Masturbation, sexual function, and genital self-image of undergraduate women: a cross-sectional study.

BACKGROUND: The relationship between factors related to masturbation, sexual function, and genital self-image among women has not been fully explored in the literature. AIM: The study sought to investigate the association between masturbation frequency, feelings, and behaviors with sexual function and genital self-image in young women. METHODS: A cross-sectional survey among 110 undergraduate female students was conducted. Online self-administered questionnaires to assess sociodemographic characteristics, masturbatory frequency, feelings, and behavior were completed. Participants also answered the Brazilian version of the Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS). OUTCOMES: The outcome includes masturbation frequency and behaviors associated, as well as scores on the FSFI and FGSIS. RESULTS: Women showed higher scores in FSFI subdomains when masturbation was considered important for them, along with reported feelings of empowerment and satisfaction during this activity. However, those who experienced negative emotions during masturbation, such as shame or guilt, demonstrated a significant association with lower scores in both FSFI and FGSIS. Masturbation frequency was found to correlate with better sexual function specifically in the desire domain among women who engaged in daily masturbation. Additionally, an association was observed between higher scores in the FGSIS and increased scores in the domains of satisfaction, arousal, and orgasm within the FSFI. There was an association in the domain's satisfaction, arousal, and orgasm of the FSFI with greater scores in FGSIS. CLINICAL IMPLICATIONS: The clinical implications encompass the augmentation of understanding pertaining to female sexual function. STRENGTHS AND LIMITATIONS: The study provides valuable insights into the sexual behavior of undergraduate female students, and its methodology improves openness in responses, as it provides anonymity given the sensitive nature of the topic studied. Study limitations include the unsuitability of the FSFI questionnaire for sexually inactive women in the past 4 weeks; the participation bias and reporting bias in sexuality searches; and the unknown validity of the investigator-derived questionnaire about masturbation, as it has not been previously validated. CONCLUSION: Masturbation frequency has minimal to no impact on female sexual function, whereas harboring positive feelings toward it and maintaining a positive genital self-image may exert a positive influence on sexual function.

Extrauterine growth restriction in very-low-birthweight infants: prevalence and concordance according to Fenton, Olsen, and INTERGROWTH-21st growth charts in a multicenter Spanish cohort.

Multiple criteria and growth references have been proposed for extrauterine growth restriction (EUGR). We hypothesized that these may impact the diagnosis of EUGR. The objective was to evaluate the prevalence of EUGR with its different definitions and the concordance according to Fenton, Olsen, and INTERGROWTH-21st in very-low-birthweight (VLBW) infants. This is an observational, retrospective, and multicenter study including VLBW infants from the Spanish SEN1500 Network from 2011 to 2020. Patients with major congenital anomalies, embryopathies, and gestational age less than 24 weeks were excluded. EUGR prevalence was calculated at discharge with cross-sectional, longitudinal, "true" cross-sectional, and "true" longitudinal definitions. Concordance was assessed with Fleiss' kappa coefficient. 23582 VLBW infants from 77 NICUs were included. In total, 50.4% were men with a median of gestational age of 29 (4) weeks. The prevalence of EUGR (cross-sectional, longitudinal, and "true") was variable for weight, length, and head circumference. Overall, the prevalence was higher with Fenton and lower with Olsen (cross-sectional and "true" cross-sectional) and INTERGROWTH-21st (longitudinal and "true" longitudinal). Agreement among the charts by weight was good only for cross-sectional EUGR and moderate for longitudinal, "true" cross-sectional, and "true" longitudinal. Concordance was good or very good for EUGR by length and head circumference.Conclusions: The prevalence of EUGR with the most commonly used definitions was variable in the cohort. Agreement among growth charts was moderate for all the definitions of EUGR by weight except cross-sectional and good or very good for length and head circumference. The choice of reference chart can impact the establishment of the diagnosis of EUGR. What is known: • EUGR has been defined in the literature and daily practice considering weight, length and head circumference with multiple criteria (cross-sectional, longitudinal, and "true" definition) • Different growth charts have been used for EUGR diagnosis What is new: • Prevalence of EUGR is variable depending on the definition and growth chart used in our cohort of VLBW infants • For the most frequently EUGR criteria used, traditionally considering weight, concordance among Fenton, Olsen and INTERGROWTH-21st growth charts is only moderate for all the definitions of EUGR by weight except cross-sectional definition. Concordance among the charts is good or very good for the different criteria of EUGR by head circumference and length.

