Sex differences in the impact of lower respiratory tract infections on older adults' health trajectories: a population-based cohort study.

BACKGROUND: Lower respiratory tract infections (LRTIs) are a major global health concern, particularly among older adults, who have an increased risk of poorer health outcomes that persist beyond the acute infectious episode. We aimed to investigate the mid-term (up to 7 years) and long-term (up to 12 years) effects of LRTIs on the objective health status trajectories of older adults, while also considering potential sex differences. METHODS: Cohort data of adults aged ≥ 60 years from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) collected between 2001 and 2016 was analyzed. Information on LRTIs was obtained from the Swedish National Patient Register, and objective health status was assessed using the Health Assessment Tool (HAT) which incorporates indicators of mild and severe disability, cognitive and physical functioning, and multimorbidity. The LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders. Mixed linear models were used to analyze the association between LRTIs and changes in HAT scores. RESULTS: The study included 2796 participants, 567 of whom were diagnosed with a LRTI. LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period. CONCLUSION: LRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age.

Enhancing health assessments with large language models: A methodological approach.

Health assessments have long been a significant research topic within the field of health psychology. By analyzing the results of subject scales, these assessments effectively evaluate physical and mental health status. Traditional methods, based on statistical analysis, are limited in accuracy due to their reliance on linear scoring methods. Meanwhile, machine learning approaches, despite their potential, have not been widely adopted due to their poor interpretability and dependence on large amounts of training data. Recently, large language models (LLMs) have gained widespread attention for their powerful natural language understanding capabilities, offering a viable solution to these issues. This study investigates the application of LLMs in enhancing physical and mental health assessments, introducing ScaleLLM. ScaleLLM employs language and knowledge alignment to turn LLMs into expert evaluators for health psychology scales. Experimental results indicate that ScaleLLM can improve the accuracy and interpretability of health assessments.

Online Mental Health Assessment in a psychiatry emergency department in adults using touchscreen mobile devices: A randomised controlled trial.

OBJECTIVE: To determine whether completion of an online mental health self-assessment by patients who are waiting in the emergency department can save clinician time taken to complete clinical assessment and documentation. METHODS: Patients presenting to a psychiatric emergency department for a period of 6 months were allocated by week of presentation to either the intervention arm (online mental health self-assessment, followed by a clinical interview) or the control arm (usual assessment) arm on a random basis. Time at the beginning and end of the interview was recorded and used to derive interview time. Similarly, time at the beginning and end of the clinical documentation was recorded and used to derive the time to complete clinical documentation. RESULTS: Of 168 patients who presented during the study period, 69 (38.55%) agreed to participate, 33 completed the usual assessment and 30 completed the online mental health self-assessment followed by a clinical interview. Patients receiving usual care had a statistically significant, t(61) = 2.15, p = 0.035, longer interview duration (M = 48.7 minutes, SD = 19.8) compared with those in the online mental health self-assessment arm (M = 38.9 minutes, SD = 15.9). There was no statistically significant difference between groups for documentation time, t(61) = -0.64, p = 0.52. CONCLUSION: Online mental health self-assessment was associated with a statistically significant reduction in interview time by approximately 10 minutes without increasing documentation time. While online mental health self-assessment is not appropriate for all patients in the emergency department setting, it is likely to yield greater benefits in less acute settings.

Urban Lake Health Assessment Based on the Synergistic Perspective of Water Environment and Social Service Functions.

Urban lakes serve as vital ecological and recreational anchors within built environments, essential for enhancing urban resilience. Evaluating lake health predominantly focuses on water quality, assessing indicators such as nutrient levels, toxicity, pH balance, and water clarity to monitor changes. This study proposes a comprehensive evaluation framework that systematically describes specific spatiotemporal manifestations and periodic exogenous regulation characteristics across five dimensions: physical structure, water quality, shoreline dynamics, external regulation, and social service. Furthermore, it introduces an urban lake health assessment model based on synergistic development to evaluate the integrated development and interaction between water environments and social services. This model is applied across urban lakes in various developmental stages in China. Key findings include: 1) Urban development often impacts lake health disparately, with varying degrees of synergy observed between water environments and social services across different urban lakes. However, shifts in urban ideologies and improvements in governance, along with protective policies and project implementations, have contributed to improving water quality to some extent. 2) Engineering interventions do not consistently correspond with improvements in water quality, and governance measures sometimes yield mixed outcomes, underscoring the necessity for systematic solutions to lake health. Restoring hydrological processes emerges as crucial for enhancing sustainability.

