetes has been studied in few prospective studies considering the diet during pregnancy but none during lactation. Our aim was to study whether gluten, cereals, or dietary fiber in maternal diet during pregnancy and lactation is associated with the risk of islet autoimmunity or type 1 diabetes in the offspring.

METHODS

We included 4943 children with genetic susceptibility to type 1 diabetes from the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Study, born between 1996 and 2004. Maternal intake of gluten, different types of cereals, and dietary fiber were derived from a semi-quantitative validated food frequency questionnaire covering the eighth month of pregnancy and the third month of lactation. Children were monitored for islet autoantibodies up to age of 15 years and type 1 diabetes until year 2017. Risk of islet autoimmunity and clinical type 1 diabetes were estimated using Cox regression model, adjusted for energy intake, child's sex, HLA genotype, and familial diabetes.

RESULTS

Altogether 312 children (6.4%) developed islet autoimmunity at median age of 3.5 (IQR 1.7, 6.6) years and 178 children (3.6%) developed type 1 diabetes at median age of 7.1 (IQR 4.3, 10.6) years. Gluten intake during pregnancy was not associated with islet autoimmunity (HR 0.96; 95% CI 0.68, 1.35), per 1 g/MJ increase in intake nor type 1 diabetes (HR 0.96; 95% CI 0.62, 1.50) in the offspring. Higher barley consumption during lactation was associated with increased risk of type 1 diabetes (HR 3.25; 95% CI 1.21, 8.70) per 1 g/MJ increase in intake. Maternal intake of other cereals or dietary fiber was not associated with the offspring outcomes.

CONCLUSIONS

We observed no association between maternal intake of gluten, most consumed cereals, or dietary fiber during pregnancy or lactation and the risk of islet autoimmunity or type 1 diabetes in children from a high-risk population.

Multisystem inflammatory syndrome in children: an evolving understanding of a syndrome amid the inflammatory continuum

Multisystem inflammatory syndrome in children (MIS-C) is a rare hyperinflammatory and immunosuppressed condition affecting children exposed to COVID-19. MIS-C has been associated with an over-exaggerated innate and adaptive immune response characterized by a 'selective' cytokine production and T cell suppression. As COVID-19 information has evolved, the knowledge and field surrounding MIS-C is ever evolving. Thus, a comprehensive clinical review that concisely presents current literature findings regarding common clinical presentations and comparisons with similar conditions, associations with the COVID-19 vaccine effects and relevant epigenetic markers and evaluates treatment and long-term outcomes to help guide future studies is needed and provided.

Association of uninsured status and rurality with risk of financial toxicity after pediatric trauma

BACKGROUND

Pediatric traumatic injury is associated with long-term morbidity as well as substantial economic burden. Prior work has labeled the catastrophic out-of-pocket medical expenses borne by patients as financial toxicity. We hypothesized uninsured rural patients to be vulnerable to exorbitant costs and thus at greatest risk of financial toxicity.

METHODS

Pediatric patients (<18 years) experiencing traumatic injury were identified in the 2016-2019 National Inpatient Sample. Patients were considered to be at risk of financial toxicity if their hospitalization cost exceeded 40% of post-subsistence income. Individual family income was computed using a gamma distribution probability density function with parameters derived from publicly available US Census Bureau data, in accordance with prior work. A multivariable logistic regression was developed to assess factors associated with risk of financial toxicity.

RESULTS

Of an estimated 225,265 children identified for study, 34,395 (15.3%) were Rural. Rural patients were more likely to experience risk of financial toxicity (29.1 vs 22.2%, P < .001) compared to Urban patients. After adjustment, rurality (reference: urban status; adjusted odds ratio 1.45, 95% confidence interval 1.36-1.55) and uninsured status (reference: private; adjusted odds ratio 1.85, 95% confidence interval 1.67-2.05) remained linked to increased odds of risk of financial toxicity. Specifically among those with private insurance, Rural patients experienced markedly higher predicted risk of financial toxicity, relative to Urban.

CONCLUSION

Our findings suggest a complex interplay between rural status and insurance type in the prediction of risk of financial toxicity after pediatric trauma. To target policy interventions, future studies should characterize the patients and communities at greatest risk of financial devastation among rural pediatric trauma patients.

The Association of Race and Ethnicity with Mortality in Pediatric Patients with Congenital Heart Disease: a Systematic Review

CONTEXT

Congenital heart disease (CHD) is a common condition with high morbidity and mortality and is subject to racial and ethnic health disparities.

OBJECTIVE

To conduct a systematic review of the literature to identify differences in mortality in pediatric patients with CHD based on race and ethnicity.

DATA SOURCES

Legacy PubMed (MEDLINE), Embase (Elsevier), and Scopus (Elsevier) STUDY SELECTION: English language articles conducted in the USA focused on mortality based on race and ethnicity in pediatric patients with CHD.

DATA EXTRACTION

Two independent reviewers assessed studies for inclusion and performed data extraction and quality assessment. Data extraction included mortality based on patient race and ethnicity.

RESULTS

There were 5094 articles identified. After de-duplication, 2971 were screened for title and abstract content, and 45 were selected for full-text assessment. Thirty studies were included for data extraction. An additional 8 articles were identified on reference review and included in data extraction for a total of 38 included studies. Eighteen of 26 studies showed increased risk of mortality in non-Hispanic Black patients. Results were heterogenous in Hispanic patients with eleven studies of 24 showing an increased risk of mortality. Results for other races demonstrated mixed outcomes.

LIMITATIONS

Study cohorts and definitions of race and ethnicity were heterogenous, and there was some overlap in national datasets used.

CONCLUSION

Overall, racial and ethnic disparities existed in the mortality of pediatric patients with CHD across a variety of mortality types, CHD lesions, and pediatric age ranges. Children of races and ethnicities other than non-Hispanic White generally had increased risk of mortality, with non-Hispanic Black children most consistently having the highest risk of mortality. Further investigation is needed into the underlying mechanisms of these disparities so interventions to reduce inequities in CHD outcomes can be implemented.

