Hemoglobin levels and cognitive trajectory: unveiling prognostic insights in post-stroke geriatric cohort.

PURPOSE: Evidence is scarce regarding the association between anemia and alterations in cognitive level among hospitalized older patients. We aimed to evaluate the associations between baseline hemoglobin (Hb) levels and changes in cognitive level in patients undergoing rehabilitation after stroke. METHODS: A retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Data on serum Hb levels were extracted from medical records, specifically tests conducted within 24 hours of admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the length of hospital stay. Multivariate linear regression analyses were employed to assess the association between Hb levels at admission and the designated outcomes, adjusting for potential confounding factors. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median Hb level at admission was 13.3 [11.9, 14.5] g/dL. After fully adjusting for confounding factors, the baseline Hb level was significantly and positively associated with FIM-cognition at discharge (ß = 0.045, p = 0.025) and its gain (ß = 0.073, p = 0.025). Further, the baseline Hb level was independently and negatively associated with length of hospital stay (ß = -0.013, p = 0.026). CONCLUSION: Elevated baseline Hb levels are correlated with preserved cognitive level and shorter hospital stays in post-stroke patients. Evaluating anemia at the outset serves as a crucial prognostic indicator.

The effect of reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes: a randomised controlled trial.

BACKGROUND: Evidence suggests that reminiscence therapy can effectively reduce cognitive and psychological symptoms. This study was conducted to examine the effect of individual reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes. METHODS: This study is an experimental type, randomised controlled study designed in pre-test - post-test design. The sample size of the study consisted of 58 older adults with type 2 diabetes, consisting of 29 intervention and 29 control subjects. The older adults in the intervention group were individually subjected to 5 weeks of reminiscence therapy in two sessions (each session 40-45 min) per week. No intervention was applied to the control group. Personal Information Form, Standardised Mini Mental Test, SF-36 Quality of Life and Beck Depression Inventory were used to collect the data. RESULTS: While there was no significant difference between the pre-test Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group and the mean scores of those in the control group (P > 0.05), the difference between the Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention and control groups in the post-test was found to be statistically significant (P < 0.05). The post-test Mini Mental Test total score, SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group were higher than the older adults in the control group. It was determined that the post-test Beck Depression Inventory total mean scores of the older adults in the intervention group were lower than the older adults in the control group. CONCLUSION: Reminiscence therapy can positively affect cognitive levels, quality of life and depression symptoms of older adults living in the community. Individual reminiscence therapy can be used as a nursing intervention in primary healthcare.

Quercetin promotes the proportion and maturation of NK cells by binding to MYH9 and improves cognitive functions in aged mice.

BACKGROUND: Quercetin is a flavonol compound widely distributed in plants that possesses diverse biological properties, including antioxidative, anti-inflammatory, anticancer, neuroprotective and senescent cell-clearing activities. It has been shown to effectively alleviate neurodegenerative diseases and enhance cognitive functions in various models. The immune system has been implicated in the regulation of brain function and cognitive abilities. However, it remains unclear whether quercetin enhances cognitive functions by interacting with the immune system. RESULTS: In this study, middle-aged female mice were administered quercetin via tail vein injection. Quercetin increased the proportion of NK cells, without affecting T or B cells, and improved cognitive performance. Depletion of NK cells significantly reduces cognitive ability in mice. RNA-seq analysis revealed that quercetin modulated the RNA profile of hippocampal tissues in aging animals towards a more youthful state. In vitro, quercetin significantly inhibited the differentiation of Lin-CD117+ hematopoietic stem cells into NK cells. Furthermore, quercetin promoted the proportion and maturation of NK cells by binding to the MYH9 protein. CONCLUSIONS: In summary, our findings suggest that quercetin promotes the proportion and maturation of NK cells by binding to the MYH9 protein, thereby improving cognitive performance in middle-aged mice.

Hyponatremia as a predictor of cognitive deterioration in hospitalized post-stroke patients.