School Nurse-Led Health Assessment for Students Experiencing Homelessness: A Quality Improvement Project.

Childhood homelessness is increasing and is associated with negative health and academic outcomes. The goal of this quality improvement project was to improve access to healthcare and health outcomes for students experiencing homelessness through a school nurse-led comprehensive health assessment. The multilevel intervention included identifying students experiencing homelessness, conducting a standardized health assessment, and making referrals to care. This 8-month project was conducted in an urban school district. Feasibility and acceptability data were collected to guide sustainability. Student health and referral data were analyzed using descriptive statistics. At the project start, 688 students were identified as experiencing homelessness. More than half (67%) had a partial or fully completed health assessment during the project. Of the students assessed, most had a primary care provider, some had a health condition, and half had a dental home. Students experiencing homelessness would benefit from systematic school-based health assessments to identify unmet health needs.

Insights into the associated risk factors of malnutrition among nursing home residents: A longitudinal study.

BACKGROUND & AIMS: Malnutrition often remains undetected in older persons, leading to increased health problems and comorbidity, prolonged hospital stays and readmissions. In 2020, data from the interRAI Home Care (interRAI HC) instrument was used to determine malnutrition status according to some of the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The interRAI HC instrument showed to be effective as a screening tool for the risk of malnutrition. The goal of the present study is to use the interRAI Long Term Care Facilities (interRAI LTCF) instrument for nursing home residents to identify factors related to older people's health that are significantly associated with the development of malnutrition. METHODS: This study analyzes data collected in the period 2019-2023 from nursing home residents, 65 or older, with a follow-up period of 1 year. After applying the GLIM criteria to the available interRAI LTCF data, a cross-sectional sample a longitudinal sample were analyzed by means of bivariate analysis. Factors included in the bivariate analysis were based in previous studies and expert opinion. Unadjusted and adjusted regression models were built to explore associations between several potential risk factors and nutritional status. RESULTS: The sample consisted of 5598 older people with a mean age of 83.98 ± 7.30 years old and 71.2 % being female. Most people needed extensive assistance with activities of daily living (70.9%) and had at least a mild cognitive impairment (63.9%). According to the GLIM definition using the interRAI items, 8.43% of the residents were malnourished and 4.67% of the residents became malnourished over the period of 1 year. The final adjusted logistic regression yielded significant odds ratios for seven determinants: age (O.R. 1.03; C.I.: 1.01; 1.04), depressive symptoms (O.R.: 1.32; 1.01; 1.73), assistance needed for walking (O.R. 1.49; C.I.: 1.13; 1.95), wandering behavior (O.R. 1.16; C.I.: 1.01; 1.33), falls (O.R. 1.17; C.I.: 1.02; 1.35), visual impairment (O.R. 1.22; C.I.: 1.05; 1.42) and diabetes (protective factor - O.R.: 0.67; C.I.: 0.46; 0.98). CONCLUSIONS: The study showed the main risk factor for malnourishment in nursing home residents, such as age, depressions, assistance for walking, wandering and visual impairment. These significant factors can be used to identify people at risk of malnourishment. Periodically screening residents with the interRAI LTCF can help identify malnourished residents or residents at risk of malnourishment.

Oral Health Assessment for Older Residents in Long-Term Care Facilities Using Video Recording by a Mobile Electronic Device.

BACKGROUND/OBJECTIVES: Many older adults who require long-term care need oral health management. However, access to dental care is limited, and connecting older patients with dental professionals is a future challenge. Therefore, the development of a remote oral health assessment system is required. This study aimed to investigate the usefulness of video-based oral health assessments in older adults residing in facilities. METHODS: This study comprised 60 older adults residing in facilities who consented to dental home visit treatment by the Department of Oral Function Management at Showa University Dental Hospital between July 2021 and December 2022. The Oral Health Assessment Tool (OHAT) was used to evaluate the oral health status at the facilities by one dentist. The concordance of the oral health assessments conducted by this dentist at the facilities (OHAT-B) was compared with those conducted by the same dentist (OHAT-V1) and two other dentists (OHAT-V2 and V3) using approximately 1 min video recordings of the oral cavity taken with a mobile electronic device. RESULTS: On the OHAT total score, the intraclass correlation coefficient (ICC [1.1]) for OHAT-B and V1 was 0.931; the ICC (2.1) was 0.889 when compared with V2 and 0.788 when compared with V3. Moreover, the comparison between V2 and V3 showed high agreement, with an ICC (2.1) of 0.750. CONCLUSIONS: This study revealed that the oral health assessment of older adults residing in facilities using video recordings of the oral cavity taken with a mobile electronic device may be possible, suggesting the possibility of remote oral health assessment.