Consumer characteristics and preferences for mobulid gill plates in China

Mobulid species are endangered globally, and the market trade for gill plates is believed to be a major threat. Successful conservation and the sustainable use of mobulids therefore require an objective understanding of consumer characteristics and preferences for gill plates. Previous studies focused on qualitative descriptions, and reliable quantitative analyses are currently lacking. We used a latent class choice experiment method and a semistructured questionnaire to provide important new quantitative information about gill plate consumer characteristics and the heterogeneous nature of demand for gill plates. From May to July 2019, we conducted a field study in Guangzhou, the primary consumption hub for mobulid gill plates in mainland China. Utilizing a simple random sampling method, we engaged in face-to-face interviews with 428 consumers of gill plates in the major trading markets in Guangzhou. Our results showed that 59.8% of consumers of gill plates were over 40 years old, 62.6% were female, 80.7% had annual household incomes of <200,000 yuan, and 84.5% recognized the medical and health value of gill plates and purchased them. About seventy-two percent of consumers preferred to purchase imported and less expensive gill plates from unprotected species, but they had a strong preference for large gill plates from protected species, such as Mobula birostris. This contradiction arose from consumers' lack of knowledge of mobulids and their conservation status. We found, for example, female consumers over 40 years old had the least understanding of conservation status of mobulid species and the link between size of gill plates and rarity of mobulids. This suggests there may be opportunities to promote mobulid conservation through education and marketing targeted at this demographic. Consumers who had a positive preference for gill plates from protected species (regardless of price) (10%) may be harder to influence. Overall, we believe education alone is not enough and that the conservation of mobulids would benefit from an integrated approach that involves conservation education and strengthened trade regulations, such as the introduction of traceability systems and a stiffer legal framework for consumption of protected species.

A Dietary Pattern With More Fruits and Vegetables in Children of Mothers Who Immigrated to the United States From Latin America Is Associated With Healthful Nutrient Intake and Weight Status

BACKGROUND

Children from families who immigrated to the United States may consume a lower-quality diet compared with their US-born peers. However, specific features of their dietary patterns, which could be a focus for improving diet quality, are not well-studied.

OBJECTIVE

The aim of this study was to examine dietary patterns that distinguish interpersonal variability in dietary intake and explore the association of dietary patterns with nutrient intake and weight status.

DESIGN

This study was a cross-sectional analysis of baseline data from the Live Well randomized controlled trial collected between 2009 and 2010.

PARTICIPANTS/SETTING

Study participants included 313 children (3-12 years) whose mothers immigrated to the United States from Latin America and resided in Somerville, Massachusetts.

MAIN OUTCOME MEASURES

Dietary patterns (derived using principal component analysis); nutrient intake (derived from dietary data collected using the Block Food Screener); and weight status (categorized using body mass index z score based on measured height and weight).

STATISTICAL ANALYSES PERFORMED

Nutrient intake levels were compared across quartiles for dietary patterns using analysis of covariance. Multivariable logistic or linear regression models were used to determine the associations between dietary pattern scores and odds of overweight or obesity or z scores.

RESULTS

Two dietary patterns emerged: "fruits and vegetables" and "meat and sweets." Highest adherence to the fruits and vegetables pattern was associated with more healthful nutrient intake and lower odds of having overweight or obesity (odds ratio 0.37; 95% CI 0.16 to 0.98), but not body mass index z score (β = -.07; 95% CI -.51 to 0.36) compared with the lowest adherence. Adherence to the meat and sweets pattern was associated with less healthful nutrient intake but not with the odds of experiencing overweight or obesity (odds ratio 0.48; 95% CI 0.16 to 1.46).

CONCLUSIONS

A healthful dietary pattern in children of families who immigrated to the United States from Latin America may include a variety of fruits and vegetables. Longitudinal studies should be conducted to further assess the role of dietary intake patterns on the health of these children.

Intraspecific Variation in Mercury Contamination of Alligator Snapping Turtles (Macrochelys temminckii)

Macrochelys temminckii (alligator snapping turtle) is an aquatic turtle endemic to the southeastern United States that was proposed for listing under the Endangered Species Act in 2021. In the present study we analyzed total mercury (THg) concentrations in skeletal muscle, tail clips, and nail tissue of 93 M. temminckii sampled from 14 waterbodies in eastern Texas (USA). Our objectives were to assess (1) the degree of correlation between internal tissue (skeletal muscle and tail clip samples) and keratin (nail samples), (2) the influence of ecological factors (turtle size and waterbody/sampling site) on THg concentrations, and (3) whether THg concentrations were high enough to pose a risk to human consumers. The mean (±SE) THg concentrations of muscle and nail were 1.16 ± 0.08 μg/g dry weight and 4.21 ± 0.24 μg/g dry weight, respectively, and THg concentrations were highly dependent on the sampling site. The THg concentrations of nails were correlated with muscle concentrations (R2 = 0.56, p < 0.001). The effect of body size on THg concentrations varied by sampling site, indicating that size is not a good predictor of Hg concentration across sites. Finally, THg concentrations in M. temminckii of eastern Texas were high enough to pose a potential risk to human health based on US Environmental Protection Agency dietary guidelines. Environ Toxicol Chem 2024;43:1903-1913. © 2024 SETAC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Characteristics and Habits of Psychiatrists and Neurologists With High Occupational Well-Being: A Mixed Methods Study

Objective

To identify the characteristics that distinguish occupationally well outliers (OWO), a subset of academic psychiatrists and neurologists with consistently high professional fulfillment and low burnout, from their counterparts with lower levels of occupational well-being.

Participants and Methods

Participants included faculty physicians practicing psychiatry and neurology in academic medical centers affiliated with the Professional Well-being Academic Consortium. In this prospective, longitudinal study, a mixed qualitative and quantitative approach was used. Quantitative measures were administered to physicians in a longitudinal occupational well-being survey sponsored by the academic organizations where they work. Four organizations participated in the qualitative study. Psychiatrists and neurologists at these organizations who competed survey measures at 2 consecutive time points between 2019 and 2021 were invited to participate in an interview.

Results

Of 410 (213 psychiatrists and 197 neurologists) who completed professional fulfillment and burnout measures at 2 time points, 84 (20.5%) met OWO criteria. Occupationally well outliers psychiatrists and neurologists had more favorable scores on hypothesized determinants of well-being (values alignment, perceived gratitude, supportive leadership, peer support, and control of schedule). Ultimately, 31 psychiatrists (25% of 124 invited) and 33 neurologists (18.5% of 178 invited) agreed to participate in an interview. Qualitatively, OWO physicians differed from all others in 3 thematic domains: development of life grounded in priorities, ability to shape day-to-day work context, and professional relationships that provide joy and support.

Conclusion

A multilevel approach is necessary to promote optimal occupational well-being, targeting individual-level factors, organizational-level factors, and broader system-level factors.

Outcomes from Individual Alpha Frequency Guided Repetitive Transcranial Magnetic Stimulation in Children with Autism Spectrum Disorder - A Retrospective Chart Review

AIMS AND OBJECTIVES

Individual alpha frequency (IAF) is a biomarker of neurophysiological functioning. The IAF-guided repetitive transcranial magnetic stimulation (α-rTMS) is increasingly explored in diverse neurological conditions. However, there is limited data on the efficacy and safety of α-rTMS in children with autism spectrum disorder (ASD).

