Psychosocial Self-efficacy and its Association with Selected Potential Factors Among Adults with Type 1 Diabetes: A Cross-Sectional Survey Study

INTRODUCTION

The management of type 1 diabetes, a non-preventable chronic disease, leads to a high physical and psychological burden on the individual. Digital health technology can improve a person's psychosocial self-efficacy and thereby contribute to improved diabetes self-care. The aim of this study was to explore associations between psychosocial self-efficacy and demographic-, disease specific-, well-being as well as digital health technology (DHT) related factors among adults with type 1 diabetes.

METHODS

A primarily web-based cross sectional survey was conducted among adults with type 1 diabetes in Sweden (n = 301). Psychosocial self-efficacy was assessed using the Swedish version of the Diabetes Empowerment Scale, Swe-DES-23. The survey also contained questions related to demographic-, disease specific-, well-being as well as digital health technology related variables.

RESULTS

Higher well-being scores and lower HbA1c levels were associated with higher psychosocial self-efficacy in multiple linear regression analysis. In multivariate analysis, gender, body mass index, well-being scores, and HbA1c levels showed association with psychosocial self-efficacy. None of the DHT factors were found associated with psychosocial self-efficacy.

CONCLUSIONS

In this study, higher well-being score and lower self-reported HbA1c levels were associated with higher psychosocial self-efficacy in both univariate- and multivariate analysis and accounted for 30% of the variation in psychosocial self-efficacy in the regression model. Thus, measures to improve psychosocial self-efficacy in adults with type 1 diabetes may help maintain their psychological well-being and blood glucose control.

Sociodemographic Correlates of Postpartum Depression: A Survey-Based Study

Objective: Post-partum depression (PPD) has been reported in about one-seventh to one-tenth of women. The aim of this study is to identify the demographic, obstetrics, social, and psychological risk factors of PPD among the eastern region of the United Arab Emirates. Method : A community-based cross-sectional study was performed on 200 women who had a recent singleton pregnancy and delivered newborn within past six months via convenience sampling and email snowballing. Several demographics, obstetrics, social, and psychological factors of the respondents were assessed using a survey form. The Edinburgh depression rating scale (EDRS) was used for the identification of women with possible PPD. Descriptive statistics were utilized for the representation of demographic variables, whereas Chi-square test was employed to assess categorical variables. Also, logistic regression was applied to evaluate the association of investigated variables and PPD. Results: The median EDRS score amongst the study participants was found to be 11 (0-26). The prevalence of PPD was found to be 57% in the studied population. Significant differences were observed in the adverse life events, emotional supports, marital conflicts and history of depression of the participants with and without PPD (P < 0.01). The risk factors significantly associated with PPD were age of the newborn (OR = 6.50, 95%CI: 1.17-19.91), marital relationship (OR = 4.15, 95%CI: 1.31-15.22), maternal educational level (OR = 5.10, 95%CI: 4.30-16.58), adverse life events (OR = 9.32, 95%CI: 1.33-35.32), and history of depression (OR = 5.24, 95%CI: 3.14-11.96). Conclusion: Given the findings, there is an urgent need for policy initiatives to address the identified risk factors, such as improving access to education, strengthening supportive marital relationships, and providing comprehensive mental health services for pregnant women.

Knowledge, Attitude, and Practice of Breast Cancer Patients Toward Lymphedema Complications: Cross-Sectional Study

Breast cancer is commonly treated through surgical resection, but a common complication of the procedure is lymphedema of the upper limbs, which can significantly impact patients' daily life. This study aims to investigate the knowledge, attitude, and practice (KAP) of breast cancer patients with regard to lymphedema complications. This cross-sectional study was conducted by a self-administered questionnaire between August and October 2022 toward breast cancer patients in our Hospital of Traditional Chinese Medicine. A total of 529 breast cancer patients were enrolled, including 186 (35.16%) aged < 50 years old. Participants had moderate knowledge, attitudes, and practices with scores of 18.24 ± 3.145 (possible range: 0-30), 62.24 ± 10.260 (possible range: 17-85), and 63.27 ± 20.967 (possible range: 21-105), respectively. Multivariate logistic regression showed that high school/technical secondary school (OR = 1.880, 95% CI = 1.107-3.194, P = 0.019) and being retired (OR = 0.482, 95% CI = 0.245-0.947, P = 0.034) were independently associated with good knowledge. Knowledge (OR = 1.321, 95% CI = 1.222-1.428, P < 0.001) was independently associated with a good attitude. Furthermore, knowledge (OR = 1.262, 95% CI = 1.151-1.384, P < 0.001) and attitude (OR = 1.122, 95% CI = 1.085-1.160, P < 0.001) were independently associated with good practice. Breast cancer patients have moderate knowledge, attitudes, and practices regarding lymphedema complications. Effective education and self-management programs are needed to improve patients' KAP toward lymphedema.

Examination of Behavioural Patterns of Psychological Distress and Evaluation of Related Factors: A latent class regression

Objectives

This study aimed to identify the behavioural pattern of psychological distress (PD) in the population of 18 to 65 years old people in Mashhad, Iran, using latent class regression and evaluate the related factors. PD is a unique emotional state with suffering in response to a stressor or specific need that leads to temporary or permanent impacts. Due to its negative effects on several features of life like the quality of life, health, performance and productivity of individuals, PD and its consequences are considered a public health priority.

Methods

A cross-sectional study was performed on 425,286 individuals aged 18 to 65, who were referred to health centres in Mashhad, northeastern Iran in the first half of 2018. The information required for this study, including a checklist of demographic information and the six-item Kessler Psychological Distress Scale (K-6), was obtained from the Sina System.

Results

Latent class regression identified three latent patterns of PD in answering the questions of the K-6 questionnaire, including severe PD (14%), low PD distress (40%) and no PD (46%). Statistical variables of this study due to the results are considered as the following: women, illiterate people, unemployed and divorced people, individuals aged between 50 and 59 years and people with low weight were more likely to be in the severe PD class than in the no PD class.

Conclusion

Although a small percentage of people were classified as severely disturbed, the findings showed a high rate of symptoms of distress and sadness even in the no PD class.

The relationship between physical activity and the severity of menopausal symptoms: a cross-sectional study

OBJECTIVE

To investigate the relationship between physical activity and the severity of menopausal symptoms in middle-aged women in northwest China.