PURPOSE: Evidence is scarce regarding the association between hyponatremia and alterations in cognitive function among hospitalized older patients. We aimed to investigate the associations between hyponatremia and the baseline cognitive status, as well as the improvement in cognitive function, in hospitalized post-stroke patients. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration < 135 mEq/L. The main outcomes included admission and discharge scores for cognitive levels, assessed through the cognitive domain of the Functional Independence Measure (FIM-cognition), as well as the score changes observed during the hospitalization period. Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6 % men) were included in the analysis. The median baseline blood sodium level was 139 [137, 141], and 84 patients (8.8 %) exhibited hyponatremia. After full adjustment for confounders, the baseline hyponatremia was significantly and negatively associated with FIM-cognition values at admission (ß = -0.009, p = 0.016), discharge (ß = -0.038, p = 0.043), and the gain during hospital stay (ß = -0.040, p = 0.011). CONCLUSION: Baseline hyponatremia has demonstrated a correlation with decline in cognitive level over the course of rehabilitation in individuals after stroke. Assessing hyponatremia at the outset proves to be a pivotal prognostic indicator.

Assessing question characteristic influences on ChatGPT's performance and response-explanation consistency: Insights from Taiwan's Nursing Licensing Exam.

BACKGROUND: Investigates the integration of an artificial intelligence tool, specifically ChatGPT, in nursing education, addressing its effectiveness in exam preparation and self-assessment. OBJECTIVE: This study aims to evaluate the performance of ChatGPT, one of the most promising artificial intelligence-driven linguistic understanding tools in answering question banks for nursing licensing examination preparation. It further analyzes question characteristics that might impact the accuracy of ChatGPT-generated answers and examines its reliability through human expert reviews. DESIGN: Cross-sectional survey comparing ChatGPT-generated answers and their explanations. SETTING: 400 questions from Taiwan's 2022 Nursing Licensing Exam. METHODS: The study analyzed 400 questions from five distinct subjects of Taiwan's 2022 Nursing Licensing Exam using the ChatGPT model which provided answers and in-depth explanations for each question. The impact of various question characteristics, such as type and cognitive level, on the accuracy of the ChatGPT-generated responses was assessed using logistic regression analysis. Additionally, human experts evaluated the explanations for each question, comparing them with the ChatGPT-generated answers to determine consistency. RESULTS: ChatGPT exhibited overall accuracy at 80.75 % for Taiwan's National Nursing Exam, which passes the exam. The accuracy of ChatGPT-generated answers diverged significantly across test subjects, demonstrating a hierarchy ranging from General Medicine at 88.75 %, Medical-Surgical Nursing at 80.0 %, Psychology and Community Nursing at 70.0 %, Obstetrics and Gynecology Nursing at 67.5 %, down to Basic Nursing at 63.0 %. ChatGPT had a higher probability of eliciting incorrect responses for questions with certain characteristics, notably those with clinical vignettes [odds ratio 2.19, 95 % confidence interval 1.24-3.87, P = 0.007] and complex multiple-choice questions [odds ratio 2.37, 95 % confidence interval 1.00-5.60, P = 0.049]. Furthermore, 14.25 % of ChatGPT-generated answers were inconsistent with their explanations, leading to a reduction in the overall accuracy to 74 %. CONCLUSIONS: This study reveals the ChatGPT's capabilities and limitations in nursing exam preparation, underscoring its potential as an auxiliary educational tool. It highlights the model's varied performance across different question types and notable inconsistencies between its answers and explanations. The study contributes significantly to the understanding of artificial intelligence in learning environments, guiding the future development of more effective and reliable artificial intelligence-based educational technologies. TWEETABLE ABSTRACT: New study reveals ChatGPT's potential and challenges in nursing education: Achieves 80.75 % accuracy in exam prep but faces hurdles with complex questions and logical consistency. #AIinNursing #AIinEducation #NursingExams #ChatGPT.

Design of Household Cognitive Level Assessment System Based on Grip Force and Finger Force Distribution.

In this paper we designed a household cognitive level assessment system based on finger force distribution. The system evaluates the user's current cognitive level according to the degree of matching between the characteristics of user's grip force and finger force distribution data and the characteristics in the database. The system based on finger force distribution will greatly reduce the space and economic cost of household cognitive level assessment.