Infection prevention and control in conflict-affected areas in northeast Syria: A cross-sectional study.

Objectives: In northeastern Syria (NES), the adherence of health care facilities to infection prevention and control (IPC) standards remains underexplored. This study evaluates the IPC performance of various health facilities against World Health Organization (WHO) benchmarks using the IPC Assessment Framework (IPCAF) and the Hand Hygiene Self-Assessment Framework (HHSAF). Methods: We conducted a cross-sectional survey of 33 health care facilities, including primary (PHC), secondary (SHC), and tertiary health care centres (THC). Data were collected via on-site evaluations using the IPCAF and HHSAF tools. Results: A significant 91% of facilities did not meet half of the WHO IPC minimum requirements. Specifically, 57% of PHCs met 26-50% of the standards, while none exceeded 75%. Among SHCs, 71% met 26-50% of the standards, while 44% of THCs fell within this range. Notably, 81.8% of facilities were classified as 'inadequate' per the IPCAF, with none achieving 'intermediate' or 'advanced' levels. The HHSAF results were similarly concerning, with 34.4% deemed 'inadequate' and 65.6% at the 'basic' level. A weak positive correlation (0.137) was found between IPCAF and HHSAF scores. Conclusions: NES health care facilities demonstrate substantial deficiencies in IPC compliance, with critical gaps in IPC programmes, health care-associated infection surveillance, and training. Urgent interventions are required to enhance IPC practices, leveraging local strengths and fostering international collaborations to improve patient safety and health care quality in the region.

From palm to practice: prescription digital therapeutics for mental and brain health at the National Institutes of Health.

Prescription Digital Therapeutics (PDTs) are emerging as promising tools for treating and managing mental and brain health conditions within the context of daily life. This commentary distinguishes PDTs from other Software as Medical Devices (SaMD) and explores their integration into mental and brain health treatments. We focus on research programs and support from the National Institutes of Health (NIH), discussing PDT research supported by the NIH's National Institute on Child Health and Development (NICHD), National Institute of Mental Health (NIMH), and National Institute on Aging (NIA). We present a hierarchical natural language processing topic analysis of NIH-funded digital therapeutics research projects. We delineate the PDT landscape across different mental and brain health disorders while highlighting opportunities and challenges. Additionally, we discuss the research foundation for PDTs, the unique therapeutic approaches they employ, and potential strategies to improve their validity, reliability, safety, and effectiveness. Finally, we address the research and collaborations necessary to propel the field forward, ultimately enhancing patient care through innovative digital health solutions.

Long term analysis of air quality parameters for Ludhiana, India: sources, trends and health impact.

Ludhiana, a pollution hot spot in North India, has seen a rapid deterioration in air quality over the years due to urbanization and industrialization. This study interprets the variations of particulate matter (PM) and gaseous pollutants (Nitrogen oxide, Nitrogen dioxide, NOX, Sulphur dioxide, Carbon monoxide, Benzene, Toluene, Ozone, and Ammonia) for the data observed from 2017 to 2023 in Ludhiana. This also covers the analysis focused on capturing the changes that occurred at the times of lockdown imposed during the Coronavirus Disease (COVID-19). The maximum 24-h averaged mass concentration values exceeded the National Ambient Air Quality Standards (NAAQS) of 100 µg/m3 for PM10 concentration and 60 µg/m3 for PM2.5 concentration in 2018 by the factor of 5 and 8. With the onset of the COVID-19 lockdown in 2020 year, PM10 and PM2.5 reached the minimum level while CO, T, O3, and NO2 increased by the factor of 3.9, 1.9, 1.4, and 1.3 from their previous year. This NO2 is a precursor of ozone formation, a higher NO2 to NO ratio observed during the lockdown, confirms the role of nitrogen compounds in the higher ozone formation rate. Based on the NO2/NO ratio, the probability rate of ozone formation determined using survival analysis is observed to be 94% from 2017 to 2023. The local sources' contribution to these air pollutants during Pre-Lockdown, Lockdown, and Post-Lockdown are analyzed using principal component analysis. The impact of the lockdown on ozone concentration sources has been observed. During the Pre- and Post-Lockdown phases, three sources (PC1, PC2, and PC3) were positively identified. Ozone levels are linked to PC3 in these phases, but during the lockdown, a negative loading in PC3 and positive loadings in PC1 and PC2 indicate a decrease in ozone from reduced emissions and an increase from secondary reactions involving nitrogen compounds. Moreover, the Toluene to Benzene concentration ratio is > 2, indicating the source of their origin from industrial emission or other non-traffic sources. Health assessment for the years 2017-2019 reveals a significant decrease in the number of cases of all-cause mortality, ischemic heart disease, stroke, and chronic obstructive pulmonary disease associated with reducing PM2.5 concentrations to national and international standards.