Phenolic glycolipid-1 of Mycobacterium leprae is involved in human Schwann cell line ST8814 neurotoxic phenotype.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae infection in Schwann cells. Axonopathy is considered a hallmark of leprosy neuropathy and is associated with the irreversible motor and sensory loss seen in infected patients. Although M. leprae is recognized to provoke Schwann cell dedifferentiation, the mechanisms involved in the contribution of this phenomenon to neural damage remain unclear. In the present work, we used live M. leprae to infect the immortalized human Schwann cell line ST8814. The neurotoxicity of infected Schwann cell-conditioned medium (SCCM) was then evaluated in a human neuroblastoma cell lineage and mouse neurons. ST8814 Schwann cells exposed to M. leprae affected neuronal viability by deviating glial 14 C-labeled lactate, important fuel of neuronal central metabolism, to de novo lipid synthesis. The phenolic glycolipid-1 (PGL-1) is a specific M. leprae cell wall antigen proposed to mediate bacterial-Schwann cell interaction. Therefore, we assessed the role of the PGL-1 on Schwann cell phenotype by using transgenic M. bovis (BCG)-expressing the M. leprae PGL-1. We observed that BCG-PGL-1 was able to induce a phenotype similar to M. leprae, unlike the wild-type BCG strain. We next demonstrated that this Schwann cell neurotoxic phenotype, induced by M. leprae PGL-1, occurs through the protein kinase B (Akt) pathway. Interestingly, the pharmacological inhibition of Akt by triciribine significantly reduced free fatty acid content in the SCCM from M. leprae- and BCG-PGL-1-infected Schwann cells and, hence, preventing neuronal death. Overall, these findings provide novel evidence that both M. leprae and PGL-1, induce a toxic Schwann cell phenotype, by modifying the host lipid metabolism, resulting in profound implications for neuronal loss. We consider this metabolic rewiring a new molecular mechanism to be the basis of leprosy neuropathy.

B lymphocytes deficiency results in altered immune response and increased susceptibility to Mycobacterium leprae in a murine leprosy model.

Leprosy is a chronic and infectious disease that primarily affects the skin and peripheral nervous system, presenting a wide spectrum of clinical forms with different degrees of severity. The distinct host immune response patters developed in the response to the bacillus Mycobacterium leprae, the leprosy etiologic agent, are associated with the spectral clinical forms and outcome of the disease. In this context, B cells are allegedly involved in the disease immunopathogenesis, usually as antibody-producing cells, but also as potential effector or regulatory elements. In order to determine the regulatory B cells role in experimental leprosy, this study evaluated the outcome of M. leprae infection in B cell deficient mice (BKO) and WT C57Bl/6 control, by means of microbiological/bacilloscopic, immunohistochemical and molecular analysis, performed 8 months after M. leprae inoculation. The results demonstrated that infected BKO showed a higher bacilli number when compared with WT animals, demonstrating the importance of these cells in experimental leprosy. The molecular analysis demonstrates that the expression of IL-4, IL-10 and TGF-ß was significantly higher in the BKO footpads when compared to WT group. Conversely, there was no difference in IFN-γ, TNF-α and IL-17 expression levels in BKO and WT groups. IL-17 expression was significantly higher in the lymph nodes of WT group. The immunohistochemical analysis revealed that M1 (CD80+) cells counts were significantly lower in the BKO group, while no significant difference was observed to M2 (CD206+) counts, resulting a skewed M1/M2 balance. These results demonstrated that the absence of B lymphocytes contribute to the persistence and multiplication of M. leprae, probably due to the increased expression of the IL-4, IL-10 and TGF-ß cytokines, as well as a decrease in the number of M1 macrophages in the inflammatory site.

Current enzyme-mediated insecticide resistance status of Aedes aegypti populations from a dengue-endemic city in southern Mexico.