Glycyrrhizic acid inhibits myeloid differentiation of hematopoietic stem cells by binding S100 calcium binding protein A8 to improve cognition in aged mice.

BACKGROUND: Glycyrrhizic acid (GA), a saponin compound often used as a flavoring agent, can elicit anti-inflammatory and anti-tumor effects, and alleviate aging. However, the specific mechanism by which GA alters immune cell populations to produce these beneficial effects is currently unclear. RESULTS: In this study, we systematically analyzed single-cell sequencing data of peripheral blood mononuclear cells from young mice, aged mice, and GA-treated aged mice. Our in vivo results show that GA reduced senescence-induced increases in macrophages and neutrophils, and increased numbers of lymphoid lineage subpopulations specifically reduced by senescence. In vitro, GA significantly promoted differentiation of Lin-CD117+ hematopoietic stem cells toward lymphoid lineages, especially CD8+ T cells. Moreover, GA inhibited differentiation of CD4+ T cells and myeloid (CD11b+) cells by binding to S100 calcium-binding protein 8 (S100A8) protein. Overexpression of S100A8 in Lin- CD117+ hematopoietic stem cells enhanced cognition in aged mice and the immune reconstitution of severely immunodeficient B-NDG (NOD.CB17-Prkdcscid/l2rgtm1/Bcgen) mice. CONCLUSIONS: Collectively, GA exerts anti-aging effects by binding to S100A8 to remodel the immune system of aged mice.

Relationship between learning approach, Bloom's taxonomy, and student performance in an undergraduate Human Anatomy course.

Researchers have long been interested in understanding how different learning approaches impact learning outcomes. Learning approaches are often conceptualized as a dichotomy of superficial and deep, and learning outcomes are typically viewed on a cognitive scale that ranges from lower- to higher-order. While there appears to be an inherent relationship between learning approach and outcomes where superficial approaches lead to lower-order learning and deep approaches result in higher-order learning, this concept is not well documented. The purpose of this study is to better understand this relationship by evaluating whether student performance on higher- and lower-order examination questions is influenced by the approach a student takes when studying. To investigate this, survey and examination data were collected from an upper-level undergraduate Human Anatomy course at the University of Cincinnati. Results indicate that, on average, students in the course favored a deep approach to learning. The impact that learning approach had on examination performance was investigated using a series of analytical approaches, which revealed that students who took a deep approach to learning performed marginally better on both higher- and lower-order examination questions in lecture and practical examination settings. These results are contextualized within the literature, which highlights the need for more research surrounding the interrelatedness and dependency of categories within both learning approaches and cognitive levels.

Soy protein increases cognitive level in mice by modifying hippocampal nerve growth, oxidative stress, and intestinal microbiota.

BACKGROUND: Three kinds of diet containing chicken protein isolate (CPI), bovine milk protein isolate (BMPI), and soy protein isolate (SPI), respectively, were designed to investigate the influences of proteins on cognitive levels and related mechanisms in mice. RESULTS: A Morris water maze (MWM) test showed that the SPI group had a higher cognitive level than the BMPI group. Immunohistochemical staining and chemical analysis of the hippocampus showed that the SPI group had higher synaptophysin expression, doublecortin-positive cell proportion, superoxide dismutase activity, and lower malondialdehyde content compared with the BMPI group. The same parameters in the CPI group were between those of the BMPI and SPI groups. Microbiome sequencing indicated that the three groups differed significantly at the phylum, genus, and species levels, with higher microbial alpha diversity in the CPI and SPI groups. The association of intestinal microbiota with cognitive improvement was also assessed. The present study suggests that soy protein may increase cognitive function by the gut-brain axis. CONCLUSION: In contrast with CPI and BMPI, SPI had a better effect on improving the cognitive level in mice, which was achieved through the regulation of hippocampal neural growth, oxidative stress, and intestinal microbiota. © 2022 Society of Chemical Industry.

The effect of access to electronic resources during examination on medical and dental students scores in summative assessment: quasi experimental study.