Community events to increase uptake of Indigenous-specific health assessments: a scoping review.

INTRODUCTION: Innovative, culturally safe strategies are required to address the disproportionate level of poorer health outcomes for Indigenous people in Australia compared to non-Indigenous populations. An emerging body of evidence supports the efficacy of Indigenous-specific health assessments, or health checks, despite poor uptake since their introduction in Australia. This poor uptake is attributed to a range of system, patient and provider barriers. Services have begun to deliver preventative health assessments as a community event to address barriers faced by Aboriginal and Torres Strait Islander people in accessing quality preventative care. However, there is a lack of literature exploring how community events have increased the uptake of Indigenous-specific health assessments to date. We expect this review will underpin a larger study to better understand how community engagement supports increased uptake of health checks. The objective of this scoping review was to investigate what is currently known about how community events have been used to increase uptake of Indigenous-specific health assessments. METHODS: A scoping review guided by the Joanna Briggs Institute methodology for scoping reviews was conducted. A search was completed in eight electronic databases using keywords relating to Aboriginal and Torres Strait Islander health, community engagement and preventative health assessments. Published and unpublished sources of evidence were included in the review. As this study aims to explore the entire published literature on the topic, and given there was an expectation that the subject itself is specific, no date ranges were included in the search criteria. Extracted data were reviewed by numerical analysis and conventional content analysis to conduct a narrative synthesis, allowing a summary of the main findings, and addressing the research question. RESULTS: Eighteen sources met the eligibility criteria and were included in the scoping review. Programs varied widely in the characteristics of program design and delivery across geographical location, setting of delivery, program format and target population. Programs employed a range of methods to engage with community, including incentivising participation, identifying and addressing specific community healthcare needs, and utilising cultural or sporting ambassadors to promote the program. The conventional content analysis identified three key themes regarding how community events have been used to increase uptake of health checks: adapting the program to the community; providing a culturally safe participant experience; and prioritising community engagement. DISCUSSION: The findings indicate that an individualised approach to community events is important to their success. Aboriginal Controlled Community Health Services may be best placed to have responsibility for program design and implementation to ensure community control of programs. Aboriginal health workers play a critical role in ensuring the programs deliver culturally safe healthcare, and a clear role for Aboriginal health workers in program delivery is important in their success. An authentic commitment to community engagement is important for program uptake, including the use of passionate cultural ambassadors and individualised cultural programs. CONCLUSION: Community events are a promising and well-regarded strategy to increase uptake of Indigenous-specific health assessments. Future research that explores how specific community supports increase engagement with Health Check Day programs and evaluates the delivery of 715 health check programs will strengthen the capacity of Aboriginal Community Controlled Health Services to delivery this intervention effectively.

Identification of atmospheric emerging contaminants from industrial emissions: A case study of halogenated hydrocarbons emitted by the pharmaceutical industry.