OBJECTIVE: To identify the enzyme-mediated insecticide resistance in Aedes aegypti in Tapachula, Mexico. MATERIALS AND METHODS: Biochemical assays were undertaken to determine the enzyme levels in mosquitoes from 22 sites collected in 2018 and 2020 in Tapachula. Results of 2018 were correlated with the resistance to insecticides pub-lished. RESULTS: Mosquitoes had higher levels than those of the susceptible strain in 2018 and 2020 respectively of α-esterases in 15 and 12 sites; ß-esterases in 7 and 6 sites; glutathione-S-transferases in 11 and 19 sites; ρNPA-esterases in 21 and 17 sites; and cytochromes P450 in 20 and 22 sites. In mosquitoes of 2018, there was a moderate correlation between previously documented Malathion resistance ratios and the insensitive acetylcholinesterase (r=0.459, p= 0.03). CONCLUSIONS: The elevated enzyme levels found indicate its contribution to the resistance to pyrethroids and organo-phosphates already published in mosquitoes from Tapachula. Bioassays using enzyme inhibitors resulted in greater mor-tality, confirming that metabolism contributes to resistance.

Evaluation of commercial aerosol insecticides for control of Aedes aegypti susceptible or resistant to pyrethroids.

OBJECTIVE: To evaluate indoor use of commercial aerosols for dengue vector mosquito control, and estimate the number of treatable houses per can. MATERIALS AND METHODS: Four aerosol products containing combinations of pyrethroids (two containing propoxur and one containing synergists too), were evaluated with mosquitoes in a room of a Tapachulastyle house. Eight cages containing 20 insecticide susceptible or resistant females were hung from tripods, another set was placed in sheltered areas of the room. From the entrance of the room, one of 4-9 concentrations was sprayed for each aerosol, leaving the mosquitoes for 30 min after sprayed. Mortality was recorded after 24 h and lethal concentrations were calculated. RESULTS: Aerosol A had the highest LC50, with 0.308 g for mosquitoes hanging from tripods and 0.453 g for sheltered mosquitoes; followed by aerosols C, D and B, with statistical differences between types of exposure. CONCLUSIONS: Aerosols B-D could spray 20-25 3-room houses (56 m3-room), killing all resistant mosquitoes. Aerosols may become a good tool for indoor mosquito control, if the optimal concentration and correct spray method are used.

Entomopathogenic fungi for the control of larvae and adults of Aedes aegypti (Diptera: Culicidae) vector of dengue, chikungunya and Zika viruses in Mexico.

OBJECTIVE: To assess larvicide and adulticide activity of different native strains of fungi on Aedes aegypti. MATERIALS AND METHODS: Third instar larvae were exposed for 72 h at a concentration of 1x108 conidia/ml of 15 fungi; only fungi that significantly affected the larvae were evaluated against the adult phase at a concentration of 2x1010 conidia/ml. Mortality readings were performed at 24, 48, and 72 h for larvae, and every day to 30 days for adults. RESULTS: Trichoderma longibrachiatum, Aspergillus aculeatus, and Metarhizium anisopliae had the best larvicidal activity at 24 h of exposure (p<0.05), causing mortalities of 100, 72, and 62%, respectively. Adult mosquitoes were more affected by Gliocladium virens (45% mortality), M. anisopliae (30% mortality), and T. longibrachiatum (23.33% mortality). CONCLUSION: The larval stage of Ae. aegypti was more susceptible than the adult phase to the pathogenic action of native fungi, with T. longibrachiatum being with the highest virulence.

Factors associated with changes in nurses' emotional distress during the COVID-19 pandemic.

PURPOSE: The purpose of this study was twofold: to assess if nurses experienced changes in emotional distress (stress, depression, and anxiety) as the number of patients infected with coronavirus disease 2019 (COVID-19) increased and if there were any sociodemographic, psychosocial, and work environmental influence on the change. METHODS: Using a repeated cross-sectional study design, we collected survey data among 198 South Dakota (SD) nurses. Data were collected in two waves, during the first 12 months of the COVID-19 pandemic in the United States (July and December 2020). Participants completed two online surveys: (a) The Depression, Anxiety, and Stress Scale (DASS-21); and (b) Change Fatigue Scale. Predictive factors were divided into three groups: sociodemographic, psychosocial, and work environment variables. Multiple linear regression models were run to estimate the factors associated with the change in DASS-21 subscale score. RESULTS: Total DASS-21 score and scores for all subscales significantly increased from Survey 1 to Survey 2. Significant positive associations were found between change fatigue and workplace barriers with change in depression, anxiety, and stress scores. A linear relationship was identified between self-worry about COVID-19 risk and depression and stress and being male and young were associated with changes in depression. CONCLUSIONS: Increase in emotional distress of nurses as the pandemic progresses is consistent with other studies. It is vital for healthcare organizations to recognize the factors associated with the changes in emotional distress and their role in decreasing the stress levels of nurses.