MATERIALS AND METHODS

The IAF, childhood autism rating scale (CARS), Pediatric Quality of Life Inventory 4.0 (PedsQLTM 4.0), and semi-structured interview data of patients that received 19 α-rTMS sessions (4 weeks) were aggregated and analysed using paired student t-test and descriptive method.

RESULTS

Data were retrieved from 28 patients (26 males, aged 3-9years (mean ± SD age: 6.1 ± 1.8years)). The post-α-rTMS data shows a significant improvement in IAF (9.4 Hz; p ≤ 0.025) towards 10 Hz. The CARS and PedsQLTM 4.0 surveys indicate that patients' ASD symptoms and quality of life improved significantly. Specifically, reports from semi-structured interviews suggest improved sleep trouble - the most significant comorbidity. The experiences of minor side effects such as hyperactivity resolved within two hours following α-rTMS sessions.

CONCLUSION

This study presents evidence on the efficacy and safety of α-rTMS in improving ASD symptoms, quality of life and comorbid sleep troubles in children. However, these findings should be interpreted as preliminary pending the presentation of double-blind, randomised clinical trials.

Peer relationships, adolescent anxiety, and life satisfaction: a moderated mediation model in Turkish and syrian samples

Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11-19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.

Bloody stressed! A systematic review of the associations between adulthood psychological stress and menstrual cycle irregularity

Regular menstruation is a key indicator of general health and irregular menstrual parameters have been associated with elevated risk of adverse health outcomes. While psychological stress is believed to contribute to abnormal menstruation, little is known of the effects of discrete psychological stressors, including the COVID-19 pandemic, on menstrual function. A systematic database search was performed and studies investigating the relation between psychological stress and menstrual cycle irregularity in otherwise healthy adults were included. Two independent investigators completed abstract and full-text screening, data extraction, and risk of bias assessment. In the 41 included studies, a variety of stressors were assessed, namely COVID-19 pandemic stress, academic stress, and occupational stress. Our review found most studies report an association between psychological stress and menstrual dysfunction, with the most common disruptions being irregular menstruation and abnormal menstrual flow. Our findings also underlined notable discrepancies in the operational definitions used in the study of menstrual disorders. These observations emphasize the importance of psychological stress as a modifiable risk factor associated with irregular menstruation.

Mechanistic screening of reproductive toxicity in a novel 3D testicular co-culture model shows significant impairments following exposure to low-dibutyl phthalate concentrations

To improve the mechanistic screening of reproductive toxicants in  chemical-risk assessment and drug development, we have developed a three-dimensional (3D) heterogenous testicular co-culture model from neonatal mice. Di-n-butyl phthalate (DBP), an environmental contaminant that can affect reproductive health negatively, was used as a model compound to illustrate the utility of the in vitro model. The cells were treated with DBP (1 nM to 100 µM) for 7 days. Automated high-content imaging confirmed the presence of cell-specific markers of Leydig cells (CYP11A1 +), Sertoli cells (SOX9 +), and germ cells (DAZL +). Steroidogenic activity of Leydig cells was demonstrated by analyzing testosterone levels in the culture medium. DBP induced a concentration-dependent reduction in testosterone levels and decreased the number of Leydig cells compared to vehicle control. The levels of steroidogenic regulator StAR and the steroidogenic enzyme CYP11A1 were decreased already at the lowest DBP concentration (1 nM), demonstrating upstream effects in the testosterone biosynthesis pathway. Furthermore, exposure to 10 nM DBP decreased the levels of the germ cell-specific RNA binding protein DAZL, central for the spermatogenesis. The 3D model also captured the development of the Sertoli cell junction proteins, N-cadherin and Zonula occludens protein 1 (ZO-1), critical for the blood-testis barrier. However, DBP exposure did not significantly alter the cadherin and ZO-1 levels. Altogether, this 3D in vitro system models testicular cellular signaling and function, making it a powerful tool for mechanistic screening of developmental testicular toxicity. This can open a new avenue for high throughput screening of chemically-induced reproductive toxicity during sensitive developmental phases.

Super-resolution Multispectral Imaging Nanoimmunosensor for Simultaneous Detection of Diverse Early Cancer Biomarkers

In medical diagnosis, relying on only one type of biomarker is insufficient to accurately identify cancer. Blood-based multicancer early detection can help identify more than one type of cancer from a single blood sample. In this study, a super-resolution multispectral imaging nanoimmunosensor (srMINI) based on three quantum dots (QDs) of different color conjugated with streptavidin was developed for the simultaneous screening of various cancer biomarkers in blood at the single-molecule level. In the experiment, the srMINI chip was used to simultaneously detect three key cancer biomarkers: carcinoembryonic antigen (CEA), C-reactive protein (CRP), and alpha-fetoprotein (AFP). The srMINI chip exhibited 108 times higher detection sensitivity of 0.18-0.5 ag/mL (1.1-2.6 zM) for these cancer biomarkers than commercial enzyme-linked immunosorbent assay kits because of the absence of interfering signals from the substrate, establishing considerable potential for multiplex detection of cancer biomarkers in blood. Therefore, the simultaneous detection of various cancer biomarkers using the developed srMINI chip with high diagnostic precision and accuracy is expected to play a decisive role in early diagnosis or community screening as a single-molecule biosensor.

Social Determinants of Health and Perceived Cognitive Difficulties in High School Students in the United States

OBJECTIVE

The United States Centers for Disease Control and Prevention (CDC) conducted the Adolescent Behavior and Experiences Survey (ABES) to examine disruption and adversity during the COVID-19 pandemic. We examined the association between social determinants of health (SDoH) and cognitive problems attributed to physical or mental health problems among high school students.

METHOD

The ABES was an online survey. Perceived cognitive problems were assessed with the question: "Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?" A SDoH index was created by summing endorsements to 12 variables.

RESULTS

Participants were 6,992 students, age 14-18, with 3,294 boys (47%) and 3,698 girls (53%). Many adolescents reported experiencing cognitive problems (i.e., 45%), with girls (56%) more likely to report cognitive difficulties than boys (33%) [χ2(1) = 392.55, p < 0.001]. Having poor mental health was strongly associated with cognitive problems in both girls [81%, χ2(1, 3680) = 650.20, p < 0.001] and boys [67%, χ2(1, 3267) = 418.69, p < 0.001]. There was a positive, linear association between the number of SDoH experienced and reporting cognitive problems. Binary logistic regressions were used to identify predictors of cognitive difficulty for both boys and girls (e.g., being bullied electronically, experiencing food insecurity during the pandemic, being treated unfairly because of their race or ethnicity, and being in a physical fight).