With the development of the pharmaceutical industry, halogenated hydrocarbons, which are the main raw materials and emissions of the pharmaceutical industry, may be defined as atmospheric emerging contaminants due to toxicity and low oxidation of the atmosphere. This study analyzed the volatile organic compounds (VOCs) emissions from four pharmaceutical companies located in the Yangtze River Delta. Samples were taken three times at each of the selected fixed and fugitive sampling sites in each company. Through testing, 141 VOCs were identified. The mean concentration and proportion of halogenated hydrocarbons from the four pharmaceutical companies were the highest of all the industries in the industrial park. They reached 18.9 ppm and 28.8 %, respectively. Fixed emissions of the companies exhibited the mean maximum concentration of dichloromethane and chlorobenzene, which are 11.4 ppm and 250.67 ppb. The mean concentration of fugitive emission of dichloromethane from the four companies in this study is lower than that of pharmaceutical companies in other studies. Newly detected halogenated hydrocarbons, such as 1,1-dichloropropanone and dichloronitromethane, present potential non-cancer and cancer risks to workers. Chlorobenzene was identified as a key potential cancer risk halogenated hydrocarbon the value of which reaches 0.00965. 2,6-dichloropyridine could be a potential emerging contaminant due to its lower MIR value and higher potential cancer risk. The study suggests that relevant pharmaceutical companies focus on the emissions of chlorobenzene and dichloromethane, which may be the atmospheric emerging contaminants for the pharmaceutical industry and focus on improve the treatment of waste gases in workshops and sewage stations.

Predictors of clinical features in early-onset severe systemic sclerosis: An analysis from a multicenter prospective observational Japanese cohort.

As the clinical course of systemic sclerosis (SSc) varies widely, prognostic indicators have been sought to predict the outcomes of individual patients. Racial differences in SSc render it necessary to validate prognostic indicators in different patient cohorts. In this study, we aimed to assess clinical and laboratory parameters in Japanese patients with early-stage SSc with diffuse cutaneous involvement and/or interstitial lung disease, and identify predictive factors for disease progression. We performed multivariate analyses of baseline clinical information to estimate symptoms 4 years later in Japanese patients with diffuse cutaneous SSc and/or SSc with interstitial lung disease. Patients were enrolled in the study within 5 years of disease onset at 10 Japanese SSc centers. Over 12 years, 115 patients followed up for 4 years were included in this study. The modified Rodnan skin score (mRSS) at 4 years correlated with the baseline mRSS and finger-to-palm distance, defined as the average length from the distal tip of the fourth finger to the distal palmar crease. The percentage predicted vital capacity (%VC) in year 4 positively and negatively correlated with initial %VC and the presence of anti-topoisomerase I antibodies, respectively. The Health Assessment Questionnaire Disability Index (HAQ-DI) at 4 years was positively and negatively associated with baseline HAQ-DI and %VC, respectively. The occurrence of digital ulcers within 4 years was associated with the initial presence of digital ulcers, finger-to-palm distance, and the presence of digital pitting scars and anti-topoisomerase I antibodies. This study identified several factors that may predict the progression of early-stage SSc in Japanese patients. Finger-to-palm distance may be a useful tool for predicting the progression of skin thickening and the development of digital ulcers in the early stages of severe SSc, but larger, long-term prospective studies are needed to confirm our findings.

Seeking the aim - perspectives of asylum seekers, nurses, and authorities on the objectives of the asylum seekers' initial health assessment: a qualitative study.

BACKGROUND: A voluntary and free initial health assessment is offered to all asylum seekers upon arrival in Finland. The central aim of this initial health assessment is early identification of service needs. There is, however, limited information on how effective the initial assessment is in fulfilling its aims. This study explores the viewpoints of asylum seekers, reception centre nurses, and health authorities regarding the objectives of the initial health assessment. It serves as a starting point for effectiveness research, where effectiveness is defined as the achievement of intended aims. METHODS: This qualitative descriptive study is based on 31 semi-structured individual interviews (13 asylum seekers, 14 nurses, and four asylum health authorities) conducted in January and February 2019. Reflective thematic analysis was employed for data analysis, involving initial separate analyses for each group, followed by an assessment of differences and similarities between the groups. RESULTS: The importance of a comprehensive initial health assessment and preventing infections was emphasized by all groups. The main differences were views on service needs assessment in relation to persons in vulnerable situation and information provision. All groups described both individual and public health perspectives. CONCLUSIONS: This study provides valuable insights for developing a more effective assessment. Asylum seekers require comprehensive health assessment and details about their rights. To address these needs, it is crucial to update reception centre nurses' practices. Additionally, authorities responsible for planning and guiding services should refine their instructions concerning the information provided to asylum seekers and persons in vulnerable situations. The findings of this study can be used to enhance information provision and develop targeted training programs for nurses, as well as to evaluate the achievement of established aims.

Health Behavioral Assessment among the Head and Neck Cancer Patients: A Cross-Sectional Analysis.