Urinary incontinence and quality of life in high-performance swimmers: An observational study.

Each day more women around the world practice high impact physical activities and this may be a risk factor for urinary incontinence (UI) in young. We verified the prevalence of UI and the impact in quality of life (QoL) in high-performance swimmers, through a cross-sectional observational study with 9 high performance swimmers and 9 sedentary women who responded the International Consultation on incontinence Questionnaire - Short Form (ICIQ-SF), participated in a functional evaluation of pelvic floor muscles with bidigital palpation and pad test. We verifed that was present in 78% of high-performance swimmers, and the quality of life was significantly worse (p =.037) when compared to sedentary women. These findings led us to conclude that presence of UI affects the quality of life, even if it is not a factor of abandonment of the sport.

Intake and digestibility of two diets for nine-banded armadillos (Dasypus novemcinctus: Linnaeus, 1758) kept under human care.

The study aimed to evaluate metabolic parameters, nutrient intake, and absorption of two diets formulated for Dasypus novemcinctus armadillos under human care. Were studied two diets: D1-a diet with dry dog food, ground beef, and boiled chicken egg with shells; D2-a diet with the same ingredients as D1, with added banana and papaya. Both are mixed in water. The parameters analyzed were body weight (BW), weight gain (WG), maintenance energy requirement (MER), Lee index, biometrics, body condition score, glucose, triglycerides, total cholesterol, and cholesterol fractions for eight male armadillos. Dietary intake (DI) and efficiency, nutrient intake, metabolizable energy, and digestibility coefficient for the diets were evaluated in six male armadillos. The diet that included fruits showed higher BW, WG, MER, Lee index, and better glucose metabolism. Both diets promoted increases in WG and Lee Index, as well as improvements in glucose metabolism. The diet without fruit improved the lipid profile of the animals. D2 presented the highest DI, better dietary efficiency, and higher energy intake but also a lower crude fiber intake. However, it showed the best utilization of gross fiber and all other nutrients. In conclusion, the diets constituted an adequate nutritional option for captive armadillos and can be used in malnutrition and pathological processes recovery. Although both diets were adequate, the nonfruit diet was preferable due to the improved lipid profile.

Trends in Eligibility and Geographic Variations in Breast Cancer Screening Participation Among Underserved Women in South Dakota.

INTRODUCTION: Breast cancer is the most common cancer among women and early detection is critical to improve breast cancer survival. The All Women Count! (AWC!) Program, part of the National Breast and Cervical Cancer Early Detection Program, provides breast and cervical screening services at no cost to underserved women in South Dakota. Aiming to investigate program participation, we examined trends in the number of women eligible for breast cancer screening services through the AWC! Program along with mammography screening participation by county. METHODS: Using the State-level Small Area Health Insurances Estimates data and the AWC! data, we calculated the proportion of South Dakotan women eligible for mammography screening under the AWC! Program from 2016 to 2019, and calculated the standardized participation ratio and 95 percent confidence interval by county (2019). To investigate differences in screening participation over time and by counties, analysis of variance (ANOVA) and Tukey statistical test were conducted, respectively. RESULTS: From 2016 to 2019, the number of women eligible for breast cancer screening services declined by 12 percent. Differences in screening participation were not statistically significant over the four-year period. Conversely, county-level variations in screening participation were found. In 2019, among the 59 counties with screening data, 15 percent presented statistically higher participation in screening. CONCLUSION: A decrease in the number of women eligible for breast cancer services provided by AWC! was observed. Additionally, screening participation varied by county. A more comprehensive investigation is needed to explain these geographic disparities so prevention strategies can reduce the burden of breast cancer among South Dakota underserved women.

Antimicrobial Resistance among Leprosy Patients in Brazil: Real-World Data Based on the National Surveillance Plan.

