Long term update on toxicity and survival of a phase II trial of linac-based stereotactic body radiation therapy for low-intermediate risk prostate cancer.

BACKGROUND: In 2016 we published a phase II study exploring safety and efficacy of Stereotactic Body Radiation Therapy (SBRT) delivered with Volumetric Modulated Arc Therapy (VMAT) and Flattening Filter Free (FFF) beams techniques in prostate cancer (PC) patients. We present herein the updated results on late toxicity and long-term survival. METHODS: Patients enrolled in the study had a biopsy-confirmed localized PC and the features of a low- or intermediate-risk disease (National Comprehensive Network Criteria). The radiotherapy (RT) schedule consisted of 35 Gy delivered in five fractions every other day. Toxicities were registered according to the common toxicity adverse events v4.0. Biochemical recurrence was defined as an increase of prostate specific antigen after nadir, confirmed at least once. Local recurrence (LR) and distant metastases were detected either with Choline- or PSMA-PET/CT scans. Kaplan-Meier curves for Biochemical Recurrence-Free Survival (BFS), Local Control (LC), Distant Metastasis Free Survival (DMFS) and Cancer Specific Survival, were calculated by using MedCalc. RESULTS: Ninety patients were submitted to SBRT between February 2012 and March 2015. Fifty-eight patients (64.5%) had a Gleason Score of 6, while 32 (35.5%) had a Gleason Score of 7. A late grade 1 Genito-Urinary toxicity was observed in 54.5% of patients while a grade 2 in 3.3%. A late Gastro-intestinal grade 1 toxicity was reported in 18.9% of patients, while a grade 2 in 2.2%. Erectile dysfunction was reported by 13% of patients No heavier toxicities were observed. At a median follow-up of 102 months, 5- and 8-year BFS were 93.0% and 84.4% respectively, 5- and 8-year LC were 95.2% and 87.0% respectively, 5- and 8-year DMFS were 95.3% and 88.4%, respectively. CONCLUSIONS: This long-term update confirms that SBRT is a valid therapeutic strategy for low-intermediate risk PC. RT with VMAT and FFF warrants optimal results in terms of toxicity and disease control.

Assessment of Cardiovascular Events Caused by New-Generation Androgen Receptor Pathway Inhibitors Used for Prostate Cancer: A Real-World Study in Japan.

INTRODUCTION: Androgen receptor pathway inhibitors (ARPIs) that significantly improve the prognosis of patients with prostate cancer include abiraterone acetate (androgen synthesis inhibitor) and enzalutamide (androgen receptor inhibitor). A recent analysis of ARPI and cardiovascular events using the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) has been reported; however, the evidence on cardiovascular events for abiraterone acetate and enzalutamide in real-world clinical practice is insufficient. Using a large Japanese database of medical institutions, the Japanese Medical Data Center (JMDC) medical institution database (JMDC Inc., Tokyo, Japan), this study tested the hypothesis that the risk of cardiovascular events with enzalutamide is lower than that with abiraterone acetate. METHOD: Using the JMDC medical institution database, patients with new use of abiraterone acetate or enzalutamide who had not experienced a major cardiovascular event between October 2014 and February 2022 were included. After adjusting for age, comorbidities, and concomitant medications using propensity score matching, cumulative incidence rates were compared for cardiovascular death and all cardiovascular events as the primary endpoints, and major cardiovascular events, myocardial infarction, heart failure, and stroke as secondary endpoints. RESULT: A total of 3,033 patients in the enzalutamide group and 2,021 in the abiraterone group met the eligibility criteria. After propensity score matching, the cohort included 1,940 patients in the enzalutamide group and 1,940 patients in the abiraterone group. Enzalutamide was associated with significantly lower cumulative rates of cardiovascular death (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.10-0.93), all cardiovascular events (HR: 0.79, 95% CI: 0.64-0.98), major cardiovascular events (HR: 0.79, 95% CI: 0.64-0.97), and myocardial infarction (HR: 0.62, 95% CI: 0.46-0.84) compared to abiraterone. CONCLUSION: In a national sample of males with prostate cancer, those newly treated with enzalutamide had a lower risk of adverse cardiovascular events than those treated with abiraterone acetate.