CONCLUSIONS

A strikingly high proportion of adolescents reported experiencing problems with their cognitive functioning. After adjusting for current mental health problems, several SDoH remained associated with adolescents' reported cognitive difficulties, including experiencing racism, bullying, parental job loss, and food insecurity.

Ornamental plants as vectors of pesticide exposure and potential threat to biodiversity and human health

The production of conventional ornamental plants is pesticide-intensive. We investigated whether pesticide active ingredients (AIs) are still present in ornamentals at the time of purchase and assessed their potential ecotoxicity to non-target organisms. We purchased 1000 pot plants and 237 cut flowers of different species from garden centers in Austria and Germany between 2011 and 2021 and analyzed them for up to 646 AIs. Ecotoxicological risks of AIs were assessed by calculating toxic loads for honeybees (Apis mellifera), earthworms (Eisenia fetida), birds (Passer domesticus), and mammals (Rattus norvegicus) based on the LD50 values of the detected AIs. Human health risks of AIs were assessed on the basis of the hazard statements of the Globally Harmonized System. Over the years, a total of 202 AIs were detected in pot plants and 128 AIs in cut flowers. Pesticide residues were found in 94% of pot plants and 97% of cut flowers, with cut flowers containing about twice as many AIs (11.0 ± 6.2 AIs) as pot plants (5.8 ± 4.0 AIs). Fungicides and insecticides were found most frequently. The ecotoxicity assessment showed that 47% of the AIs in pot plants and 63% of the AIs in cut flowers were moderately toxic to the considered non-target organisms. AIs found were mainly toxic to honeybees; their toxicity to earthworms, birds, and mammals was about 105 times lower. Remarkably, 39% of the plants labeled as "bee-friendly" contained AIs that were toxic to bees. More than 40% of pot plants and 72% of cut flowers contained AIs classified as harmful to human health. These results suggest that ornamental plants are vectors for potential pesticide exposure of consumers and non-target organisms in home gardens.

Advancing equity, diversity, inclusivity, and accessibility in primary care: The development of an integrated educational experience model

This article presents the development of the Equity, Diversity, Inclusivity, and Accessibility (EDIA) Cross-Cutting Theme Project within the Team Primary Care (TPC) initiative, aimed at addressing systemic inequities through innovative educational strategies. Grounded in the social accountability of health professions framework, this project aims to equip primary care teams with the knowledge, skills, and attitudes necessary to promote health equity. The EDIA Integrated Educational Experience (IEE) model includes a self-assessment tool, digital learning space, and national mentorship network, providing a comprehensive approach for primary care teams to promote health equity. The IEE model utilizes a layered micro, meso, and macro approach to support cultural transformation within highly complex healthcare environments. Key lessons learned involve trust- and relationship-building processes to help dismantle historical silos and encourage open dialogue. Future efforts focus on implementation, ensuring adaptability, scalability, and sustainability, positioning the model as a catalyst for equitable primary care delivery.

The Association Between Proneness to Smartphone Addiction and Social Anxiety Among School Students and the Mediating Role of Social Support: A Call to Advance Jordanian Adolescents' Mental Health

BACKGROUND

Social anxiety is an emerging public health issue associated with significant impairment of social functioning during adolescence. Among many determinants of social anxiety, proneness to smartphone addiction may significantly contribute to the development of social anxiety. To cope with the consequential development of social anxiety, adolescent school students may rely on various forms of social support. Particularly in the Middle East, including Jordan, the relationship between proneness to smartphone addiction and adolescent social anxiety is understudied.

AIM

To examine the mediating role of social support in the relationship between proneness to smartphone addiction and social anxiety in a sample of adolescent school students.

METHODS

In this cross-sectional study, 432 adolescents were recruited via a random cluster sample from public schools across three provinces in Jordan. The data were collected face-to-face using the Social Anxiety Scale for Adolescents, the Smartphone Addiction Proneness Scale, and the Multidimensional Scale of Perceived Social Support.

RESULTS

Significantly higher levels of social anxiety were associated with females of lower economic status who reported more gaming hours and higher levels of proneness to smartphone addiction. Familial social support significantly mediated the relationship between proneness to smartphone addiction and social anxiety, controlling for the other covariates in the social anxiety model.

CONCLUSIONS

Familial social support reduced the impact of proneness to smartphone addiction on social anxiety. Nurses may supplement treatment for reducing social anxiety in adolescents suffering from proneness to smartphone addiction by fostering sources of familial social support.

A Scoping Review of Equine-Assisted Therapies on the Mental Health and Well-Being of Autistic Children and Adolescents: Exploring the Possibilities

Animals are increasingly being utilized to assist with therapies for people with various health conditions. Horses are often used as a mechanism of engagement and development for autistic children and adolescents. Horses offer a unique opportunity for interaction as the child or adolescent can physically ride and interact with the animal, thus creating a therapy that involves contact that is different to other animals. Benefits derived from equine-assisted therapies can be physical, social, behavioral, emotional, sensory, and cognitive. However, a current and specific research gap exists in understanding the potential mental health impacts of horse riding on autistic children and adolescents, as perceived and experienced by their parents, carers, and horse-riding service providers. This scoping review examined research on parents' and service providers' perceptions of the benefits of horse-related therapies, with a particular focus on perceptions of positive mental health impacts. A comprehensive electronic search across PubMed, Scopus and Cumulative Index to Nursing and Allied Health Literature identified 16 articles from 15 studies which met the inclusion criteria. Findings included non-mental health-related benefits (as perceived by parents and service providers), mental health-related benefits (as perceived by parents and service providers), benefits for those other than the child/adolescent, and limitations of equine-assisted therapies. With the increased use of equine therapy, and the mounting evidence of its positive impacts on mental health, it is timely to expand research on how to better harness interventions and maximize the mental health benefits for autistic children and adolescents.

Linking heart and mind - lived experiences of parents to children with congenital heart disease and mental health issues

Children with congenital heart disease are more likely to receive special educational services in schools and have an increased risk of mental health issues. We explored the lived experiences of parents caring for a child with heart disease and concurrent mental health issues in Denmark. Semi-structured interviews with ten parents (age 39-57 years) to these children (age 5-17 years) were analysed using interpretative phenomenological analysis. Three Group Experiential Themes (GETs) were generated from the analysis: The first GET, Parental roles and caring behaviours, described parental struggles of fulfilling their parenting role ideals and experiences with stigmatization of MHI. GET two, Parental reflections on their illness explanations, portrayed how parents utilize different illness explanations to make sense of their child's MHI. GET three, Differences in access to help and support, captured how the CHD affected overall access to mental health support. The results may inform various topics of importance for health professionals to address in their clinical encounters with these families.