Brazil ranks second among countries for new cases and first for relapse cases of leprosy worldwide. The Mycobacterium leprae Resistance Surveillance Plan was established. We aimed to present the results of a 2-year follow-up of the National Surveillance Plan in Brazil. A cross-sectional study of leprosy cases was performed to investigate antimicrobial resistance (AMR) in Brazil from October 2018 to September 2020. Molecular screening targeting genes related to dapsone (folP1), rifampin (rpoB), and ofloxacin resistance (gyrA) was performed. During the referral period, 63,520 active leprosy patients were registered in Brazil, and 1,183 fulfilled the inclusion criteria for molecular AMR investigation. In total, only 16 (1.4%) patients had genetic polymorphisms associated with AMR. Of these, 8 (50%) had cases of leprosy relapse, 7 (43.8%) had cases of suspected therapeutic failure with standard treatment, and 1 (6.2%) was a case of new leprosy presentation. M. leprae strains with AMR-associated mutations were found for all three genes screened. Isolates from two patients showed simultaneous resistance to dapsone and rifampin, indicating multidrug resistance (MDR). No significant relationship between clinical variables and the presence of AMR was identified. Our study revealed a low frequency of AMR in Brazil. Isolates were resistant mainly to dapsone, and a very low number of isolates were resistant to rifampin, the main bactericidal agent for leprosy, or presented MDR, reinforcing the importance of the standard World Health Organization multidrug therapy. The greater frequency of AMR among relapsed patients supports the need to constantly monitor this group.

Probing the Role of bba30, a Highly Conserved Gene of the Lyme Disease Spirochete, Throughout the Mouse-Tick Infectious Cycle.

Borrelia burgdorferi, the causative agent of Lyme disease, has a complex and segmented genome consisting of a small linear chromosome and up to 21 linear and circular plasmids. Some of these plasmids are essential as they carry genes that are critical during the life cycle of the Lyme disease spirochete. Among these is a highly conserved linear plasmid, lp54, which is crucial for the mouse-tick infectious cycle of B. burgdorferi. However, the functions of most lp54-encoded open reading frames (ORFs) remain unknown. In this study, we investigate the contribution of a previously uncharacterized lp54 gene during the infectious cycle of B. burgdorferi. This gene, bba30, is conserved in the Borrelia genus but lacks any identified homologs outside the genus. Homology modeling of BBA30 ORF indicated the presence of a nucleic acid binding motif, helix-turn-helix (HTH), near the amino terminus of the protein, suggesting a putative regulatory function. A previous study reported that spirochetes with a transposon insertion in bba30 exhibited a noninfectious phenotype in mice. In the current study, however, we demonstrate that the highly conserved bba30 gene is not required by the Lyme disease spirochete at any stage of the experimental mouse-tick infectious cycle. We conclude that the undefined circumstances under which bba30 potentially confers a fitness advantage in the natural life cycle of B. burgdorferi are not factors of the experimental infectious cycle that we employ.

Genetic Manipulation of Borrelia.

Genetic studies in Borrelia require special consideration of the highly segmented genome, complex growth requirements and evolutionary distance of spirochetes from other genetically tractable bacteria. Despite these challenges, a robust molecular genetic toolbox has been constructed to investigate the biology and pathogenic potential of these important human pathogens. In this review we summarize the tools and techniques that are currently available for the genetic manipulation of Borrelia, including the relapsing fever spirochetes, viewing them in the context of their utility and shortcomings. Our primary objective is to help researchers discern what is feasible and what is not practical when thinking about potential genetic experiments in Borrelia. We have summarized published methods and highlighted their critical elements, but we are not providing detailed protocols. Although many advances have been made since B. burgdorferi was first transformed over 25 years ago, some standard genetic tools remain elusive for Borrelia. We mention these limitations and why they persist, if known. We hope to encourage investigators to explore what might be possible, in addition to optimizing what currently can be achieved, through genetic manipulation of Borrelia.

A CRISPR interference platform for selective downregulation of gene expression in Borrelia burgdorferi.