The current study sought to evaluate the health-seeking behavior and related factors among head and neck cancer patients who were visiting a cancer treatment center. A total of 150 patients with head and neck cancer in the age range of 20-65 years were included in the study. A pretested, structured questionnaire with 20 closed-ended questions was used to cover topics like sociodemographics, personal vices, the patient's medical history, events after diagnosis, and knowledge of cancer. Patients who were unemployed were more likely to put off seeking medical attention than those who were employed. This finding was statistically significant. More initiative and creative action should be made by government and non-government organizations to provide ongoing periodic screening, counseling, and health education to the general public.

Assessment of health risk of antibiotics resistance genes from human disturbed habitat to wild animals: Metagenomic insights into availability and functional changes of gut microbiome.

Not all antibiotic resistance genes (ARGs) pose an ecological risk to their host animals. A standard should be developed to study which types of ARGs posed an ecological risk to wild animals under human disturbances (HDs). In this study, the golden snub-nosed monkeys (Rhinopithecus roxellana) were used as sentinel species. According to the animals-associated enrichment, mobility, and pathogenicity, the ARGs in habitat of sentinel species were divided into four levels. If the mobile and pathogenic ARGs that could be collinear with the metagenome-assembled genome (MAGs) in the gut of the sentinel species, the ARGs were defined as Rank I ARGs and they were considered to have ecological risk to sentinel species. Functional genes in the MAGs that collinear with the Rank I ARGs were used to predict the health risks of sentinel species. The ecological risk to sentinel species was present in 0.158 % of the ARGs-contigs in the habitat. Cultivation and villages, but not grazing, agriculture and ecotourism, increased the ecological risk of the ARGs to wild animals, The ability of gut microbiome to acquire mobile and pathogenic ARGs increased, as did the collinear functional genes, and the health risks of the wild animals also enhanced by the disturbances of cultivation and villages. Cultivation and villages increased the nutrient content of the soil, and they had a positive effect on the ecological risk of Rank I ARGs by affecting the mobile genetic elements (MGEs), microbiome and the resistant group in the habitat, which was why the cultivation and villages increased the health risks of wild animals. We proposed that cultivation and living should be controlled, while grazing, agriculture and ecotourism could be developed in nature reserves of wild animals, but the nutrients in the wild animals' habitat should be monitored.

A Cross-Sectional Study Assessing the Functional Status in Children With Juvenile Idiopathic Arthritis and Its Correlation With Their Quality of Life and Burden on Caregivers.

Background Juvenile idiopathic arthritis (JIA) is a common rheumatic disease in children, significantly impacting their functional status and quality of life (QoL), as well as imposing a burden on caregivers. This study aims to assess the functional status of children with JIA, their QoL, and the associated caregiver burden while exploring the correlations between these factors. Methodology A prospective, cross-sectional, observational study was conducted over 18 months. A total of 33 children diagnosed with JIA were evaluated using the Childhood Health Assessment Questionnaire (CHAQ), and Euro Quality of Life-5 Dimension-Youth (EQ-5D-Y). Caregiver burden was assessed using the Family Burden Interview Schedule (FBIS). Data were analyzed using descriptive statistics, regression analysis, and Spearman's rank correlation. Results A total of 33 consecutive children with JIA were prospectively enrolled. The mean age was 10.1 ± 3.7 years, with a male predominance (63.6%, n = 21). Enthesitis-related arthritis was the most common subtype (42%, n = 14). The CHAQ scores indicated moderate disability, with profound impacts on walking and arising. Most children reported "some problems" in all EQ-5D-Y domains, with a mean health status visual analog scale score of 60.97 ± 23.43. The mean FBIS score was 9.64 ± 5.78, indicating a moderate caregiver burden. The majority of caregivers reported moderate financial, family routine, and family leisure disruptions. Significant correlations were found between CHAQ and EQ-5D-Y scores in several domains (p ≤ 0.040), as well as between specific CHAQ domains and FBIS scores (p ≤ 0.037). Conclusions Children with JIA experience significant functional limitations and reduced QoL, which also impacts their caregivers. Early rehabilitation and comprehensive care strategies are crucial for improving functional outcomes and QoL, as well as alleviating caregiver burden.

Health assessments of refugee minors arriving in Norway - a modified Delphi study among health professionals in primary care settings.