Person-focused interventions for fall risk assessment, fall prevention and fall injury prevention in long-term care facilities: a scoping review.

OBJECTIVE: Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk assessment and prevention in LTCFs in order to identify evidence-based practices in LTCFs. METHODS: We included three databases (Ovid-Medline, CINAHL and EMBASE) to identify original research from 2007 to 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. From the initial search, we identified 988 articles. Following the removal of duplicates, title and abstract screening, and full-text review against inclusion/exclusion criteria, 20 studies remained for analysis. Then, we conducted a narrative synthesis to summarise the included studies. RESULTS: Identified evidence-based interventions for fall prevention include (1) exercise programmes (eg, high-intensity functional exercise, aerobic exercise, short stick exercises, etc); (2) multifactorial programmes; and (3) other interventions (eg, lavender olfactory stimulation). Outcomes of included studies included the number of falls, fall rate, risk of falls and fear of falls before and after interventions. CONCLUSION: Overall, most studies reported significant effects of person-focused interventions in LTCFs. Available evidence supports that well-designed person-focused interventions can reduce falls and fear of falls for individuals in LTCFs.

The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco.

INTRODUCTION: Centering affected individuals and forming equitable institutional-community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE-PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco. METHODS: Community engagement (PRECEDE phases 1-2) informed the "Pregnancy Village" prototype, which would unite key organizations to deliver valuable services alongside one another, as a recurring "one-stop-shop" community-based event, delivered in an uplifting, celebratory, and healing environment. Semi-structured interviews with key partners identified participation facilitators and barriers (PRECEDE phases 3-4) and findings informed our implementation roadmap. We measured feasibility through the number of events successfully produced and attended, and organizational engagement through meeting attendance and surveys. RESULTS: The goals of Pregnancy Village resonated with key partners. Most organizations identified resource constraints and other participation barriers; all committed to the requested 12-month pilot. During its first year, 10 pilot events were held with consistent organizational participation and high provider engagement. CONCLUSION: Through deep engagement and equitable partnerships between community and institutional stakeholders, novel systems of care delivery can be implemented to better meet comprehensive community needs.

Receptive and expressive vocabulary performance in 2- to 5-year-olds in care: The role of different care types and temperament.

The detrimental role of institutionalization in children's development has prompted the introduction of alternative care types designed to offer more personalized care. The current study aimed to test whether children in alternative care types (care villages, care homes, and foster care) performed better on vocabulary than those in institutions. The role of temperament, specifically perceptual sensitivity and frustration, and the interaction between temperament and care types on vocabulary performance were also explored. The study involved 285 2- to 5-year-old children from different care types, and they were assessed through receptive and expressive vocabulary tests and temperament scales. The results of the linear mixed model revealed that children in alternative care types exhibited significantly higher vocabulary scores compared with those in institutions. Moreover, perceptual sensitivity showed a positive association with receptive and expressive vocabulary skills and seemed to act as a protective factor by mitigating the lower vocabulary scores in institutions. Frustration moderated vocabulary outcomes differently for children in institutions and foster care, aligning with the diathesis-stress model and vantage sensitivity theory, respectively. The findings emphasize the positive role of alternative care types in vocabulary performance and the importance of children's temperamental traits in this process.

Challenges to the operation of Brazilian LTCIs and changes in oversight.

BACKGROUND: Despite 18 years since health surveillance regulations were promulgated in Brazil to govern Long-Term Care Institutions for Older Adults (LTCIs), many institutions fail to comply with the Differentiated Regime for Public Procurement (Resolution No. 502/2021) due to structural and operational conditions. This study aimed to investigate Brazilian LTCI managers' understanding of challenges that significantly impact institutional operation and gather suggestions for enhancing RDC No. 502/21. METHODS: A cross-sectional, exploratory, and qualitative study was conducted, involving 90 managers or technical supervisors from Brazilian LTCIs. Data were collected using a self-administered Google Forms instrument and analyzed through Thematic Analysis based on the Organizing for Quality (OQ) framework. RESULTS: The most impactful challenges for LTCIs were healthcare, financing, human resources, relationship with oversight bodies, and family members. DISCUSSION: Proposed improvements for RDC No. 502/21 included enhanced professional training, infrastructure revision, increased financial support from the state, realistic oversight/regulations, and tailored monitoring approaches. CONCLUSION: LTCIs in Brazil face numerous challenges, and the suggested improvements aim to adapt regulations to institutional realities. However, considering the regulations' variability and purposes, further investigation is warranted.