METHODS

This was a cross-sectional online survey study. Using a snowball sampling method, 468 women aged 45 to 60 were recruited from northwest China and their demographic information was collected. The modified Kupperman Menopausal Index scale and International Physical Activity Questionnaire short form were used in this study. Random forest was used to rank the importance of variables and select the optimal combination. The direction and relative risk (odds ratio value) of selected variables were further explained with an ordinal logistic regression model.

RESULTS

The prevalence of menopausal syndromes was 74.8% and more than one-half of the participants had moderate or severe symptoms (54.3%). The Mantel-Haenszel linear-by-linear chi-square test showed a strong and negative correlation between physical activity level and the severity of menopausal symptoms (P < 0.001). Random forest demonstrated that the physical activity level was the most significant variable associated with the severity of menopausal symptoms. Multiple random forest regressions showed that the out-of-bag error rate reaches the minimum when the top 4 variables (physical activity level, menopausal status, perceived health status, and parity) in the importance ranking form an optimal variable combination. Ordinal logistic regression analysis showed that a higher physical activity level and a satisfactory perceived health status might be protective factors for menopausal symptoms (odds ratio (OR) < 1, P < 0.001); whereas perimenopausal or postmenopausal status and 2 parities might be risk factors for menopausal symptoms (OR > 1, P < 0.001).

CONCLUSIONS

There is a strong negative correlation between physical activity and the severity of menopausal symptoms. The results have a clinical implication that the menopausal symptoms may be improved by the moderate-to-high level physical activity in the lives of middle-aged women.

Association between asthma and work absence in working adults in the United States

The present study aimed to investigate the association between asthma and work absence in a large sample of US working adults, while controlling for several sociodemographic and health characteristics. This study used data from the 2019 Health and Functional Capacity Survey of the RAND American Life Panel (ALP). Work absence corresponded to the number of days of absence from work for health-related reasons in the past 12 months. Current asthma was self-reported and was included in the analyses as a dichotomous variable. Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, and number of chronic physical or psychiatric conditions. Finally, the association between asthma and work absence was analyzed using logistic regression models. This study included 1,323 adults aged 22-65 years (53.1% males; mean [SD] age 43.1 [11.7] years). Individuals with asthma were more likely to report at least one (81.5% versus 56.8%, p-value <0.001) or three days of absence (56.9% versus 31.3%, p-value =0.003) from work in the past 12 months than those without asthma. These findings were corroborated in the regression analyses, as asthma was positively and significantly associated with work absence after adjusting for all control variables (at least one day of absence: OR =3.24, 95% CI =1.44-7.29; at least three days of absence: OR =2.61, 95% CI =1.26-5.40). This US study of working adults showed that asthma was a risk factor for work absence. Further research is warranted to better understand the factors predisposing to work absence in the asthma population.

The Knowledge of Palliative Care among Geriatric Home Staff in Jordan

Background

Palliative care in nursing homes (NHS) is a major challenge, because it gives the demands of the knowledge and skills of nursing staff to provide high-quality care.

Purpose

The purpose of this study was to assess the knowledge of palliative care among nursing home staff.

Methods

A descriptive study design was used, 124 nurses, aged over 30 years and most of them were male working in the nursing home in Jordan. Around 109 participants were responded to the questionnaire. All licensed nurses were included in the study, except of that will be excluded. The knowledge of palliative care was measured via the palliative care survey. knowledge scores were ranged 0-1, with higher scores indicate greater knowledge.

Results

Descriptive statistics was used. The Knowledge of palliative care issues is 0.21 in Jordan (95% confidence interval (CI) 0.19-0.24). Knowledge of physical aspects that can contribute to pain is 0.22 (95% CI 0.2-0.25), and knowledge of psychological aspects that can contribute to pain is 0.21 (95% CI 0.2-0.22).

Conclusion

Education for nursing staff needs to be enhanced to address the specific knowledge gaps. Additional studies with large sample size recommended to explore the effect of educational programs in regard of palliative care in nursing homes.

Functional Outcomes Associated With Independence in Walking Among People With Hereditary Ataxias: An Exploratory Cross-sectional Study

OBJECTIVE

This study aimed to identify functional outcomes related to independence in walking among people affected by hereditary ataxias.

METHODS

Sixty participants were selected by convenience in a list provided by an organization of people with ataxia. Sociodemographic and clinical data were collected using a semistructured questionnaire. The Assessment and Rating of Ataxia was used to assess and rate cerebellar ataxia. Changes in body structure and function, limitation in activities, and restriction in participation were evaluated with specific outcome measures. Participants were classified as independent in walking if they were able to walk without walking aids or human assistance and as dependent in walking if they have been using walking aids (sticks, crutches, or walkers) for more than 6 months, using a wheelchair for locomotion most of the day, or both. Multivariate logistic regression analyses were conducted hierarchically and in blocks considering upper limbs function, balance systems, sensory functions, postural control, walking, independence, cognition, and perception as independent variables. The prevalence ratio for walking independence was determined.

RESULTS

The final regression model pointed out that gait capacity assessed by the 6-Minute Walk Test and dexterity assessed by the Box and Blocks test were the main markers related to walking independence in individuals with hereditary ataxias.

CONCLUSION

The distance covered in 6 minutes of walking (walking endurance) and upper extremity dexterity can be used to better assess the progression of cerebellar disease related to walking independence in individuals with hereditary ataxias.

IMPACT

This study supports early detection of individuals who are at risk of loss of walking independence and an optimized rehabilitation plan.

Sexual Activity and Related Factors of Older Women in Hunan, China: A Cross-Sectional Study

BACKGROUND

Sexuality has an important impact on people's physical and mental health, but current research on the sexual activity of older Chinese women has many limitations and more detailed studies are needed.

AIM

The objective was to determine the prevalence of sexual activity and related factors in women aged 55 to 85 years in Hunan, China.

METHODS

Based on the data from the Hunan Provincial Women Health Needs Survey in 2018, we conducted a secondary analysis of 2,401 older women aged 55 and above. The dependent variable was sexual activity, and independent variables included sociodemographic characteristics, health behaviors, reproductive and chronic medical history, and psychological characteristics. All statistical analyses were performed using SPSS 26.0. Chi-square test was used to assess the association between categorical variables, and binary logistic regression was used to examine factors related to sexual activity.