BACKGROUND: Access to electronic (E) resources has become an indispensable requirement in medical education and practice. OBJECTIVE: Our objective was to assess the effect of E-resources access during examination on end-course-exam scores of medical and dental students. METHODS: A quasi-experimental study which included two cohorts of medical (n = 106 & 85) and three cohorts of dental students (n = 66, 64 and 69) who took end-course- exams. Each exam was composed of two- parts (Part I and II), that encompassed equal number of questions and duration. Access to E-resources was allowed in part-II only. Items Difficulty Index (DI), Discrimination Index, (DisI), Point Biserial, (PBS) and cognitive level were determined. RESULTS: The study included 390 students. The proportion of items at various levels of DI, DisI, and PBS and the average values for item DI, DisI in both parts of each exam were comparable. The average scores in part-II were significantly higher than part-I (P < 0.001, < 0.001 and 0.04) and lower-order cognitive-level items scores were higher in three exams (P < 0.0001, 0.0001, 0.0001). Higher- order cognitive level items scores were comparable between part I and II in all courses. The significant factor for change in marks were questions cognitive level and type of the course. CONCLUSION: Access to E-resources during examination does not make a significant difference in scores of higher-order cognitive level items. Question cognitive level and course type were the significant factors for the change in exam scores when accessing E-resources. Time-restricted E-resources accessed tests that examine higher cognitive level item had no significant academic integrity drawback.

Trends in Dyslexia Research during the Period 1950 to 2020-Theories, Definitions, and Publications.

INTRODUCTION: The focus of the present paper is on (1) how dyslexia research and hence definitions have developed during the period 1950-2020 and includes (2) a database search of scientific publications on dyslexia during the same period. The focus is on the definitions of dyslexia and the organization of the network search based on the causal four-level model by Morton and Frith. METHOD: (1) The definitions are presented in accordance with a historic review of dyslexia research from 1950 to 2020 and based on (2) Google Scholar counts of publications on dyslexia, on defining dyslexia, on dyslexia at the four levels (symptomatic, cognitive, biological, environmental), and by areas (sensorimotor, comorbidity). Finally, a percentage calculation shows the relative development within each level and area by decennium (1950-1960, 1960-1970, 1970-1980, 1990-2000, 2002-2010, 2010-2020). RESULTS: (1) Of the seven definitions presented, only the definition by the BDA 2007 included the four levels of the causal model. (2) The number of publications increased substantially over the period. However, relatively few publications have defined dyslexia. An increase in publications from 1950 to 2020 was seen across the four levels and two areas-however, with an alteration in the thematic focus over this time span. SUMMARY: Defining dyslexia has still not reached a consensus. This uncertainty may explain why only one of the seven definitions proved satisfactory according to the four-level model. Along with the general increase in research, publications on dyslexia have increased accordingly during the period 1950 to 2020. Although the symptomatic level has played a dominant role over the whole period, thematic shifts have been seen over these 70 years. In particular, a substantial thematic shift was seen by the turn of the millennium. There has been a relative increase in the focus on literacy at the symptomatic level, on phonological awareness at the cognitive level, in gender at the biological level, and second language learning as comorbidities. However, increases in counts are not alone a valid indication of scientific progress. In particular, the lack of definitional criteria as a basis for participant and method selection should attract much more focus in future studies. The present study underlines the multifactorial nature of dyslexia, as evidenced by a substantial increase in the number of publications on the subject. It is a challenge for future research to continuously use and possibly redefine dyslexia definitions in line with such standards.

Flipped Classroom in Restorative Dentistry: A First Test Influenced by the Covid-19 Pandemic.