Preferential Partitioning of Per- and Polyfluoroalkyl Substances (PFAS) and Dissolved Organic Matter in Freshwater Surface Microlayer and Natural Foam

Per- and polyfluoroalkyl substances (PFAS) are surfactants that can accumulate in the surface microlayer (SML) and in natural foams, with potential elevated exposure for organisms at the water surface. However, the impact of water chemistry on PFAS accumulation in these matrices in freshwater systems is unknown. We quantified 36 PFAS in water, the SML, and natural foams from 43 rivers and lakes in Wisconsin, USA, alongside measurements of pH, cations, and dissolved organic carbon (DOC). PFAS partition to foams with concentration ranging 2300-328,200 ng/L in waters with 6-139 ng/L PFAS (sum of 36 analytes), corresponding to sodium-normalized enrichment factors ranging <50 to >7000. Similar enrichment is observed for DOC (∼70). PFAS partitioning to foams increases with increasing chain length and is positively correlated with [DOC]. Modest SML enrichment is observed for PFOS (1.4) and FOSA (2.4), while negligible enrichment is observed for other PFAS and DOC due to low specific surface area and turbulent conditions that inhibit surfactant accumulation. However, DOC composition in the SML is distinct from bulk water, as assessed using high-resolution mass spectrometry. This study demonstrates that natural foams in unimpacted and impacted waters can have elevated PFAS concentrations, whereas SML accumulation in surface waters is limited.

Melatonin in Human Milk: A Scoping Review

Melatonin is vital in human circadian rhythm and infant development. This scoping review summarized the current knowledge about melatonin's presence and effects in human milk to promote better understanding of its secretion pattern and clinical advancement of maternal-infant health. The review followed the Joanna Briggs Institute guideline and answered the question: What is the current knowledge about melatonin hormone in human milk? The databases searched were PubMed, CINAHL, SCOPUS, Web of Science, LILACS, Scielo, EMBASE, Science Direct, Eric, Cochrane, in addition to grey literature and reference lists of included sources. Research papers included English, Spanish, or Portuguese languages, regardless of study type or publication date. The study selection and data extraction involved two independent reviewers. Twenty-nine studies met inclusion criteria. The studies, conducted between 1993 and 2023, employed diverse designs, with cross-sectional studies being the most prevalent. Melatonin concentration exhibited a consistent pattern, being higher at night, and elevated in colostrum. The analysis methods for melatonin concentration evolved, with recent advancements contributing to more accurate measurements. Factors influencing melatonin levels, such as delivery type, maternal age, and health conditions, demonstrated a complex relationship, potentially impacting the health and development of infants. The dynamic nature of melatonin in human milk calls for continued interdisciplinary research, bridging gaps between clinical, biochemical, and epidemiological perspectives. Standardizing melatonin analysis methods are needed. Nurses should assess factors influencing melatonin levels in milk to promote interventions and guidance aimed at enhancing the regulation of the circadian cycle during the perinatal period and its benefits.

A deficit to reach the isokinetic velocity in youth wheelchair users with spina bifida

INTRODUCTION

The self-paced adopted by wheelchair users in their postural transfers and locomotion may require sufficient levels of speed-strength in the upper limbs. In clinical practice, we observed limited functional independence and social participation.

OBJECTIVES

This study aimed to investigate and compare the speed-strength relationship between wheelchair users with spina bifida (SB) and typically developing youth. In particular, to analyze if SB wheelchair users reached the preset velocities in the isokinetic evaluation of shoulder and elbow.

DESIGN

Cross-sectional observational study.

SETTING

Ribeirão Preto Medical School of the University of São Paulo.

PARTICIPANTS AND PROCEDURES

SB (SB; n = 11) and controls (CT; n = 22) performed the isokinetic assessment of shoulder abductors (SAB), adductors (SAD), flexors (SFL), extensors (SEX), and elbow flexors (EFL) and extensors (EEX) at velocities of 60 and 120degree.s-1. The analysis of covariance was used to identify the intergroup differences in muscle performance.

OUTCOME MEASURES

The values of peak torque (PT), power (Pow), time to peak torque (tPT) and the percentage to reach the isokinetic velocity.

RESULTS

The percentage to reach 120degree.s-1 was moderate-to-low for both groups (26-75.9%). CT presented a significantly greater relative risk of reaching the preset velocities than SB. SB presented higher PT and Pow for SAB and SFL at 60degree.s-1, higher PT for SFL and EEX at 120degree.s-1, and lower tPT for SFL at 120degree.s-1 compared to CT.

CONCLUSION

SB had difficulty reaching 120degree.s-1, probably related to neuromuscular differences. However, arm movements in their daily tasks seem to maintain the ability to produce PT and Pow.

"Deeds not words": the forgotten class

The Sir Stanley Peart Essay Competition is an annual event run by the British and Irish Hypertension Society to encourage Early Career Researchers to continue the ethos of Sir Stanley Peart. Sir Stanley Peart was a clinician and clinical researcher who made a major contribution to our understanding of blood pressure regulation. He was the first to demonstrate the release of noradrenaline in response to sympathetic nerve stimulation. He was also the first to purify, and determine the structure of, angiotensin and he later isolated the enzyme, renin, and carried out many important investigations of the factors controlling its release in the body. This year, the essay topic was "Do we need new classes of antihypertensive drugs?". In her prize-winning essay, "Deeds not words": the forgotten class, Dr Jenner proposes that there is a need to address the unmet needs of hypertensive women, to increase their involvement in clinical trials and develop antihypertensives that are fit for purpose. Dr Jenner proposes that women are therefore the perfect class for new antihypertensives.

Weight stereotypes in eating disorder recognition

OBJECTIVE

We investigated weight stereotypes in the recognition and referral of eating disorders (EDs) by assessing if recognition, health care referral, perceived acceptability, perceived distress, and perceived prevalence of an ED differ depending on the weight of the subject in the vignette.

METHOD

Community participants (N = 180, age = 19-74) read three different vignettes describing three females with different EDs [anorexia nervosa/atypical anorexia nervosa (AN/AAN), bulimia nervosa (BN), binge eating disorder (BED)] and were randomized to three different experimental conditions concerning an individual with a different weight (overweight, normal, and underweight).

RESULTS

Across EDs, participants were more likely to recognize a problem, refer for treatment, and rate a higher perceived level of distress in the vignettes of overweight individuals than in the vignettes of normal weight individuals. For BED, a larger proportion of participants in the overweight condition classified the issue described in the vignette as a form of eating pathology compared to the normal weight condition.

DISCUSSION

These results highlight several weight stereotypes that exist in the recognition and health care referral of EDs. Future ED education and awareness programs should emphasize that EDs can occur in any individual, regardless of their weight.