OUTCOMES

Sexual activity and related factors.

RESULTS

The prevalence of sexual activity among older women was 12.5% (301/2401) in the past month. Having a partner (OR = 1.484; 95% CI, 1.048-2.101; P = .026), jogging (OR = 2.061; 95% CI, 1.391-3.054; P < .001), dancing (OR = 1.477; 95% CI, 1.106-1.974; P = .008), vegetarian-based diet (OR = 2.197; 95% CI, 1.334-3.618; P = .002), meat-based diet (OR = 2.196; 95% CI, 1.144-4.216; P = .018) were positively associated with being sexually active. Whereas, aging (OR = 0.781; 95% CI, 0.647-0.942; P = .010), living in the urban (OR = 0.628; 95% CI, 0.488-0.808; P < .001), hypertension (OR = 0.702; 95% CI, 0.520-0.949; P = .021), and anxiety (OR = 0.680; 95% CI, 0.475-0.972; P = .034) were negatively associated with being sexually active.

CLINICAL IMPLICATIONS

Health care workers need to be aware that older women still have sexual activity and understand the needs of older women for sex education, take the initiative to discuss safe sex with them, and solve their sexual problems.

STRENGTHS AND LIMITATIONS

This is one of the largest studies to determine the prevalence of sexual activity among older women in China and its related factors. In addition, new factors such as exercise types and eating habits related to sexual activity were discovered. The limitation of this study is that it did not use a specific questionnaire to assess the sexual activity and did not consider physical tenderness other than sexual intercourse.

CONCLUSIONS

Some older women still have had sexual activity in the past month and factors such as lifestyles that can be changed and chronic diseases that can be self-managed were found to predict sexual activity. Li T, LuoY, Meng Y, et al. Sexual Activity and Related Factors of Older Women in Hunan, China: A Cross-Sectional Study. J Sex Med 2022;19:302-310.

Association between sleep insufficiency and dyslipidemia: a cross-sectional study among Greek adults in the primary care setting

Objective

To investigate the potential association between sleep insufficiency and dyslipidemia (DL) in the primary care setting using self-reported questionnaires.

Material and Methods

957 adults aged between 19 and 86 years old from the rural area of Thrace, Greece were enrolled in this cross-sectional study. Multistage stratifed cluster sampling was used and the subjects were classifed into three groups according to sleep duration [short (<6h), normal (6-8h), and long (>8h) sleep duration]. DL was defined by a positive response to the question "Have you ever been told by a doctor or health professional that your blood cholesterol or triglyceride levels were high?", or if they were currently taking antilipidemic agents. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined.

Results

DL prevalence was significantly associated with short sleep duration (aOR=2.18, p<0.001) and insomnia (aOR=1.43, p=0.050), while its relation with poor sleep quality (aOR=1.31, p=0.094) and risk for obstructive sleep apnea (aOR=1.32, p=0.097) were of marginal statistical significance. Concerning insomnia subtypes, DL was significantly associated with difficulties maintaining sleep (aOR=2.99, p<0.001) and early morning awakenings (aOR=1.38, p=0.050), but not difficulties initiating sleep (aOR=1.18, p=0.328).

Conclusion

This study reveals an association between sleep pathology and DL. Thus, early pharmacological and cognitive or behavioral interventions that improve sleep are deemed necessary in order to decrease DL burden.

Predictors of Healthcare Workers' intention to vaccinate against COVID-19: A Cross Sectional Study from Saudi Arabia

Background

Vaccination is considered the best way to prevent the spread of COVID-19 and to prevent the complications of the disease. Nevertheless, no awareness campaigns were conducted in Saudi Arabia until March 1, 2021, when the Vaxzevria, or ChAdOx1 nCoV-19 (AZD1222), vaccine became available.

Objectives

This study aims to determine the factors that can predict healthcare workers’ acceptance of the COVID-19 vaccine.

Methods

A cross-sectional study was conducted from July to September 2021, in our university tertiary hospital (King Saud University Medical City [KSUMC]), Riyadh, Saudi Arabia. The study targeted potential participants among healthcare workers at KSUMC. We assessed healthcare workers’ perceptions and beliefs about the COVID-19 vaccine via a questionnaire that was distributed via social media applications such as WhatsApp, Twitter, and Google. Participants were informed about the questionnaire before they filled it out, and they were asked to respond to three screening questions before beginning the main questionnaire. These screening questions ensured that the participants met the inclusion criteria. Included participants were over the age of 18, agreed to answer the questions, and were residents of Saudi Arabia. The participants filled out the self-administered questionnaire.

Results

A total of 529 participants completed the questionnaires. All participants were vaccinated, 68% were female, 55% were married, 35% had been working for less than five years, and 65% had a bachelor’s degree. More than half of participants had not previously been infected with COVID-19, and most did not interact with COVID-19 patients. More convenient access to the vaccine increased the odds ratio of participant vaccination by 0.39. An increase in the number of vaccinated friends and family members increased the odds ratio of participant vaccination by 0.30. However, COVID- 19 vaccination mandates decreased the odds ratio of participant vaccination by 0.27. The fitted linear regression model explained 32% of the variation observed in the dependent variable, acceptance of the COVID-19 vaccine, and the adjusted R squared was 0.32. The fitted regression model was statistically significant at a 95% confidence interval; the p-value was 0.00001.

Conclusion

In Saudi Arabia, there is an immense need to increase uptake of the COVID-19 vaccine. This requires encouraging more positive beliefs and attitudes regarding vaccination in general and the COVID-19 vaccine in particular.