BACKGROUND: Refugee minors are considered particularly vulnerable to negative health consequences from war, flight and resettlement. Offering health assessments after arrival in a host country could uncover unmet health needs and provide access to treatment. In Norway, a national guide describes these assessments, but little is known about its implementation especially for refugee minors. Thus, the aim of this study was first to explore how health assessments of refugee minors are carried out, second how health professionals perceive the needs of refugee minors and third, the competencies they perceive as necessary to meet the needs of refugee minors. METHOD: A modified Delphi study in three rounds was conducted using online surveys and one focus group to collect data on the needs and resources of refugee minors, essential factors for a good and health assessment practice. Participants were 54 health professionals responsible for early health assessments of refugee minors, throughout the Norwegian municipalities, working in primary care settings. Quantitative data was analysed descriptively, and qualitative data with content analysis. RESULTS: Health assessments of refugee minors were predominantly conducted by public health nurses, but the organisational structures surrounding assessments varied greatly according to the size of the municipalities and to how much resources were allocated. The feeling of safety was found to be paramount to ensure a good start in a new country for refugee minors. The top four competences professionals should have, were 'general communication skills', a 'health professional background', 'expertise in children's health' and 'knowledge about the national guide'. To ensure good health services for refugee minors, improved, more comprehensive, and mandatory directives for children and young individuals was highlighted. CONCLUSION: Although most refugee minors were invited and attend health assessments, one third of participating municipalities did not offer health assessments to all newcomers and the organisation and content of the assessments were diverse. Several topics, especially mental health, were postponed or not routinely addressed, contrasting with current knowledge of unmet health needs for this group. Missing documentation, practical barriers and providing general health information took time away from doing the actual assessments. The perceived needs of refugee minors were safety and stability, combined with meaningful activities, thus a coordinated effort from several services is necessary. Suggestions for improvements were more time given to assessments, better organisation and co-operation, improved competence and guidelines adjusted for age.

Insights into the occurrence, distribution and dissipation of widespread agrochemicals in celery agrosystems for joint risk assessment.

Elucidating exposure risks associated with the most widely used agrochemicals and their metabolites in celery agrosystems are vital for food safety and human health. The occurrence, distribution, dissipation and metabolism of imidacloprid (IMI), acetamiprid (ACE), thiamethoxam (THM) and difenoconazole (DIF) in celery tissues reflected by initial depositions, uptake characteristics, half-lives, concentration variations. DIF exhibited unacceptable ecological risk to soil organisms under multi-risk evaluation models, including toxicity exposure ratio, risk quotient, and BITSSD model. The joint dietary risks of target pesticides were 37.273-647.454% and 0.400-2522.016% based on deterministic and probabilistic models, with non-carcinogenic risks of 30.207-85.522% and 1.229-2524.662%, respectively. Children aged 1-6 years suffered the highest exposure, with the leaves posing higher risk than other tissues. Long-term exposure risks should be continuously assessed for ecological sustainability and human health, given the widespread usage and cumulative effects of target pesticides, especially for rural children.

"Sometimes it can be like an icebreaker": A mixed method evaluation of the implementation of the Refugee Health Screener-13 (RHS-13).

Background: Forced migrants are at risk of developing mental illness, yet challenges remain with underutilization of mental healthcare among this population. This study examined the implementation of the Refugee Health Screener-13 (RHS-13) in the health assessment for forced migrants in eight primary health care centres in Stockholm Region, Sweden. Methods: A mixed-methods convergent parallel design was used, combining nurses self-reported quantitative data on the levels and reasons for RHS-13 use in the health assessment with qualitative interview data on the barriers and facilitators for RHS-13 use. The Consolidated Framework for Implementation Research (CFIR) was used as a coding framework for the qualitative analysis. Results: Levels of RHS-13 use varied between primary health care centres, resulting in two groups: three centres with high-level (65-92%) and five centres with low-level (0-36%) implementation. Factors related to the tool itself, as well as the inner and outer context, influenced the use of RHS-13. Language barriers, insufficient time, and lack of trust in the validity and utility of RHS-13 were the main barriers, while its availability in many languages and that it was perceived as an important complement to the health assessment were the main facilitators. Conclusion: RHS-13 contributes to the standardization of assessing mental health in the health assessment. Identifying context-based implementation strategies and addressing language and time issues as well as nurses trust in the tool's utility are recommended to enhance the use of RHS-13.