The Legal Framework for Public-Private Partnerships in Drug R&D.

Public-private partnerships in drug R&D have great potential for driving innovation. They can bridge between excellent fundamental research and development and commercialization of innovative medicines to address unmet needs for the therapy of severe diseases in the interest of public health and human welfare. Therefore, public-private partnerships in drug R&D are promoted and publicly funded by governments and the European Commission. Nonetheless, they need to comply with legal requirements, particularly stemming from State aid law and competition law. Those requirements do not only protect a fair competition, but rather also further open information exchange as well as fair sharing of risks and fair participation in gains and results with the goal of having a successful collaboration and increasing the chance of successful commercialization of pharmaceutical innovations.

Research on collaborative development mechanism of multiple stakeholders in medical institutions based on rough set.

Reducing doctor-patient conflict is an important part of coordinating doctor-patient disputes and easing doctor-patient relationship, which is conducive to building a harmonious medical environment and promoting the healthy development of medical undertakings. This paper constructs a multi-decision-maker mixed conflict model based on rough set theory, puts forward the matrix operation expression of the conflict degree theory in the Pawlak model, and gives a more objective and scientific evaluation function. Combined with hot issues of doctor-patient conflict, the proposed multi-decision-maker mixed conflict model is applied to doctor-patient conflict, examines the doctor-patient relationship in the medical institution system from multiple internal perspectives, and calculates feasible solutions in the conflict system. The results show that high medical quality, high standardize medication, high institutional efficiency, high staff efficiency, high hospital benefits, high hospital revenue, medium employee development, medium equipment development, or high medical quality, high standardize medication, high institutional efficiency, medium staff efficiency, medium hospital benefits, high hospital revenue, high employee development, and high equipment development are important conditions for building a harmonious medical environment and reducing doctor-patient conflicts.

A qualitative study of the factors impacting implementation of the national action plan to contain antimicrobial resistance (2016-2020) in medical institutions.

OBJECTIVE: Antimicrobial resistance (AMR) has emerged as a serious global public health crisis. In response, 2016, 14 ministries in China, under the leadership of the National Health Commission, collaboratively issued the National Action Plan (NAP) to Contain Antibacterial Resistance (2016-2020). The NAP outlines strategies for medical institutions to adopt stewardship and implement AMR control. The purpose of this study was to comprehend stakeholders' perceptions of the NAP and explore the factors that influence its implementation in medical institutions. METHODS: Semi-structured interviews were conducted with practitioners from medical institution in March and April 2021. Interviews were audio-recorded, transcribed and analyzed using thematic analysis via the framework approach. RESULTS: Twenty practitioners, representing diverse roles (4 administrators, 7 clinicians, 3 microbiologists, 3 pharmacists, 3 nosocomial infection management personnel) from seven institutions, participated in the study. Substantial efforts have been undertaken to regulate the rational use of antibiotics and enhance the management of hospital infections. Participants demonstrated awareness and concern regarding antimicrobial resistance, with widespread support expressed for the NAP. Among all professions, there were varying opinions on whether they felt restricted in their daily work. The tertiary hospitals have established multidisciplinary cooperation mechanisms. Six main themes were identified as both barriers and facilitators to the implementation of the NAP in the medical institutions: individual factors, leadership, multidisciplinary collaboration, patient factors, training and culture. The capacity for administrative attention is constrained or limited, poor enforcement of guidelines, insufficient specialist staff and the liability pressure on clinicians were perceived barriers. To containing AMR in medical institutions, management of hospital infections, the public's knowledge of antibiotics' usage, routine education and multidisciplinary support would be facilitators. CONCLUSIONS: Practitioners from medical institutions were highly supportive for the NAP. Consideration of practitioners' perceived barriers and facilitators might enhance implementation of the NAP to contain antimicrobial resistance.

What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study.