Predictors of Limited Access to Dental Health Care Among NYC Taxi/FHV Drivers

Taxi and for-hire vehicle (FHV) drivers are a largely immigrant, low-income occupational group at increased cardiovascular disease (CVD) risk. Poor dental health is a CVD risk factor, and dental care access is an unexamined taxi/FHV driver CVD risk factor. A cross-sectional survey was administered to 422 taxi/FHV drivers (2016-2017) to identify predictors of access to dental health care among drivers. One-third (n = 128, 30.3%) reported needing dental care/tests/treatment within the past six months, and nearly one-half (n = 61, 48%) were delayed/unable to obtain care. Only 57.6% (n = 241) had past-year dental cleanings. Not having enough money to cover household expenses was a significant predictor of being delayed/unable to obtain needed dental care/tests/treatment in the prior six months (0.5 OR; 95% CI, 0.28-0.89; p < .05). Lack of dental insurance coverage (2.72 OR; 95% CI, 1.60-4.63; p < .001) or lack of primary care provider (2.72 OR; 95% CI, 1.60-4.63; p < .001) were associated with lack of past-year dental cleaning. Seventeen percent of drivers with Medicaid were unaware of their dental coverage, which was associated with both inability to access needed dental care/tests/treatment in the past 6 months (p = .026) and no past-year dental cleaning (p < .001). Limited understanding of dental coverage was associated with both an inability to access needed dental care/tests/treatment in the past 6 months (p = .028) and lack of past-year dental cleaning (p = .014). Our findings can inform targeted intervention development to increase taxi/FHV driver dental care access/uptake, potentially improving their CVD risk.

Anemia and Cognitive Performance in the ELSA-Brasil Cohort Baseline

OBJECTIVE

The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of individuals from six Brazilian cities.

METHODS

A total of 13,624 participants (mean age=51.6 years [SD=9.0]) were included in this cross-sectional study. Cognitive performance was evaluated by using standardized scores for verbal learning, late recall, word recognition, a semantic verbal fluency test, and the Trail-Making Test, Part B (TMT-B). The association between anemia and cognitive performance was examined by using linear regression models adjusted for sociodemographic characteristics and cardiovascular risk factors.

RESULTS

Anemia was diagnosed in 713 (5.2%) participants. No association was found between anemia and worse cognitive performance for the main models. Global cognitive scores were similar between participants with and without anemia in adjusted models for the entire sample (β=-0.004; 95% CI=-0.052, 0.044) or for men (β=0.047; 95% CI=-0.053, 0.146) and women (β=-0.015; 95% CI=-0.070, 0.040) separately. In addition, hemoglobin levels (in quintile groups) were not associated with global cognitive scores. Similarly, no significant associations with anemia or hemoglobin levels were observed when each cognitive performance test was evaluated separately.

CONCLUSIONS

Anemia and hemoglobin levels were not associated with worse cognitive performance in this large cohort.

Hyperuricemia Is Not an Independent Predictor of Erectile Dysfunction

INTRODUCTION

Erectile dysfunction (ED) is strongly associated with physiological and metabolic disturbances, and hyperuricemia has been proposed to predict the onset of ED.

AIM

To investigate if hyperuricemia is an independent predictor for ED when all relevant confounding factors are taken into account.

METHODS

This is a cross-sectional study of men aged between 45 and 70 years. The population was well characterized for established cardiovascular risk factors, metabolic syndrome, as well as kidney function, depression, and socioeconomic factors. Analysis was limited to 254 men with complete data and also serum uric acid (SUA) measurements were available. This included 150 men with and 104 without ED. The presence and severity of ED was evaluated using International Index of Erectile Function-5 questionnaire. Risk of ED by SUA level was calculated using univariate and multivariable-adjusted logistic regression. Effect modification by participant characteristics were evaluated in subgroup analyses.

MAIN OUTCOME MEASURES

The main outcome measures of this study are prevalence and severity of erectile dysfunction.

RESULTS

Patients with ED (59% of the study population) were older than men without ED (59 vs 54 years) and had lower serum testosterone (14.3, 95% CI 11.3-17.3 vs 15.1 nmol/l, 95% CI 12.1-18.8, respectively). Regarding all other variables, the groups were comparable. No significant difference was found for SUA by ED. SUA was not associated with ED risk in univariate or multivariable analysis (multivariable-adjusted OR 1.14, 95% CI 0.59-2.19, P = .7) for SUA level higher than median compared with median or lesser (OR 1.00, 95% CI 0.997-1.006, P = .7 for continuous variable). No subgroup analysis modified the association. After multivariable adjustment age, education level and depression were statistically significant predictors of ED.

CONCLUSIONS

Elevated SUA was not found to be an independent risk factor for ED. Metabolic syndrome, glomerular filtration rate, or cardiovascular risk factors did not modify this result. ED cannot be predicted based on the level of SUA. A Tuokko, T Murtola, P Korhonen, et al. Hyperuricemia Is Not an Independent Predictor of Erectile Dysfunction. Sex Med 2021;9:100319.

Plagiarism Perceptions and Attitudes Among Medical Students in Saudi Arabia

Objectives

This study aimed to determine attitudes towards and perceptions of plagiarism among medical students in Saudi Arabia.

Methods

This cross-sectional, multicentre study was conducted between April and May 2018 and involved medical students enrolled in three medical schools in Riyadh, Saudi Arabia. The previously validated Attitude Towards Plagiarism questionnaire was used to evaluate approval (i.e. a positive attitude) and disapproval of plagiarism (i.e. a negative attitude) among medical students. Furthermore, this study evaluated whether attending medical writing courses or courses in medical ethics influenced medical students’ attitudes towards plagiarism.

Results

A total of 551 students participated in the study (response rate = 73.5%). A significant association was found between mean negative and positive attitude scores and grade point average (GPA; P = 0.004 and 0.007, respectively). Students attending medical ethics courses had higher mean negative attitude scores compared to students who did not attend such courses (odds ratio = 2.369, 95% confidence interval: 1.540–3.645; P <0.001). Attending medical ethics courses was associated with a significantly more negative attitude towards plagiarism (P <0.001, each).

Conclusion

The majority of medical students in Saudi Arabia included in this study indicated a highly negative attitude towards plagiarism. A higher GPA, the authoring of a published manuscript and attending courses in medical ethics were associated with negative attitudes towards plagiarism among medical students.

Psychiatric Disorders in Women Seeking Fertility Treatments: A Clinical Investigation in India

Fertility treatments began in several countries, including India, in the1970s. Despite various advancements in intra uterine insemination (IUI) and in vitro fertilization (IVF), empirical investigations on the psychological endurance and emotional tolerance of Indian women to such treatments are rather scarce. Thus, the aim of this study is to estimate the prevalence of psychiatric disorders in Indian women seeking fertility treatments. It is a cross-sectional study with three hundred women participants undergoing various treatments at the Manipal Assisted Reproductive Centre, Kasturba Medical College, Karnataka, India. Psychiatric disorders were assessed in women using the "ICD- 10 Classification of Mental and Behavioural Disorders" followed by descriptive data analysis. The results show that 78% of women have psychological issues and 45% of them have a diagnosable psychiatric condition. Adjustment Disorders, Anxiety Disorders and Mixed Anxiety and Depression Disorder are established as the top three categories of diagnoses. The findings of this study suggest that women have a high emotional stake in infertility treatments. The data highlights the need for modification of the existing treatment protocol (in Indian clinics) in ways that ensure the emotional wellbeing of patients.