The spirochete Borrelia burgdorferi causes Lyme disease, an increasingly prevalent infection. While previous studies have provided important insight into B. burgdorferi biology, many aspects, including basic cellular processes, remain underexplored. To help speed up the discovery process, we adapted a CRISPR interference (CRISPRi) platform for use in B. burgdorferi For efficiency and flexibility of use, we generated various CRISPRi template constructs that produce different basal and induced levels of dcas9 and carry different antibiotic resistance markers. We characterized the effectiveness of our CRISPRi platform by targeting the motility and cell morphogenesis genes flaB, mreB, rodA, and ftsI, whose native expression levels span two orders of magnitude. For all four genes, we obtained gene repression efficiencies of at least 95%. We showed by darkfield microscopy and cryo-electron tomography that flagellin (FlaB) depletion reduced the length and number of periplasmic flagella, which impaired cellular motility and resulted in cell straightening. Depletion of FtsI caused cell filamentation, implicating this protein in cell division in B. burgdorferi Finally, localized cell bulging in MreB- and RodA-depleted cells matched the locations of new peptidoglycan insertion specific to spirochetes of the Borrelia genus. These results therefore implicate MreB and RodA in the particular mode of cell wall elongation of these bacteria. Collectively, our results demonstrate the efficiency and ease of use of our B. burgdorferi CRISPRi platform, which should facilitate future genetic studies of this important pathogen.IMPORTANCE Gene function studies are facilitated by the availability of rapid and easy-to-use genetic tools. Homologous recombination-based methods traditionally used to genetically investigate gene function remain cumbersome to perform in B. burgdorferi, as they often are relatively inefficient. In comparison, our CRISPRi platform offers an easy and fast method to implement as it only requires a single plasmid transformation step and IPTG addition to obtain potent (>95%) downregulation of gene expression. To facilitate studies of various genes in wild-type and genetically modified strains, we provide over 30 CRISPRi plasmids that produce distinct levels of dcas9 expression and carry different antibiotic resistance markers. Our CRISPRi platform represents a useful and efficient complement to traditional genetic and chemical methods to study gene function in B. burgdorferi.

Myelin breakdown favours Mycobacterium leprae survival in Schwann cells.

Leprosy neuropathy is a chronic degenerative infectious disorder of the peripheral nerve caused by the intracellular obligate pathogen Mycobacterium leprae (M. leprae). Among all nonneuronal cells that constitute the nerve, Schwann cells are remarkable in supporting M. leprae persistence intracellularly. Notably, the success of leprosy infection has been attributed to its ability in inducing the demyelination phenotype after contacting myelinated fibres. However, the exact role M. leprae plays during the ongoing process of myelin breakdown is entirely unknown. Here, we provided evidence showing an unexpected predilection of leprosy pathogen for degenerating myelin ovoids inside Schwann cells. In addition, M. leprae infection accelerated the rate of myelin breakdown and clearance leading to increased formation of lipid droplets, by modulating a set of regulatory genes involved in myelin maintenance, autophagy, and lipid storage. Remarkably, the blockage of myelin breakdown significantly reduced M. leprae content, demonstrating a new unpredictable role of myelin dismantling favouring M. leprae physiology. Collectively, our study provides novel evidence that may explain the demyelination phenotype as an evolutionarily conserved mechanism used by leprosy pathogen to persist longer in the peripheral nerve.

Improving treatment outcomes for leprosy in Pernambuco, Brazil: a qualitative study exploring the experiences and perceptions of retreatment patients and their carers.