Enhanced blood glucose levels prediction with a smartwatch

Ensuring stable blood glucose (BG) levels within the norm is crucial for potential long-term health complications prevention when managing a chronic disease like Type 1 diabetes (T1D), as well as body weight. Therefore, accurately forecasting blood sugar levels holds significant importance for clinicians and specific users, such as type one diabetic patients. In recent years, Continuous Glucose Monitoring (CGM) devices have been developed and are now in use. However, the ability to forecast future blood glucose values is essential for better management. Previous studies proposed the use of food intake documentation in order to enhance the forecasting accuracy. Unfortunately, these methods require the participants to manually record their daily activities such as food intake, drink and exercise, which creates somewhat inaccurate data, and is hard to maintain along time. To reduce the burden on participants and improve the accuracy of BG level predictions, as well as optimize training and prediction times, this study proposes a framework that continuously tracks participants' movements using a smartwatch. The framework analyzes sensor data and allows users to document their activities. We developed a model incorporating BG data, smartwatch sensor data, and user-documented activities. This model was applied to a dataset we collected from a dozen participants. Our study's results indicate that documented activities did not enhance BG level predictions. However, using smartwatch sensors, such as heart rate and step detector data, in addition to blood glucose measurements from the last sixty minutes, significantly improved the predictions.

Occupational therapy experiences of interprofessional collaboration in the support of autistic children

INTRODUCTION

Autistic children commonly receive simultaneous services from various health-care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health-care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children.

METHODS

This study employed an exploratory qualitative descriptive design. Semi-structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data.

CONSUMER AND COMMUNITY CONSULTATION

This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines.

FINDINGS

Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism-related frames of reference were perceived to influence interprofessional collaboration.

CONCLUSION

Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model.

PLAIN LANGUAGE SUMMARY

This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful.

Early Onset Psychosis in a Pediatric Oncology Setting: A Case Report

Schizophrenia (SCZ) and schizoaffective disorder (SHZ) are psychiatric disorders commonly identified in individuals in their late adolescence or early adulthood. Comorbidities are common, though a concurrent diagnosis of leukemia, one of the most frequently occurring cancers of adolescence, has not yet been described in such cases. This case study outlines the clinical presentation, course, and treatment response of two 17-year-old male adolescents whose psychotic disorders complicated their leukemia treatment. The first patient was diagnosed with leukemia and subsequently with SCZ while undergoing leukemia treatment. The second patient was diagnosed with SHZ prior to the onset of leukemia. The case study will follow the methodology of Robert E. Stake (Abma & Stake, 2014), as the two cases share a leukemia diagnosis and the reported mental health impact connected with cancer-directed treatment. Early identification and treatment are critical for both psychotic disorders and cancers, often impacting the long-term prognosis. However, when co-occurring, their interplay can present unique challenges to care.

Glee in threes: Positive affect synchrony in parent-infant triads is moderated by maternal hair cortisol and parenting stress

BACKGROUND

Positive affect synchrony, or the reciprocal exchange of positive affect during free play, can scaffold infants' socioemotional development. However, parental stress may compromise the expression and exchange of positive affect within families. The current study assesses whether parenting stress and hair cortisol are associated with positive affect synchrony during a triadic play interaction.

METHOD

Within 70 different-sex dyads consisting of first-time parents and their six-month-old infants who participated in a four-minute laboratory-based free-play task, facial affect of each member of the triad was observationally microcoded at the second-by-second level. Hair samples were collected from mothers and fathers for cortisol assay, and parents completed a self-report measure of parenting stress.

RESULTS

Using dynamic structural equation modeling (DSEM), we found positive between-level and within-level affect synchrony across all family members, with one exception: infants' affect did not predict fathers' affect at the following timepoint. Mother-to-infant affect synchrony was greater in mothers with higher hair cortisol. Similarly, mothers with higher parenting stress tended to have greater infant-to-mother affect synchrony, and had infants that displayed less overall positive affect across the interaction.

CONCLUSION

We found evidence for bidirectional, time-lagged synchrony in the momentary positive affect of mothers, fathers, and infants. Maternal hair cortisol concentration and parenting stress seem to increase affect synchrony between mothers and infants- suggesting that parental stress may correlate with greater affective attunement, but less overall positive affect in infants.

Tinea capitis and its associated factors among school children in Gondar town northwest, Ethiopia

INTRODUCTION

Tinea capitis is a global public health concern with a unique therapeutic challenge and mostly affects children. The burden is double in developing countries. There is no study on school-going children from the urban residence in Ethiopia.

OBJECTIVE

To determine the prevalence of Tinea capitis and its associated factors among school children in Gondar town northwest, Ethiopia 2021.

METHODS

An institution-based cross-sectional study was conducted among school children in Gondar town from November 20 to December 20, 2021. Data was collected through an interviewer-administered structured questionnaire. A stratified simple random sampling technique was employed. Then data were entered into EPI Info version 7.22 and transferred to Statistical package for social science (SPSS) version 22 for further analysis. The binary logistic regression model was employed to identify factors associated with tinea capitis, and the strength of association and statistical significance was declared using the adjusted odds ratios with its corresponding 95% CI, and p-value ≤ 0.05 respectively.

RESULT

The prevalence of tinea capitis among school children in Gondar town was found to be 29.4%. Public school student (AOR = 2.79 95% CI: 1.34-5.87), widowed mother (AOR = 6.09, 95% CI: 1.83-11.23), students in the age group of 5-8 years (AOR = 3.79 95% CI: 1.68-8.55), animal contact (AOR = 2.61 95% CI: 1.15-5.90), and family similar illness category (AOR = 8.49 95% CI: 3.73-11.39) have risen the likelihood of tinea capitis among school children.

CONCLUSIONS

The prevalence of tinea capitis was higher. Young age, children from widowed marital status, illiterate mother, history of share blades, animal contact, a family similar illness, and lower number of living rooms are important factors contributing to tinea capitis among school children. Health education for the mother on the mode of transmission, prevention, and improve the low socioeconomic status of the parent is crucial.

KEY TERMS

Children, Ethiopia, Gondar, School age, Tinea capitis.

Prevalence of premenstrual syndrome in adolescent girls

BACKGROUND

Premenstrual syndrome (PMS) is characterized by physical, cognitive, emotional, and behavioral symptoms that appear during the luteal phase of the menstrual cycle, disappear after menstruation, and are recurrent in every cycle. PMS significantly affects the social and academic lives of adolescents, and historically, it has been neglected by healthcare professionals. We aimed to evaluate the current point prevalence of PMS in Turkish adolescents presented to a tertiary adolescent medicine clinic.