Dietary patterns in relation to lipid profiles among Iranian adults

Introduction: Lipid metabolism is one of the main concerns of cardiovascular disease and atherosclerosis. Little is known about the association between dietary patterns and dyslipidemia. Therefore, the present study aimed to determine such association among Iranian adults. Methods: This cross-sectional study was conducted on 1433 Iranian adults in Isfahan Healthy Heart Program (IHHP). Usual dietary intakes were assessed with the use of a 48 items food frequency questionnaire (FFQ). Factor analysis was used to identify dietary patterns. Three major dietary patterns were identified: western, semi healthy and healthy fat patterns. Results: After adjustment, subjects in the upper quartiles of western dietary pattern were more likely to have high total cholesterol concentrations than those in the first quartile (odds ratio [OR]: 2.07; 95% CI: 1.25-3.42). Individuals with greater adherence to western dietary pattern had greater odds of having high low-density lipoprotein-cholesterol (LDL-C) levels compared with those in the lowest quartiles (2.53; 1.45-4.40). Conclusion: Semi healthy dietary pattern was not associated with cardiovascular disease (CVD) risk factors. Same trend was observed for healthy fat dietary pattern. Significant association was found between western dietary pattern and dyslipidemia among Iranian adults.

Applications of Isolated-Check Visual Evoked Potential in Early Stage of Open-Angle Glaucoma Patients

Background:

Standard automated perimetry does not sufficiently detect early open-angle glaucoma (OAG) in the clinic. New visual function tests for early glaucoma damage are therefore needed. The present study evaluated whether an isolated-check visual evoked potential (icVEP) could be used to detect visual function abnormalities in early-stage OAG and to explore potential related factors.

Methods:

This was a cross-sectional study. Thirty-seven OAG patients with early-stage visual field loss (mean deviation ≥ −6.00 dB) detected by the Humphrey Field Analyzer (30-2 SITA program) and 26 controls were included in this study. Optical coherence tomography (OCT) was used to detect retinal nerve fiber layer (RNFL) defects. The icVEP preferentially evaluates the magnocellular-ON pathway. VEPs were recorded and signal-to-noise ratios (SNRs) were derived based on multivariate analysis. Eyes that yielded an SNR ≤1 were considered abnormal. Receiver operating characteristic (ROC) curve analysis was used to estimate the accuracy of group classification. Correlations between SNRs and related factors were analyzed.

Results:

Based on an SNR criterion of 1, the icVEP had a sensitivity of 62.2% and a specificity of 92.3% for diagnosing early-stage OAG with 74.6% classification accuracy. The ROC curve analysis, however, suggested that an SNR criterion of 0.93 would produce the highest classification accuracy (77.3%). Both RNFL thinning in the temporal superior quadrant on OCT and number of abnormal test points in the central 11° visual field (pattern deviation, P < 0.5%) significantly correlated with the SNR (P < 0.05).

Conclusions:

The icVEP detected visual function abnormalities in approximately 3/5 of eyes with early-stage OAG with greater than 90% specificity. SNR correlated with both a decrease in RNFL thickness and severity of central visual field loss.

Psychological Treatment Needs for Chronic Pain in Singapore and the Relevance of the Psychological Flexibility Model

Objective

The goals of the present study were (a) to assess the psychological treatment needs and treatment delivery preferences in people attending services or contacting a hospital website for chronic pain in Singapore, and (b) to explore potential relevance of the psychological flexibility (PF) model for this group by investigating associations between PF and pain-related outcomes.

Design and Setting

This was a cross-sectional questionnaire study of people with chronic pain in Singapore.

Subjects

Current users of treatment services at a tertiary pain management clinic (PMC), users of pain treatment services elsewhere, and non-treatment users.

Methods

Participants were either recruited face-to-face at a pain clinic or via an online portal. All participants completed a questionnaire, including a survey of treatment barriers and needs, treatment delivery preferences for chronic pain, and standardized measures of PF, pain interference, emotional functioning, and health care use.

Results

A total of 200 participants completed the study. Cost of treatment was identified as a main deterrent, while proof of treatment success was identified as a main facilitator for treatment uptake. A majority of participants (88.5%) indicated a preference for face-to-face treatment. In multiple regression analyses, after controlling for relevant demographic variables and pain intensity, PF explained 14% of the variance for pain interference and impact of depressive symptoms and 22% of the variance for depressive symptoms.

Conclusion

A focus on meeting patients' needs at low cost, and providing proof of treatment success may increase psychological treatment uptake. Increasing PF for pain in people from Singapore may also contribute to better patient functioning.

Evaluation of the perception of clinical competencies by nursing students in the different clinical settings: an observational study

INTRODUCTION

The university educational sphere has many dilemmas. The question of sufficient knowledge and skills for students to acquire abilities to provide care in different clinical setting is one important dilemma.

AIM

To measure the level of competencies by nursing students and its application in different clinical environments.

METHODS

Nursing students of two Italian universities participated in the research. Data collection took place April to July 2015 using the Nurse Competence Scale. The Strengthening Reporting of Observational Studies in Epidemiology Guidelines was used to describe the study. Pearson's chi-square test, Student's t test, and regression tests were used for statistical analysis.

RESULTS

The questionnaire response rate was 87.27% (n = 698). Most of the nursing students assessed their level of competency as 'good' and evaluated themselves as more competent than their actual nursing role. Students also appraised themselves as competent either via their clinical practices accomplished or in the therapeutic interventions.

CONCLUSION

This study shows that the self-evaluation of the competencies acquired by nursing students in clinical settings in Latium and Abruzzo is of a good standard. This study also affirms that NCS is a valuable and reliable tool to measure clinical competencies in different clinical settings.