BACKGROUND: Research evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers. METHODS: A qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis. RESULTS: Twenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers. CONCLUSIONS: This study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada.

Human rights among Korean dental hygiene students in hospital clinical practice.

BACKGROUND: The human rights of dental hygiene students should be guaranteed during practice at medical institutions for their mental and physical health as well as professionalism, for patient safety. Safe and well guaranteed clinicians can perform their work in a more stable way. This study investigated the human rights circumstances of dental hygiene students during their hospital clinical practice at dental institutions. METHODS: This study used a cross-sectional survey design. Convenience sampling was conducted on 121 third- and fourth-year dental hygiene students from universities in Seoul, Gyeonggi, and Gangwon. The survey used the Human Rights Indicators for Dental Hygiene Students to investigate the rights to safety, equality, and personality to understand participants' experiences of guaranteed fundamental rights. Data were collected from October 31 to November 8, 2019. A chi-square test was used to assess differences in experience according to general characteristics. RESULTS: During dental hygiene practice at dental institutions, less than 50% of students felt safe. When human rights violations occurred in dental institutions, only 42.4% of students received guidance on response measures from their universities. While 72.1% of students who practiced at dental university hospitals were given information on first aid supplies (facilities) within dental institutions, only approximately 45% of students who practiced at lower-scale dental institutions were given this information (p < 0.05). Regarding equality rights, only 52.5% of trainees reported that they had received equal treatment from healthcare workers during hospital clinical practice. CONCLUSIONS: During dental practice at dental institutions, Korean dental hygiene students confirmed that human rights (including safety rights, equality rights, and personality rights) were guaranteed to varying degrees. Dental hygiene students' rights during hospital clinical practice in dental institutions should be guaranteed across institutions regardless of their scale. This is necessary for dental hygiene students' human rights and safe policies and guidelines in dental institution clinical practice and regular monitoring systems.

Person-centred care in the context of higher education - a discourse analysis based on interviews with programme directors.

BACKGROUND: As person centred care (PCC) is being implemented globally, higher educational institutions (HEI) have begun to play a crucial part in enabling this transition. In Sweden, however, the delivery of PCC is inconsistently implemented in medicine, nursing, occupational therapy, and physiotherapy study programmes. This inconsistency is partly the result of a lack of a national strategy across HEI. Program directors are responsible for the PCC content of their programs, so their views influence how PCC is taught. Using interviews with programme directors in higher education, we aim to deepen the understanding of the preconditions needed to implement PCC by exploring discourses and identifying subject positions of how PCC is taught and learned. METHODS: We performed a discourse analysis based on interviews with program directors in the above-mentioned national study programmes. A discourse can be seen as a struggle over identity. The subject position - i.e., discourses designate positions for persons to occupy as subjects - guided our analysis and identification of the subject positions of the teacher and the student in teaching and learning PCC. RESULTS: This study unfolded in two main antagonistic aspects with respect to teaching and learning PCC, resulting in four subject positions for the teacher and four corresponding subject positions for the students. First, the teacher and student were given a subject position as change agents towards a more egalitarian healthcare and were assigned a subject position to cope with a practical reality they could not change. Second, the teacher and student were assigned a subject position that embodied profession-specific identities, navigating and valuing these boundaries. Simultaneously, both teachers and students assumed a subject position that required interprofessional interaction and co-creation for teaching and learning PCC. CONCLUSION: This study demonstrates the discursive tension surrounding the implementation of PCC in HEI, and the findings can serve as a basis for creating future relevant and high-quality learning activities. The process of negotiating diverse and co-existing perspectives as well as building interprofessional trust when incorporating PCC into higher education is essential and requires further exploration.

Psych Unit Gangs: An Autoethnography.