MATERIAL AND METHOD

Adolescent girls between the ages of 12 and 18 and who had regular menstrual cycles for at least three months without any mental or chronic illness were assessed. A clinic information form and the 'Premenstrual Syndrome Scale' (PMSS) questionnaire were completed. Those with a PMSS total score of more than 50% of the total score (>110 out of 220) were classified as PMS (+). Those classified as PMS were further classified as mild-moderate (score: 110-150) and severe (>150).

RESULTS

The study included 417 adolescents. The point prevalence of PMS was found to be 61.2% (n:255). Of those with PMS, 49.4% had mild-moderate and 50.6% had severe PMS. The mean PMSS score was 154.56 ± 30.43 in the PMS group and 76.17 ± 20.65 in the non-PMS group (p<0.001). The mean age was 15.41 ± 1.3 years in the PMS group and 14.88 ± 1.35 years in the non-PMS group (p=0.029). None of the youth in our study applied to our clinic due to any premenstrual complaints.

CONCLUSION

PMS is frequently observed in youth, as indicated by our study. Adolescents have little awareness of PMS and their need for healthcare services. During the evaluation of adolescents, it is important for health care providers to acquire knowledge regarding the features of menstrual cycles and conduct a comprehensive psychosocial assessment.

Factors associated with having uncontrolled asthma in rural Appalachia

BACKGROUND

Chronic respiratory disease disproportionately affects residents of Appalachia, particularly those residing in Central Appalachia. Asthma is particularly burdensome to Central Appalachian residents regarding cost and disability. Improving our understanding of how to mitigate these burdens requires understanding the factors influencing asthma control among individuals with asthma living in Central Appalachia, specifically rural Kentucky.

METHODS

This community-based, cross-sectional epidemiologic study used survey data to identify characteristics associated with uncontrolled and controlled asthma. The designation of "uncontrolled asthma" was based on a self-report of ≥ 2 asthma exacerbations in the past year. Individuals with ≤ 1 or no exacerbations were considered to have controlled asthma. Chi-square or Fisher exact tests assessed the association between categorical variables and asthma control categories. Logistic regression was conducted to determine the impact of factors on the likelihood of uncontrolled asthma.

RESULTS

In a sample of 211 individuals with self-reported asthma, 29% (n = 61, 46 females) had uncontrolled asthma. Predictors of uncontrolled asthma included depression (odds ratio 2.61, 95% CI 1.22-5.61, p = .014) and living in multi-unit housing (odds ratio 4.99, 95% CI 1.47-16.96, p = .010) when controlling for age, sex, financial status, and occupation. Being overweight or obese was not a predictor of uncontrolled asthma. Physical activity and BMI did not predict the likelihood of uncontrolled asthma.

CONCLUSION

This study highlights significant challenges rural communities in Appalachian Kentucky face in managing asthma. Factors like depression, housing conditions, and a lack of self-management strategies play pivotal roles in asthma control in this population.

Identifying the challenges of policy content related to high-risk sexual behaviors, stimulant drugs, and alcohol consumption in adolescents

BACKGROUND

This study aims to identify policy content challenges related to high-risk sexual behaviors, stimulant drugs, and alcohol consumption in Iranian adolescents.

METHODS

This qualitative study analyzed high-level and national documents pertaining to adolescent health, high-risk sexual behaviors, stimulant, and alcohol consumption in adolescents. The documents, which were published by public organizations between January 1979 and February 2023 and publicly available, were complemented by interviews with policymakers and executives. The study involved reviewing 51 papers and conducting interviews with 49 policymakers and executives at the national, provincial, and local levels who were involved in addressing adolescent behaviors related to high-risk sexual behaviors, stimulant, and alcohol consumption. The data collected was analyzed using conventional content analysis.

RESULTS

The study's results involved examining policy content and identifying challenges related to policy content. The analysis revealed that from the beginning of the Iranian revolution in 1979 until the late 1990s, the dominant approach in Iran was to deny the existence of high-risk behaviors among adolescents. However, in the early 2000s, the country began to adopt a new approach that acknowledged the social harms and ineffectiveness of previous strategies. As a result, a new policy framework was introduced to address high-risk behaviors among adolescents. The study's interviews with policymakers and executives identified 12 challenges related to policy content, including parallel programs, lack of institutional mapping, lack of evidence-based policymaking, lack of integrated approach regarding training, late parent training, lack of consideration of all occurrence reasons in adolescents' high-risk behaviors policymaking, and the existence of many abstinence policies regarding high-risk behaviors.

CONCLUSIONS

The study's findings suggest that high-risk behaviors among adolescents in Iran are primarily a health issue, rather than a social or ideological one. Unfortunately, ideological approaches, stigma, and policymaking based on anecdotes rather than evidence have had a significant impact on this area. To improve policymaking in this domain, it is crucial to address these challenges by tackling stigma, adopting an integrated and holistic approach, and implementing evidence-based policies that consider all relevant aspects, including adolescents' subcultures and policy audiences. Such an approach can also be useful for other countries facing similar conditions.

Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design

BACKGROUND

Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic.

OBJECTIVE

The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic.

METHODS

This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC's implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record-extracted health outcomes data and semistructured interviews with the CHC's staff and patients participating in the RPM program.

RESULTS

The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology.

CONCLUSIONS

While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.

Disposable e-cigarette use: Factors, frequency and cigarette smoking among United States high school students

BACKGROUND AND AIMS

Disposable e-cigarette use has increased among United States (US) high school students in recent years. However, there is limited research on the profile of these users, how often they use these products, and whether they displace cigarette smoking. This study aimed to measure how disposable e-cigarette use among US youth varies according to demographic characteristics and whether there is any association between e-cigarette use and reduced use of traditional cigarettes.

DESIGN

We used cross-sectional data from the 2022 National Youth Tobacco Survey and conducted a multinomial logistic regression to examine factors associated with the types of e-cigarette devices used in the prior 30 days, adjusting for sex, sexual identity, grade level and race/ethnicity. We also used a finite mixture model to account for unobserved differences among users and identify e-cigarette use patterns in different subgroups of users.

SETTING

United States.

PARTICIPANTS

High school students in grades 9-12 (n = 14 389).

MEASUREMENTS

Survey participants self-reported the type of e-cigarette device used, the frequency of e-cigarettes used and cigarettes smoked over the past 30 days.