Intake of specific types of fruit and vegetables is associated with higher levels of skin yellowness in young women: A cross-sectional study

Carotenoids are fat-soluble pigments primarily found in fruits and vegetables. They accumulate in human skin and contribute to skin yellowness, which has a favorable effect on appearance. The association between specific fruit and vegetable intakes and skin yellowness is currently unknown and could help to promote increased fruit and vegetable consumption in those motivated by appearance, such as young women. The objective was to evaluate associations between specific fruit and vegetable intakes and skin yellowness in young women. It was hypothesized that the intake of fruits and vegetables known to be rich in carotenoids, particularly β-carotene, would account for the greatest variation in skin yellowness. One hundred and eighteen women (18-40 years) were recruited from the Hunter region, NSW, Australia. Fruit and vegetable intakes were assessed using the 2010 Australian Eating Survey Food Frequency Questionnaire and skin yellowness was measured using reflectance spectroscopy. Multiple linear regression was used to assess how much of the variation in skin yellowness is explained by fruit and vegetable intakes. Higher combined fruit and vegetable intake (P = .0004) and higher total fruit intake (P = .005) were associated with increased skin yellowness. Three specific fruits (apple/pear, mango/pawpaw and dried fruit) and five vegetables (beans/lentils, spinach, broccoli, corn, baked beans) also accounted for a significant proportion of the variation in skin yellowness (P < .05). In conclusion, the consumption of eight specific fruits and vegetables and total combined fruit and vegetable intake are positively associated with skin yellowness and this confers a desirable effect on appearance.

IMPACT OF VITAMIN D DEFICIENCY ON COGNITIVE FUNCTIONS IN TYPE 2 DIABETIC PATIENTS

OBJECTIVE

We hypothesized that vitamin D-deficient diabetic patients might demonstrate cognitive deficits and therefore investigated this association in patients with diabetes mellitus (DM).

METHODS

This study comprised 236 patients with type 2 DM (118 with vitamin D deficiency (less than 20 ng/mL) and 118 without vitamin D deficiency as the control group). All patients were outpatients in the endocrinology clinics of Baskent University, Turkey from 1 October 2013 to 31 January 2014 and, chosen in a randomized manner according to their application time. The serum vitamin D levels were measured and cognitive functions were evaluated using the Mini Mental Status Examination (MMSE).

RESULTS

The mean age in the study and control group was 57.02±7.30 and 58.92±7.58 years, respectively (p=0.051). The male:female ratio in the study and control group was 1.00:1.46 and 1.00:2.11, respectively. The study group was further divided into three subgroups: patients with mild, moderate, and severe vitamin D deficiency. The study outcomes revealed no significant relationship between the vitamin D deficiency level and the total score or subscores of the MMSE (p<0.05).

CONCLUSIONS

These study results do not confirm the hypothesis that vitamin D deficiency unfavorably affects cognitive functions in patients with type 2 DM.

Tehran Survey of Potential Risk Factors for Multiple Births

Background

The multiple pregnancy incidence is increasing worldwide. This increased incidence is concerning to the health care system. This study aims to determine the frequency of multiple pregnancy and identify factors that affect this frequency in Tehran, Iran.

MATERIALS AND METHODS

This cross-sectional study included 5170 mothers in labor between July 6-21, 2015 from 103 hospitals with Obstetrics and Gynecology Wards. The questionnaire used in this study consisted of five parts: demographic characteristics; information related to pregnancy; information related to the infant; information regarding the multiple pregnancy; and information associated with infertility. We recruited 103 trained midwives to collect data related to the questionnaire from eligible participants through an interview and medical records review. Frequencies and odds ratios (OR) for the association between multiple pregnancy and the selected characteristics (maternal age, economic status, history of multiple pregnancy in first-degree relatives, and reproductive history) were computed by multiple logistic regression. Stata software, version 13 (Stata Corp, College Station, TX, USA) was used for all statistical analyses.

RESULTS

Multiple pregnancy had a prevalence of 1.48% [95% confidence interval (CI): 1.19-1.85]. After controlling for confounding variables, we observed a significant association between frequency of multiple pregnancy and mother's age (OR=1.04, 95% CI: 1.001-1.09, P=0.044), assisted reproductive technique (ART, OR=6.11, 95% CI: 1.7- 21.97, P=0.006), and history of multiple pregnancy in the mother's family (OR=5.49, 95% CI: 3.55-9.93, P=0.001).

CONCLUSION

The frequency of multiple pregnancy approximated results reported in previous studies in Iran. Based on the results, we observed significantly greater frequency of multiple pregnancy in older women, those with a history of ART, and a history of multiple pregnancy in the mother's family compared to the other variables.

Association between modifiable lifestyle and the prevalence of atrial fibrillation in a Chinese population: Based on the cardiovascular health score

Background

The Cardiovascular Health (CVH) Score was comprised of a series of modifiable lifestyle and health factors, which was published by American Heart Association in 2010. Its relationship with atrial fibrillation (AF) remains unclear.

Hypothesis

Individuals with a higher CVH Score had a lower risk of AF.

Methods

Participants ≥40 years of age were recruited from the Jidong community. Information regarding the following 7 CVH metrics, including smoking, body mass index, diet, physical activity, total cholesterol, and fasting blood glucose, were collected. AF was confirmed with a standard 12‐lead electrocardiography or based on the patients' medical histories. A multivariable logistic regression model was used to evaluate the relationship between ideal CVH and AF prevalence.

Results

This study included 4477 individuals, among whom 48 had AF (1.07%). Overall, participants with higher ideal components scores had a lower risk of AF (odds ratio [OR]: 0.78; 95% confidence intervals [CI]: 0.62‐0.97; P trend = 0.024). Subgroup analyses showed that the trend was consistent in the male participants ages 40 to 60 years. Moreover, patients with 5 to 7 ideal components or 3 to 4 ideal components were associated with 57% and 59% reduced risks for AF, respectively. We also detected a significant association between ideal health factors and the prevalence of AF (OR: 0.79; 95% CI: 0.68‐0.93; P = 0.004).

Conclusions

Ideal health behavior and factors are associated with lower prevalence of AF in a community‐based population. Improving healthy behavior and these factors may be beneficial to decrease the prevalence of AF.