PURPOSE: This study compared the success of dental students with flipped classroom and traditional classroom learning in the restorative dentistry course for the first time at the Faculty of Dentistry of Reims during the 2019- 2020 academic year, influenced by the Covid-19 pandemic, and analysed the correlation with students' feelings. The use of an active learning method can improve success during final exams and increase the motivation of students. MATERIALS AND METHODS: The same teacher taught half of the restorative dentistry course in the flipped classroom approach and the other half as traditional classroom. For the flipped classroom, students were required to complete their homework online before the face-to-face sessions. An exam at the beginning and the end of the semester was conducted with questions about concepts learned with each learning method. Statistical analysis was performed using a t-test at the 0.05 significance level. A questionnaire on satisfaction was conducted to determine the students' opinion on this new learning method in the flipped classroom compared to the traditional classroom. RESULTS: The flipped classroom learning method enabled students to achieve better results on the final exam, with a statistically significant difference compared to traditional classroom learning. Student responses to the satisfaction questionnaire showed an increase in motivation and interest in the lessons and correspond to the increase in exam success. CONCLUSION: The use of the flipped classroom for lower cognitive-level activities is more appreciated by students and yields better results than knowledge acquisition in the traditional classroom.

Assessment of Risk Factors and Cognitive Level Associated with Venous Thrombosis Patients in a Coexistence of Multiple Diseases Study in Shanghai.

BACKGROUND: Venous thrombosis (VTE) is a high-incidence disease that affects different systems of the body, but no comparative studies have been conducted to explore its incidence in different systems in patients with the coexistence of multiple diseases. Primary care is a medical institution that has the first contact with patients' conditions. The majority of outpatients suffer from multiple diseases, and they are more prone to VTE, which is of significance and requires investigation. At the same time, we observed that the primary care patients' cognition level of VTE is insufficiency at present, and the prevention and management of VTE in China is still in its infancy. Most studies focus on whether doctors and nurses are clear about the diagnosis and manifestations of VTE, however, few studies on patients' cognitive level and influencing factors of symptoms and prevention of VTE. Therefore, it is necessary to study the causes of cognitive deficiency of VTE from the perspective of patients, conduct targeted cognitive and behavioral interventions, and finally achieve the purpose of improving the effect of VTE prevention and management. AIM: This study aimed to explore the risk factors, cognitive level and cognitive potential influence factors of VTE in outpatients of primary care in Shanghai, as well as which diseases, are more likely to promote occurrence of VTE among patients with multiple diseases. METHODS: A total of 710 patients were included in the analysis. Shanghai in China is divided into urban and suburban areas by their geographical location, and a random sample of 10 primary care areas was investigated, including 5 urban areas and 5 suburban areas. The Padua scale and the VTE cognitive level-related knowledge test scale were used for the investigation. Statistical software was used to conduct univariate Pearson correlation analysis and multivariate logistic regression analysis for VTE high-risk factors among outpatients of primary care. Furthermore, the high-risk factors for VTE and the types of chronic disease in patients with multiple diseases were subjected to subgroup analyses. t-test was used to statistically analyze cognitive level of VTE and the potential influence factors related to the patients' VTE cognitive level. RESULTS: Univariate analysis of risk factors for VTE in 710 outpatients showed that age (χ 2=83.895, P<0.001), education (χ 2=8.324, P=0.004), region (χ 2=63.936, P<0.001), chronic disease (χ 2=18.198, P<0.001) and the coexistence of multiple diseases (χ 2=61.347, P<0.001) were the main risk factors for VTE risk in patients. Logistic multivariate regression analysis showed that age, region, chronic diseases and the coexistence of multiple diseases were independent risk factors for VTE risk in patients. The correlation between high risk of VTE in patients with multiple diseases and various types of chronic diseases was further analyzed by logistic multivariate regression. The results showed that diabetes mellitus (OR=1.636 [95% CI, 1.030-2.599], P=0.037), cerebral infarction (OR=8.484 [95% CI, 4.615-15.597], P<0.001), coronary heart disease (OR=2.987 [95% CI, 1.699-5.252], P<0.001), intracerebral hemorrhage (OR=15.130 [95% CI, 4.707-48.630], P<0.001), respiratory diseases (OR=3.470, [95% CI, 1.428-8.43], P=0.006) and malignant tumors (OR=4.576, [95% CI, 1.85-11.315], P=0.001) were independent risk factors for VTE among patients with co-existing diseases, and the risks from high to low were cerebral hemorrhage>cerebral infarction>malignant tumor>respiratory system disease>coronary heart disease> diabetes. In addition, patients' age (t=6.869, P<0.001), region (t=3.420, P<0.001), education level (t=-7.341, P<0.001), chronic disease (t=5.875, P<0.001), BMI (t=6.404, P=0.012), smoking (t=4.152, P=0.042) were related to the VTE cognitive level. CONCLUSION: General practitioners should pay close attention to independent risk factors for VTE among patients in routine outpatient care, especially patients with co-existing diseases with independent risk for VTE, placing them high risk of VTE. At the same time, health education and other measures should be strengthened to improve the patients' awareness and cognitive level of VTE to prevent the occurrence of VTE and its related complications.