The stigma against people with mental illness is a well-worn subject; however, stigma between groups of people with different mental illnesses is rarely discussed. Within the context of a psychiatric hospital, hierarchies form among patients based on symptomatology and diagnosis. In this perspectives piece, I explore, how, in my experiences with being on the bottom of this hierarchy as a person with a schizophrenia-spectrum psychotic illness in a psychiatric hospital. I, and my fellow "psychotics," were stigmatized and outcasted by other groups of individuals who were diagnosed with mental illnesses that are considered less serious than psychosis. I explore how one stigmatized, outcasted group (people with substance use and mood disorders) construct power relationships over an even more highly stigmatized, marginalized group (people with psychotic disorders). Utilizing Goffmanian and Tajfel theories, the perspective explores stigma within a total institution, and the formation of in-groups and out-groups. I explore how people, upon entering the psychiatric hospital unit, know almost immediately whether they belong to the dominant group or the subordinate group, and I conclude with recommendations to reduce the stigma of psychotic disorders within popular culture.

Institution-Wide Retreats Foster Organizational Learning and Action at a Comprehensive Cancer Center.

Providing safe and informed healthcare for sexual and gender minority (SGM) individuals with cancer is stymied by the lack of sexual orientation and gender identity (SOGI) data reliably available in health records and by insufficient training for staff. Approaches that support institutional learning, especially around sensitive topics, are essential for hospitals seeking to improve practices impacting patient safety and research. We engineered annual institutional retreats to identify and unify stakeholders, promote awareness of gaps and needs, identify initiatives, minimize redundant projects, and coordinate efforts that promote improvements in SGM cancer care, education, and research. The 2022 and 2023 retreats employed a 4-h hybrid format allowing virtual and in-person engagement. Retreat organizers facilitated small-group discussions for brainstorming among participants. We performed descriptive statistics from retreat evaluations. The retreats engaged 104 attendees from distinct departments and roles. Participants expressed robust satisfaction, commending the retreat organization and content quality. Notably, the first retreat yielded leadership endorsement and funding for a Quality Improvement pilot to standardize SOGI data collection and clinical staff training. The second retreat provided a platform for updates on focused efforts across the institution and for receiving direction regarding national best practices for SGM care and research. We report the processes and outcomes of institution-wide retreats, which served as a platform for identifying gaps in organizational healthcare practices and research for SGM individuals with cancer. The strategies described herein may be readily scaled at other cancer hospitals seeking to learn and enact system-wide practice changes that support the needs of SGM patients and families.

Institutional and personal determinants of nursing educators' job satisfaction and turnover intention: a cross-sectional study.

BACKGROUND: Nursing educators play a critical role in training future nurses, and high turnover can disrupt the training quality and process. This study identified the institutional and personal factors influencing Canadian nursing educators' job satisfaction and turnover intention. METHODS: This cross-sectional study used an online survey to obtain the levels of job satisfaction, turnover intention, role description, and institutional and personal/demographic characteristics of nursing faculty across Canadian institutions. Data were analysed using descriptive statistics, chi-square, bivariate linear regression, and hierarchical linear regression. RESULTS: A total of 645 participants, with a mean ± SD age of 48.82 ± 10.11 years, returned a completed questionnaire. The average/maximum job satisfaction and turnover intention scores were 12.59/20 ± 3.96 and 6.50/15 ± 3.05, respectively. Higher job satisfaction was significantly associated with lower turnover intention (ß=-0.559, p < 0.001). The multivariate analysis showed that having a partner or being married (ß = 0.086, p = 0.031), working ≤ 40 h weekly (ß=-0.235, p < 0.001), teaching ≤ 4 courses annually (ß=-0.115, p = 0.007), and having higher than bachelor's degree qualification (ß=-0.091, p = 0.042) predicted high job satisfaction, while high turnover intention was associated with faculty in the Prairie region (ß = 0.135, p = 0.006) and working ≥ 41 h weekly (ß = 0.151, p = 0.001). CONCLUSION: Having a partner, manageable workload, and advanced qualifications positively influenced job satisfaction, while high turnover intention was associated with high workloads. Institutions may benefit from ensuring proportionate faculty workloads, fostering career advancement, and providing robust support systems that can stabilise the workforce and preserve the quality of nursing education.

Love yourself as a therapist, doubt yourself as an institution? Therapist and institution effects on outcome, treatment length, and dropout.