Association between Serum 25-hydroxyvitamin D Levels and Type 2 Diabetes in Korean Adults

Previous studies have suggested that a vitamin D deficiency increases the risk of type 2 diabetes. This study evaluated the association between serum vitamin D levels and type 2 diabetes in Korean adults. This study included 9,014 subjects (3,600 males and 5,414 females) aged ≥50 years who participated in the Dong-gu Study. The subjects were divided into groups in whom the serum vitamin D level was severely deficient (<10 ng/mL), deficient (10 to <20 ng/mL), insufficient (20 to <30 ng/mL) and sufficient (≥30 ng/mL). Type 2 diabetes was defined by a fasting blood glucose level of ≥126 mg/dL and/or an HbA1c proportion of ≥6.5% and/or self-reported current use of diabetes medication. Multiple logistic regression was performed to evaluate the association between vitamin D status and type 2 diabetes. The age- and sex-adjusted prevalence of type 2 diabetes was 22.6%, 22.5% and 18.4% and 12.7% for severely deficient, deficient, insufficient, and sufficient, respectively. Multivariate modeling revealed that subjects with insufficient or sufficient vitamin D levels were at a lower risk of type 2 diabetes than were subjects with deficient vitamin D levels [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71-0.94 and OR, 0.51; 95% CI, 0.35-0.74, respectively]. Higher serum vitamin D levels were associated with a reduced risk of diabetes in Korean adults, suggesting that vitamin D may play a role in the pathogenesis of diabetes.

[Awareness, Treatment and Control of Hypertension in Population Aged 16 to 90 Years Old in the Valencia Region, Spain, 2010]

OBJECTIVE

Hypertension is an important risk factor in terms of mortality attributable and the main modifiable cardiovascular risk factor. The aim of the study is to estimate the degree of awareness, treatment and control of hypertension in population of Valencia Region and identify predictors that explain the lack of proper control.

METHODS

Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Automatic sphygmomanometer was used for taking blood pressure. Hypertension was defined according to the criteria of 2007 European Society of Hypertension and the European Society of Cardiology. Data on knowledge and treatment were obtained by survey. Predictors for awareness, treatment and control of hypertension were estimated by logistic regression models.

RESULTS

The prevalence of hypertension estimated for the study population was 38.2% (95% CI: 34.9%-41.5%). 51.4% (95% CI: 45.9%-57.0%) of the hypertensive population, knew his condition. 88.8% of them (95% CI: 83.9%-93.6%) were receiving drug therapy and of these, 45.1% (95% CI: 36.9%-53.3%) maintained blood pressure controlled.

CONCLUSIONS

Since the last survey in Valencia Region, the degree of awareness of hypertension has not improved although an increase in those treated with antihypertensive drugs is observed.

[Prevalence of Hypertension and Associated Factors in Population Aged 16 to 90 Years Old in Valencia Region, Spain]

OBJECTIVE

Hypertension is one of the main risk factor in terms of attributable mortality and the most common modifiable cardiovascular risk factor. The aim of the study was to estimate the prevalence of hypertension in population more than fifteen years of Valencia region and describe the strength of association between specific factors and the presence of hypertension.

METHODS

Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Data were collected through household survey and blood pressure was measured using an automated sphygmomanometer. Hypertension was defined according to criteria established in 2007 by the European Society of Hypertension and the European Society of Cardiology. Strength of association between hypertension and associated factors was measured by binary logistic regression for demographic explanatory variables, family history, lifestyle, anthropometric variables and others.

RESULTS

The prevalence of hypertension estimated for Valencia region was 38,2% [95% CI 34,9 to 41,5]; 40,7% in men [95% CI 35,0 to 45,5] and 35,7% in women [95% CI 31,1 to 40,3]. Remained as associated variables with hypertension: age [45-64 years OR 4.3, IC 95% 2.1-8.8; 65 or more years, OR 15.5, IC 95% 7.2-33.2], body mass index [overweight OR 2.1 95% CI 1.3 to 3.2; obesity OR 5.3, 95% CI 3.3 to 8.5] and diabetes [OR 2.4, 95% CI 1.2-4.8].

CONCLUSIONS

More than a third of the study population suffers from hypertension. Its risk increases with age. Overweight and diabetes mellitus double the likelihood of developing hypertension.

A nationwide study of chronic pain prevalence in the general spanish population: identifying clinical subgroups through cluster analysis

OBJECTIVE

This study aims to assess the prevalence of chronic pain, its characteristics, and its impact on the general Spanish population. Also, to establish chronic pain patient subgroups according to the characteristics of pain and to identify variables specifically associated with each subgroup.

DESIGN

Telephone-based, cross-sectional nationwide study.

SUBJECTS

A sample of 1,957 individuals representative of the Spanish population.

METHODS

Data were collected through telephone interviews. A subject was considered to have chronic pain if they had suffered pain (at least 4 days a week) during the last 3 months. The subjects were divided into two subgroups through a cluster analysis, and a regression model was established to determine the variables most specifically associated with these subgroups.

RESULTS

The prevalence of chronic pain was 16.6% (95% confidence interval: 14.9-18.3) and among these subjects, more than 50% referred to limitations in their daily activities, 30% felt sad and/or anxious, and 47.2% indicated that their pain was affecting their family life. Two subgroups of subjects with pain were identified: 1) characterized by generalized pain in more than one location and of a long evolution (150 months); and 2) characterized by pain localized to only one site with a shorter duration (100 months). Individuals who felt anxious because of their pain and those who considered that their pain was affecting their family were more likely to belong to group 1.

CONCLUSIONS

Pain affects an important proportion of the Spanish adult population and that it has a strong personal impact. Two pain groups were clearly distinguished by their clinical characteristics.

Risk factors for fatal and nonfatal road crashes in iran

Background:

Road traffic injuries are among the leading causes of death in the world and Iran.

Objectives:

The aim of this study was to assess the role of age, sex, education, and time of accident on human casualties and mortalities of road crashes in Iran.

Materials and Methods:

This study was based on data gathered by Iranian Police Department from the records of road crashes from April 4, 2008 through April 4, 2009. Road crashes are categorized into three types: with no human casualties, with injuries, and with human mortalities.