A Cognitive Level Evaluation Method Based on a Deep Neural Network for Online Learning: From a Bloom's Taxonomy of Cognition Objectives Perspective.

The evaluation of the learning process is an effective way to realize personalized online learning. Real-time evaluation of learners' cognitive level during online learning helps to monitor learners' cognitive state and adjust learning strategies to improve the quality of online learning. However, most of the existing cognitive level evaluation methods use manual coding or traditional machine learning methods, which are time-consuming and laborious. They cannot fully mine the implicit cognitive semantic information in unstructured text data, making the cognitive level evaluation inefficient. Therefore, this study proposed the bidirectional gated recurrent convolutional neural network combined with an attention mechanism (AM-BiGRU-CNN) deep neural network cognitive level evaluation method, and based on Bloom's taxonomy of cognition objectives, taking the unstructured interactive text data released by 9167 learners in the massive open online course (MOOC) forum as an empirical study to support the method. The study found that the AM-BiGRU-CNN method has the best evaluation effect, with the overall accuracy of the evaluation of the six cognitive levels reaching 84.21%, of which the F1-Score at the creating level is 91.77%. The experimental results show that the deep neural network method can effectively identify the cognitive features implicit in the text and can be better applied to the automatic evaluation of the cognitive level of online learners. This study provides a technical reference for the evaluation of the cognitive level of the students in the online learning environment, and automatic evaluation in the realization of personalized learning strategies, teaching intervention, and resources recommended have higher application value.

Metformin improves cognition of aged mice by promoting cerebral angiogenesis and neurogenesis.

Metformin is a widely used drug for type 2 diabetes that is considered to have potential anti-aging effects. However, the beneficial effects of metformin in middle-aged normoglycemic mice are less explored. Here, we report that metformin treated by tail vein injection improved cognitive function of aged mice better than oral administration, which seem to show a dose-dependent manner. Correspondingly, long-term oral administration of metformin was associated with significant disability rates. Further, metformin restored cerebral blood flow and brain vascular density and promoted neurogenic potential of the subependymal zone/subventricular zone both in vivo and in vitro. RNA-Seq and q-PCR results indicated that metformin could enhance relative mRNA glycolysis expression in blood and hippocampal tissue, respectively. Mechanistically, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), a key enzyme in glycolysis pathway, may contribute to angiogenic and neurogenic potentials of NSCs. Interestingly, the relative GAPDH mRNA expression of peripheral blood mononuclear cell was gradually decreased with aging. Meanwhile its expression level positively correlated with cognitive levels. Our results indicated that metformin represents a candidate pharmacological approach for recruitment of NSCs in aged mouse brain by enhancing glycolysis and promoting neurovascular generation, a strategy that might be of therapeutic value for anti-aging in humans.

Adolescent Haze-Related Knowledge Level Study: A Cross-Sectional Survey With Sensitivity Analysis.