OBJECTIVE: Research suggests that some therapists achieve better outcomes than others. However, an overlooked area of study is how institution differences impact patient outcomes independent of therapist variance. This study aimed to examine the role of institution and therapist differences in adult outpatient psychotherapy. METHOD: The study included 1428 patients who were treated by 196 therapists at 10 clinics. Two- and three-level hierarchical linear regression models were employed to investigate the effects of therapists and institutions on three dependent patient variables: (1) symptom change, (2) treatment duration, and (3) dropout. Level three explanatory variables were tested. RESULTS: The results showed that therapist effects (TE) were significant for all three types of treatment outcome (7.8%-18.2%). When a third level (institution) was added to the model, the differences between therapists decreased, and significant institution effects (IE) were found: 6.3% for symptom change, 10.6% for treatment duration, and 6.5% for dropout. The exploratory analyses found no predictors able to explain the systematic variation at the institution level. DISCUSSION: TE on psychotherapy outcomes remain a relevant factor but may have been overestimated in previous studies due to not properly distinguishing them from differences at the institution level.

Patterns of Energy Drink Consumption and Perceived Benefits Among Medical Students in a Tertiary Institution in South-Eastern Nigeria.

BACKGROUND: Energy drinks (EDs) have become a serious public health issue worldwide, because of the effects of the contents. There has been a remarkable surge in global consumption, particularly among college students. This trend has raised concerns regarding safety alongside the marketing claims of physiological and behavioural benefits. OBJECTIVE: This study sought to assess the prevalence, consumption patterns, and perceived benefits of Energy drinks among medical students in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra state, Nigeria. MATERIALS AND METHDS: After obtaining approval from the ethics and research committees of NAUTH Nnewi, 200 students who met the eligibility criteria were selected by a two-stage sampling procedure to participate in the study over one month. Data was collected through a pretested, self-administered, semi-structured questionnaire and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. This study's significance level was set at P < 0.05 for all analyses. RESULTS: The results of this study revealed that 81.5% of participants had consumed energy drinks at some point in their lives, with the majority starting between the ages of 10 and 20 years. The most frequently consumed energy drink was Fearless, accounting for 55.2% of the reported consumption. The primary motivations for energy drink consumption included promotion (25%), peer influence (25%), and curiosity (23.5%). Participants cited various reasons for using energy drinks, including the desire for alertness enhancement (47.2%), seeking refreshment (42.3%), stress relief (23.3%), stimulation (22.1%), and improved concentration (19.6%). CONCLUSION: The research underscores elevated rates of energy drink consumption among these students, underscoring the imperative for robust education and awareness programs aimed at empowering medical students to make well-informed choices.

CONTEXTE: Les boissons énergisantes (BE) sont devenues un sérieux problème de santé publique dans le monde entier en raison des effets de leur contenu. Leur consommation a connu une augmentation remarquable à l'échelle mondiale, en particulier chez les étudiants universitaires. Cette tendance a soulevé des inquiétudes concernant la sécurité et les allégations marketing de bénéfices physiologiques et comportementaux. OBJECTIF: Cette étude visait à évaluer la prévalence, les habitudes de consommation et les bénéfices perçus des boissons énergisantes chez les étudiants en médecine de l'hôpital universitaire Nnamdi Azikiwe, Nnewi, État d'Anambra, au Nigeria. MÉTHODES: Après avoir obtenu l'approbation des comités d'éthique et de recherche du NAUTH Nnewi, 200 étudiants répondant aux critères d'éligibilité ont été sélectionnés selon une procédure d'échantillonnage en deux étapes pour participer à l'étude sur une période d'un mois. Les données ont été collectées à l'aide d'un questionnaire semi-structuré autoadministré pré-testé et analysées à l'aide du logiciel SPSS version 25.0. Le niveau de signification de cette étude a été fixé à P < 0,05 pour toutes les analyses. RÉSULTATS: Les résultats de cette étude ont révélé que 81,5 % des participants avaient consommé des boissons énergisantes à un moment donné de leur vie, la majorité ayant commencé entre 10 et 20 ans. La boisson énergétique la plus fréquemment consommée était Fearless, représentant 55,2 % de la consommation déclarée. Les principales motivations de la consommation de boissons énergisantes étaient la promotion (25 %), l'influence des pairs (25 %) et la curiosité (23,5 %). Les participants ont cité diverses raisons pour consommer des boissons énergisantes, notamment le désir d'améliorer l'alerte (47,2 %), de se rafraîchir (42,3 %), de soulager le stress (23,3 %), de stimuler (22,1 %) et d'améliorer la concentration (19,6 %). CONCLUSION: La recherche souligne les taux élevés de consommation de boissons énergisantes chez ces étudiants, soulignant la nécessité de programmes d'éducation et de sensibilisation solides visant à permettre aux étudiants en médecine de faire des choix éclairés. MOTS-CLÉS: Boissons énergisantes, habitudes de consommation, bénéfices perçus, étudiants en médecine, établissement tertiaire, sud-est du Nigeria.