Results:

The largest rate of human causalities was observed in people aged between 25 to 34 years (P < 0.001). Illiterate people had 81% smaller odds of causality in road crashes (P < 0.001) in comparison with those with a kind of academic education. Overall, 73.4% of crashes had happened during the last ten days of a month were with human casualties (P < 0.001) and human casualties rate was slightly higher in crashes happened between 1 AM to 5 AM Fatality rate was slightly higher in the females (OR = 2.6, P = 0.068). The smallest odds of fatality were found in the people aged between 18 to 24 years and the highest odds were seen in people ≥ 55 years of age (P < 0.001). In people with a university education, 61.9% of crashes were with fatality (P = 0.026). In addition, 82.8% of crashes during winter, 60.2% of crashes during autumn, and 35.8% of crashes during summer were with mortalities. Overall, 78.3% of crashes with human casualties that had happened during 1 AM to 5 AM led to mortalities. There was also a significant association between injury and its intensity with fastening seatbelts.

Conclusions:

Older age, university degrees, female sex, wintertime, and the time of accident seem to be the most important risk factors in road crashes that lead to fatalities in Iran. Drivers in Iran should be informed and trained regarding these risk factors, which have direct effect on casualties and mortalities in road crashes.

Adherence to Medications among Type 2 Diabetes Mellitus Patients in Three Districts of Al Dakhliyah Governorate, Oman: A cross-sectional pilot study

OBJECTIVES

This pilot study aimed to assess the medication adherence of type 2 diabetes mellitus (T2DM) patients in three wilayats (districts) of the Al Dakhliyah governorate, Oman, and to identify the probable reasons for medication non-adherence.

METHODS

A cross-sectional questionnaire-based pilot survey was conducted among T2DM Omani patients between February and June 2012 to assess their medication adherence and the relationship between their socio-demographic characteristics and adherence levels.

RESULTS

A total of 158 patients participated in the survey. The majority of the participants were unemployed or were housewives (66.5%). Forgetfulness was the most frequent reason for medication non-adherence (36.4%). Participants demonstrated an excellent level of adherence to their medicines (median total score = 3). No significant difference in median total adherence scores was observed based on the evaluated parameters.

CONCLUSION

The medication adherence of T2DM patients in the area under study was good. A larger study in a wider population is warranted to obtain a more representative picture of this important factor which contributes to public health.

Prevalence of Refractive Errors among High School Students in Western Iran

PURPOSE

To determine the prevalence of refractive errors among high school students.

METHODS

In a cross-sectional study, we applied stratified cluster sampling on high school students of Aligoudarz, Western Iran. Examinations included visual acuity, non-cycloplegic refraction by autorefraction and fine tuning with retinoscopy. Myopia and hyperopia were defined as spherical equivalent of -0.5/+0.5 diopter (D) or worse, respectively; astigmatism was defined as cylindrical error >0.5 D and anisometropia as an interocular difference in spherical equivalent exceeding 1 D.

RESULTS

Of 451 selected students, 438 participated in the study (response rate, 97.0%). Data from 434 subjects with mean age of 16±1.3 (range, 14 to 21) years including 212 (48.8%) male subjects was analyzed. The prevalence of myopia, hyperopia and astigmatism was 29.3% [95% confidence interval (CI), 25-33.6%], 21.7% (95%CI, 17.8-25.5%), and 20.7% (95%CI, 16.9-24.6%), respectively. The prevalence of myopia increased significantly with age [odds ratio (OR)=1.30, P=0.003] and was higher among boys (OR=3.10, P<0.001). The prevalence of hyperopia was significantly higher in girls (OR=0.49, P=0.003). The prevalence of astigmatism was 25.9% in boys and 15.8% in girls (OR=2.13, P=0.002). The overall prevalence of high myopia and high hyperopia were 0.5% and 1.2%, respectively. The prevalence of with-the-rule, against-the-rule, and oblique astigmatism was 14.5%, 4.8% and 1.4%, respectively. Overall, 4.6% (95%CI, 2.6-6.6%) of subjects were anisometropic.

CONCLUSION

More than half of high school students in Aligoudarz had at least one type of refractive error. Compared to similar studies, the prevalence of refractive errors was high in this age group.

The impact of intravaginal ejaculatory latency time and erectile function on anxiety and depression in the four types of premature ejaculation: a large cross-sectional study in a Chinese population

INTRODUCTION

A new classification of premature ejaculation (PE) has been proposed, including the categories of lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), and premature-like ejaculatory dysfunction (PLED).

AIM

The aim of this study was to evaluate the impact of intravaginal ejaculation latency time (IELT) and erectile function on anxiety and depression among patients with PE in general and according to the four types of PE.

METHODS

Between September 2011 and September 2012, we conducted a cross-sectional study in the Anhui province of China. We enrolled 4,000 men aged over 18 years, each of whom had been in a stable, monogamous, heterosexual relationship with the same partner for at least 6 months.

MAIN OUTCOME MEASUREMENTS

Self-estimated IELT, the International Index of Erectile Function-5 (IIEF-5) and the Zung Self-Rating Anxiety and Depression Scales (SAS/SDS) were used to measure PE, erectile dysfunction (ED), anxiety, and depression, respectively, among the entire study population.

RESULTS

Of the 3,016 men evaluated, 25.80% complained of PE. Distribution of the four types of PE among men with PE was as follows: LPE, 12.34%; APE, 18.77%; NVPE, 44.09%; PLED, 24.81%. Men with PE presented lower IIEF-5 scores and higher SAS and SDS scores vs. men without PE (P < 0.001 for all). Similar findings were observed in men with APE when compared with other PE syndromes. After adjustment for age in men with PE, IELT was negatively associated with SAS and SDS scores (SAS, adjusted r = -0.42, P < 0.001; SDS, adjusted r = -0.45, P < 0.001). IIEF-5 score was negatively associated with SAS and SDS scores (SAS, adjusted r = -0.54, P < 0.001; SDS, adjusted r = -0.50, P < 0.001). These negative relationships were strongest in men with PLED (IELT vs. SAS: adjusted r = -0.63, P < 0.001; IELT vs. SDS, adjusted r = -0.60, P < 0.001; IIEF-5 vs. SAS: adjusted r = -0.57, P < 0.001; IELT vs. SDS, adjusted r = -0.55, P < 0.001).

CONCLUSIONS

APE patients reported higher rates of ED, anxiety, and depression than men with other types of PE. The negative relationships between IELT/IIEF-5 and SAS/SDS were strongest in men with PLED.