Objective: This study aimed to investigate the level of haze-related knowledge adolescents have and to explore relevant influencing factors. Methods: From June 2015 to January 2016, researchers randomly selected 2 districts from the 20 districts of Baoding, China. Then, researchers randomly selected two middle schools from two districts. By conducting a stratified cluster sampling and considering one class as a unit, researchers randomly selected, from the other middle school, five first-grade classes, five second-grade classes, five third-grade classes from the one middle school, and three first-grade classes, two second-grade classes, and two third-grade classes. Finally, 1,100 adolescents were investigated by using the demographic questionnaire and the Adolescent Haze-Related Knowledge Awareness Assessment Scale (AHRKAAS). Multiple linear regressions were conducted to explore factors affecting the adolescent haze-related knowledge. Sensitivity analysis was used to confirm associations between influencing factors and AHRKAAS scores. Results: The AHRKAAS score rate was 69.9%. The dimension of human factors of haze formation was the highest (score rate = 85.6%). The dimension of haze harms on the human body was the lowest (score rate = 57.1%). Compared with the group (monthly expenses <300 yuan), the group (monthly expenses ≥ 600 yuan) had a higher AHRKAAS score (ß = 4.882, 95% CI: 0.979, 8.784). Compared with the group (Do not live with parents), the group (Live with parents) had a higher AHRKAAS score (ß = 14.675, 95% CI: 9.494, 19.855). Compared with the group (Never undergo a physical examination), the group (Once a year) (ß = 7.444, 95% CI: 2.922, 11.966) and the group (A few times a year) (ß = 7.643, 95% CI: 2.367, 12.919) had a higher AHRKAAS score. Compared with the group (Know nothing), the group (Know most) (ß = 9.623, 95% CI: 2.929, 16.316) and the group (Know very well) (ß = 15.367, 95% CI: 7.220, 23.515) had a higher AHRKAAS score. These associations were still reliable and consistent in different sensitivity analysis models. Conclusion: The level of adolescent haze-related knowledge is low and is affected by monthly expenses, living condition, physical examination frequency, and knowledge of respiratory system diseases. Government bodies, schools, and research institutions should strengthen cooperation of health publicity and health education to improve adolescent haze-related knowledge.

Knowledge, application and how about competence? Qualitative assessment of multiple-choice questions for dental students.

Background: Many medical schools train their faculty members to construct high cognitive level multiple choice questions (MCQs) that demand a great deal of analytical and critical thinking, application, and competence. The purpose of this study is to determine the cognitive levels of MCQs by using Moore's Expanded Outcomes Framework and to understand whether the quality of MCQs has an effect on students' assessment performance.Methods: Four trained faculty members analysed 100 randomly selected questions developed at the University Clinic of Dentistry (UCD) and 100 questions developed by the National Board of Dental Examinations (NBDE). Moore's framework was applied to assist the review process.Results: The majority of questions was at the level of declarative knowledge followed by questions at the level of procedural knowledge. The cognitive level of UCD questions from 2002 to 2009 was significantly lower than that of NBDE questions but increased in questions written from 2010 to 2018. The improvement of quality of MCQs had no impact on assessment performance of students.Conclusion: The enhanced cognitive levels of UCD MCQs written 2010-2018 coincides with the implementation of a faculty training program for writing high-ordered MCQs. In addition, this study shows that the use of Moore's expanded framework is on par with other known taxonomies in supporting educators in writing items and reviewing the process.Abbreviations: MCQs: Multiple Choice Questions; UCD: University Clinic of Dentistry; NBDE: National Board of Dental Examinations.

The Relationship Between Retinal Nerve Fiber Layer Thickness and Clinical Symptoms of Alzheimer's Disease.

Background/Aim: Retinal nerve fiber layer (RNFL) thickness (RT), which can reflect the status of the retinal optic nerve cells, may be affected in patients with Alzheimer's disease (AD). There are few studies on the correlation of RT of patients with AD (AD-RT) with clinical symptoms of various cognitive domains, neuropsychiatric symptoms, and activities of daily living (ADL). This study is to investigate the relationships between RT and the abovementioned clinical symptoms of AD. Methods: A total of 96 patients with AD were included in this study. RT was measured in these patients using optical coherence tomography (OCT). Demographic variables, RT, and clinical symptoms were compared between the normal and the abnormal AD-RT groups. Clinical symptoms, including cognitive symptoms, neuropsychiatric symptoms, and ADL, were evaluated using a series of rating scales. Results: The relationships between RT and cognitive symptoms scores were analyzed in patients with AD. Reduced RT was found in 54.4% of patients with AD. The average RT, RT of the superior 1/2 quadrant, and RT of the inferior 1/2 quadrant of both eyes were all significantly decreased in the abnormal AD-RT group (p < 0.001). Overall cognitive function and performance in multiple cognitive domains, including memory, language, attention, and executive function, were also significantly impaired in the abnormal AD-RT group (p < 0.05). For lower RT value, the global cognitive function and the performance in multiple cognitive domains were worse. ADL was significantly compromised in patients with AD having lower RT values (p < 0.05). Conclusions: Lower RT value appear to be correlated with cognitive impairment, and RT may be an indicator of cognitive decline in patients with AD. Further studies are required to confirm our findings.