BACKGROUND: Brazil has a high leprosy burden and poor treatment outcomes (TOs), manifesting in high relapse rates. Pernambuco, an impoverished Brazilian state suffering notable geographical health inequalities, has 'hyperendemic' leprosy. Although current literature identifies barriers and facilitators influencing leprosy treatment compliance, inadequate investigation exists on other factors influencing TOs, including carers' roles and psycho-dermatological impact. This qualitative study explores experiences and perceptions of leprosy patients and their carers in Pernambuco, Brazil; to identify location-specific factors influencing TOs, and consequently inform future management. METHODS: 27, semi-structured, in-depth interviews were conducted with 14 patients and 13 carers. Participants were recruited using maximum variation and snowball sampling from three clinics in Petrolina, Pernambuco. Transcripts and field notes from both participant groups were separately analysed using conventional thematic and deviant case analysis. The University of Birmingham Internal Research Ethics Committee and Instituto Lauro de Souza Lima provided ethical approval. RESULTS: Two homologous sets of four, primary, interdependent themes influencing leprosy TOs emerged: 'personal factors'; 'external factors'; 'clinical factors'; and 'the healthcare professional (HCP)-patient-carer relationship'. Poor participant knowledge and lack of symptomatic relief caused patients to distrust treatment. However, because participants thought HCP-led interventions were vital for optimal TOs, patients were effectively persuaded to adhere to pharmaceutical treatments. High standard patient and population education facilitated treatment engagement by encouraging evidence-based medicine belief, and dispelling health myths and stigma. Healthcare, on occasions, was perceived as disorganised, particularly in resource-scarce rural areas, and for those with mental health needs. Participants additionally experienced incorrect/delayed diagnoses and poor contact tracing. Leprosy's negative socio-economic impact on employment - together with stigma, dependency and changing relationships - caused altered senses of identity, negatively impacting TOs. Better dialogue between patients, HCPs and carers facilitated individualised patient support. CONCLUSION: This study highlights the importance of: effective evidence-based leprosy education; communication between HCPs, patients and carers; state-funded support; and healthcare resource distribution. These findings, if prioritised on governmental scales, provide the valuable insight needed to inform location-specific management strategies, and consequently improve TOs. Future research should evaluate the effectiveness of these implementations. Failure to address these findings will hinder regional elimination efforts.

Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study.

Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and non-practitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (p < .001). Nevertheless, we did not find significant differences between the two groups for functional assessment and electromyographic parameters. The AG presented a prevalence 60% of UI, while CG only 9,5 (p < 0,001). Considering this point, tailored prevention strategies seem mandatory in this population, in order to allow early identification and management of urinary incontinence.

Parenting stress, self-efficacy and COVID-19 health risks as predictors of general stress among nurses.

AIM: The purpose of the study was to examine the influence of parenting stress, self-efficacy and COVID-19 health risks on general stress among nurses in the Midwest, United States, during the pandemic. BACKGROUND: As frontline workers amidst the coronavirus disease 2019 (COVID-19) pandemic, nurses have been subject to stressors at home and at work. METHOD: This quantitative, cross-sectional study included 896 nurses with at least one child below 18 years of age. Using purposive sampling, participants answered an online survey composed of demographic questions, perception of COVID-19 health risks, measures of self-efficacy, general stress and parenting stress. Bivariate correlation and multiple regression were conducted. Data were collected from July 13 to August 13, 2020. RESULTS: The four predictors, along with eight demographic covariates, accounted for 40% of the variance in general stress. Parenting stress and COVID-19 health risks were positively related to general stress, while self-efficacy was negatively associated with general stress. CONCLUSIONS: Results highlight the negative influence of parenting stress on nurses' general stress and the importance of self-efficacy in reducing stress. Findings suggest that support services for nurses should focus not only on work-related stressors but also consider parenting stressors, work-home imbalances and self-efficacy.

Factors associated with nurses emotional distress during the COVID-19 pandemic.

BACKGROUND: Nurses are among the frontline healthcare workers directly impacted by the burden of the coronavirus disease of 2019 (COVID-19) pandemic. This study aimed to examine the prevalence of emotional distress and the associated factors among nurses practicing in South Dakota during the COVID-19 pandemic. METHODS: An online survey was conducted among practicing, licensed nurses in South Dakota during the pandemic (July 2020 - August 2020). Emotional distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). Logistic regression models were performed to examine the association of emotional distress and the three DASS-21 subscales with: sociodemographic and work environment factors (e.g., work setting, job satisfaction, number of COVID-19 cases seen at the facility, preparedness, concerns with worsening pre-exiting mental health conditions due to the pandemic, and contracting the illness). RESULTS: Among 1505 participants, overall emotional distress was reported by 22.2%, while anxiety, depression and stress were 15.8%, 14.5% and 11.9%, respectively. Factors associated with moderate to severe emotional distress, depression, anxiety, and stress were as follows: concerns for worsening of pre-existing mental health conditions, job dissatisfaction, encountering higher number of COVID-19 cases at one's work facility, feeling unprepared for the pandemic, and concern for contracting the illness (all p < 0.05). CONCLUSIONS: Our study suggests a high prevalence of emotional distress among nurses and highlights the factors associated with emotional distress during the COVID-19 pandemic. Promoting appropriate support is imperative to reduce nurses' emotional distress and promote psychological well-being during the COVID-19 world health crisis and in future pandemics.