Nursing as total institution.

Healthcare under the auspices of late-stage capitalism is a total institution that mortifies nurses and patients alike, demanding conformity, obedience, perfection. This capture, which resembles Deleuze's enclosure, entangles nurses in carceral systems and gives way to a postenclosure society, an institution without walls. These societies of control constitute another sort of total institution, more covert and insidious for their invisibility (Deleuze, 1992). While Delezue (1992) named physical technologies like electronic identification badges as key to understanding these societies of control, the political economy of late-stage capitalism functions as a total institution with no cohesive, centralized, connected material apparatus required. In this manuscript, we outline the ways in which the healthcare industrial complex demands nurse conformity and how that, in turn, operationalizes nurses in service to the institution. This foundation leads to the assertion that nursing must foster a radical imagination for itself, unbound by reality as it presently exists, in order that we might conjure more just, equitable futures for caregivers and care receivers alike. To tease out what a radical imagination might look like, we dwell in paradox: getting folks the care they need in capitalist healthcare systems; engaging nursing's deep history to inspire alternative understandings for the future of the discipline; and how nursing might divest from extractive institutional structures. This paper is a jumping-off place to interrogate the ways institutions telescope and where nursing fits into the arrangement.

Transforming leisure time physical activity into a habit through social institutions.

Physical activity is a positive health behavior that has been shown to reduce the risk of physical and mental illnesses; There's strong evidence suggesting that Physical activity, as one of the components of a healthy lifestyle, if transformed into a consistent behavior or habit early in life, becomes easier to sustain throughout the lifecycle and leads to valuable outcomes for the society's health in various physical, mental, and social dimensions. Each social institution, considering its unique role and characteristics, can contribute to shaping individuals' behaviors in societies. Consequently, identifying the role of social institutions in the development of leisure-time physical activity (LTPA) as a regular activity and a behavioral habit can result in the selection and implementation of highly effective intervention strategies. Therefore, this research aimed to present a model of the role of social institutions in institutionalizing leisure-time physical activity among Iranian adolescent girls. To collect data, the questionnaires were employed, and for presenting the model, structural equation modeling was utilized. Data analysis showed that the role of three social institutions in the institutionalization of physical activities including habituation, objectification and sedimentation was confirmed, although sedimentation was confirmed in all three institutions at the 0.05 level, which indicates that factors in this area can be investigated. Examining the role of social institutions in institutionalizing behaviors may vary across different ages and genders, which is open to investigation in future studies.

Trauma-informed training as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists.

OBJECTIVE: Aim: To determine the conditions for the implementation of trauma-informed training as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists. PATIENTS AND METHODS: Materials and Methods: 1,100 students studying in the conditions of martial law took part in the experimental work. RESULTS: Results: As a result of the negative impact of the stressful and destructive factors of the war on the inner world, the future specialists the following manifestations of the deterioration of the health were established: depression (99%), sudden change of mood (92%), worsening of well-being during sudden changes in the weather (66%), irritability (52%), aggressiveness (11%), anger (7%). It was found that future specialists wanted to postpone completing the educational task until later, as they perceived it as very difficult (79%). CONCLUSION: Conclusions: The conditions for the implementation of trauma-informed studying were formulated as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists. 1. During the organization of learning, teachers take into account the fact that psycho-traumas, which are caused by stressful and destructive factors of war, disturb students until they experience them. 2. Teachers take into account the traumatic experience of future specialists. 3. The teachers' actions aim to restore future professionals' sense of security, reestablish contact with other study participants, and regain control over their own lives and studies.