Role of community health service programs in navigating the medical ethical slippery slope-a 10-year retrospective study among medical students from southern China.

BACKGROUND: For promoting autonomous learning motivation, the learning effect of community-oriented service is beneficial, because through community participation and service, students can transfer their implicit cognition of ethics into explicit cognition, leading to the cultivation of a sympathetic partnership between the community and medical students. Despite the proven benefits of medical students' community health service (CHS) in Western countries, CHS programs designed for medical students are not well established in mainland China, and their effects on medical students' ethical cognition are largely unknown. This study evaluated the effects of CHS programs on the ethical cognition of medical students. METHODS: A cross-sectional study was conducted on third- and fourth-year medical students and graduates working at Shantou University Medical College by using a self-administered anonymous questionnaire. Through interviews, we applied a thematic approach to analyze the responses of the participating students. The questionnaire adopted in this study was revised based on a review of the literature on medical ethics in medical students and on the CHS environment in China. The reviewed questionnaires included an evaluation questionnaire on cultivating medical ethics in a CHS context, and questionnaires used to explore the cultivation and transformation of medical ethics in medical students during the preclinical period. RESULTS: A total of 361 (54.4%) undergraduate medical students and 302 (45.6%) graduates participated in this survey. Significant differences were observed in self-evaluation of the cognitive development of ethics between those who had participated in CHS programs 1-5 times and those who had participated > 6 times. The successful identification of accepting money from the patients under the table as unethical behavior significantly differed (p = .031) among the graduates but not (p = .567) among the undergraduate students. The participants expressed the positive impact of CHS programs on their self-development. CONCLUSION: CHS programs can be widely applied in medical education in China. This educational strategy, which supports medical professionalism and incorporates humanitarian behavior as a complement to learning, should be encouraged and promoted nationally.

Factors related to hospital utilisation for people living with schizophrenia: Examining Allen's Cognitive Level Scores, recommended supports and routinely collected variables.

INTRODUCTION: Australian occupational therapists working on mental health inpatient wards are often requested to assess a person's function and, based on that assessment, recommend the best support environments for that person post-discharge. The Allen Cognitive Level Screen (ACLS) is a tool used by some therapists to screen cognitive functioning as a basis with which to make support recommendations. There is limited examination of the outcomes for people post-discharge if the ACLS score-based support recommendations are followed. METHOD: A retrospective cohort design involved quantitative analysis of archival data for 150 adult (18-65 years old) consumers with a primary diagnosis of schizophrenia and an ACLS completed pre-discharge. Data up to 12 months post-discharge from hospital were studied. Outcomes examined included re-presentations or readmission to hospital, length of time in community prior to re-presentation and length of stay in hospital if readmitted. RESULTS: Being younger, male, receiving formal supports, having a drug and alcohol disorder comorbidity, living in public housing and having a lower cognitive level as measured by the ACLS were significant univariate factors associated with higher hospital utilisation for one or more of the outcome variables. Multivariate analyses revealed fewer significant relationships, with being younger and receiving formal supports significantly associated with greater likelihood of return to hospital. CONCLUSION: This research contributes to evidence of the complexity of living with schizophrenia in the community and supporting people to stay out of hospital. More research regarding how the ACLS score-aligned support recommendations are carried out and the impact on hospital utilisation is needed in order to enhance occupational therapists confidence in their use and prescription.