FINDINGS

Disposable e-cigarettes were the most popular e-cigarette type. Sex, sexual orientation, grade level and race/ethnicity were associated with disposable e-cigarette use. The odds of disposable e-cigarette use were lower in male students than in female students (odds ratio [OR] = 0.78, 95% confidence interval [CI] = [0.64-0.96]), and higher in students who identified as gay or lesbian (OR = 1.70, 95% CI = [1.11-2.61]) or bisexual (OR = 1.52, 95% CI = [1.16-1.99]) than in heterosexual students. The odds of disposable use were higher among students in higher grades (10th, 11th and 12th) than in 9th graders (OR = 1.71, 2.24 and 2.52, respectively). Disposable e-cigarette users had a lower frequency of traditional cigarette use than other e-cigarette users, both in the low-frequency class (incidence rate ratio [IRR] = 0.33, 95% CI = [0.12-0.92]) and the high-frequency class (IRR = 0.27, 95% CI = [0.08-0.92]).

CONCLUSIONS

Disposable e-cigarette use appears to be higher among United States high school students who are female, older and/or identify as gay, lesbian or bisexual. Disposable e-cigarettes appear to be associated with reduced traditional cigarette use.

Intention to quit or reduce e-cigarettes, cannabis, and their co-use among a school-based sample of adolescents

INTRODUCTION

Little is known about the prevalence and predictors of adolescents' intention to quit or reduce use of e-cigarettes and/or cannabis.

METHODS

Frequencies of intention to change (quit, reduce) e-cigarettes and/or cannabis use were examined among 23,915 surveyed middle and high school students with sole and co-use. Predictors of intention to change were identified via LASSO/multilevel logistic regression.

RESULTS

Among those with sole e-cigarette use (n = 543), 40.9 % intended to quit and 24.1 % intended to reduce; non-daily e-cigarette use predicted intention to quit and reduce e-cigarettes (p's < 0.03). Among those with sole cannabis use (n = 546), 10.6 % intended to quit and 25.1 % intended to reduce; absence of cannabis cravings predicted intention to reduce cannabis use (p < 0.01). Among those with co-use (n = 816), 26.2 % intended to either quit or reduce (quit/reduce) both substances, 27.5 % intended to quit/reduce e-cigarettes only, and 6.9 % intended to quit/reduce cannabis only. No predictors emerged for intention to change e-cigarette use among those with co-use (p's > 0.09), but younger age, lack of poly-tobacco use, and lack of cannabis craving predicted intention to quit/reduce cannabis use (p's < 0.04).

CONCLUSIONS

More than half of adolescents with past-month e-cigarette use, regardless of concurrent cannabis use, expressed interest in changing their use. However, only heaviness of e-cigarette use emerged as a predictor of intention to change suggesting. While fewer students expressed interest in changing their cannabis use, cannabis cravings and poly-tobacco use predicted intent to change. Overall, findings emphasize the need to tailor interventions towards adolescents engaging in more problematic substance use patterns.

Mosquito (Diptera: Culicidae) diversity and arbovirus detection across an urban and agricultural landscape

Fragmented landscapes in Mexico, characterized by a mix of agricultural, urban, and native vegetation cover, presents unique ecological characteristics that shape the mosquito community composition and mosquito-borne diseases. The extent to which landscape influences mosquito populations and mosquito-borne diseases is still poorly understood. This work assessed the effect of landscape metrics -agriculture, urban, and native vegetation cover- on mosquito diversity and arbovirus presence in fragmented tropical deciduous forests in Central Mexico during 2021. Among the 21 mosquito species across six genera we identified, Culex quinquefasciatus was the most prevalent species, followed by Aedes aegypti, Ae. albopictus, and Ae. epactius. Notably, areas with denser native vegetation cover displayed higher mosquito species richness, which could have an impact on phenomena such as the dilution effect. Zika and dengue virus were detected in 85% of captured species, with first reports of DENV in several Aedes species and ZIKV in multiple Aedes and Culex species. These findings underscore the necessity of expanding arbovirus surveillance beyond Ae. aegypti and advocate for a deeper understanding of vector ecology in fragmented landscapes to adequately address public health strategies.

Pulmonary Atresia with Intact Ventricular Septum, a National Comparison Between Interventional and Surgical Approach, in Combination with a Systemic Literature Review

This study aimed to compare long-term morbidity in patients with pulmonary atresia with intact ventricular septum (PA-IVS) treated with catheter-based intervention (group A) versus those undergoing heart surgery (group B) as initial intervention. Additionally, we conducted a systematic literature review on PA-IVS treatment. All neonates born in Sweden with PA-IVS between 2007 and 2019 were screened for inclusion. The inclusion criterion was decompression of the right ventricle for initial intervention. Medical records were reviewed, as well as the initial preoperative angiogram, and the diagnostic echocardiogram. Comparisons between groups were performed with Mann-Whitney U-test and Fisher´s exact test. A systematic literature review of original studies regarding treatment of PA-IVS (2002 and onward) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to assess the outcomes of patients with PA-IVS. 34 (11 females) patients were included, 18 in group A and 16 in group B. There was no mortality in either group. Follow-up time ranged from 2 to 15 years (median 9). All attempted perforations in group A were successful, and 16 out of 18 patients reached biventricular circulation. In the surgical group 15 out of 16 patients reached biventricular circulation. The literature review presented heterogeneity in standards for treatment. This retrospective population-based multicenter study demonstrates that both catheter-based intervention and heart surgery are safe procedures. Our results are comparable to, or exceed, those in the systematic literature review. The systematic literature review displays a great heterogeneity in study design, with no definitive golden standard treatment.

Maternal victimization and neglected offspring: Child marriage, IPV and depression symptoms among Salar Muslim women

BACKGROUND

Child neglect is prevalent in western rural China, yet there is limited research among ethnic minority communities. The Salar, a Turkic-Muslim ethnic minority residing primarily in western China, also face this specific problem. The group is deeply influenced by ethnicity, Islam and Chinese Confucianism, which in turn makes women vulnerable to child marriage and IPV. These victimizations, coupled with various life stressors, further complicate the challenges of providing adequate care for their children.

OBJECTIVE

This study hypothesizes a relationship between child neglect and maternal child marriage, IPV victimization, and depression symptoms.

PARTICIPANTS AND SETTING

201 married Salar women from five villages in Xunhua Salar Autonomous County, China, were randomly selected to participate in the study.

METHOD

A probability proportional to size (PPS) sampling approach was used to collect a random representative multi-stage cluster sample in 2022. Random effects Poisson regression models were used to test the hypotheses.

RESULTS

The participants reported a 65.6 % rate of child neglect and a 30.8 % rate of IPV in the past year. 37.6 % experienced child marriage. Results revealed significant associations between child neglect and child marriage, IPV, and depression symptoms. A two-way interaction between IPV and depression symptoms was strongly positively associated with child neglect.

CONCLUSIONS

This research indicates that Salar Muslim mothers who have experienced child marriage, adulthood victimization, and depression are at a higher risk of neglecting their children. The findings represent a valuable initial step toward researching and addressing the protection needs of women and children from Muslim ethnic minorities in China.