Prevalência de transtornos psiquiátricos de pessoas em situação de rua em um grande centro urbano no Brasil / Prevalence of psychiatric disorders in homeless people in a large urban center in Brazil / Prevalencia de trastornos psiquiátricos en personas sin hogar en un gran centro urbano de Brasil

Introdução: O presente estudo visa descrever as condições de saúde mental mais prevalentes na população de rua em um grande centro urbano brasileiro. Objetivo: Descrever as condições de saúde mental mais prevalentes na população de moradores de rua em um grande centro urbano brasileiro. Métodos: Este é um estudo transversal realizado nas regiões centrais e periferias da cidade de São Paulo (SP), Brasil. Para a descrição dos transtornos psiquiátricos utilizamos o Patient Health Questionnaire-9 (PHQ-9) para sintomas depressivos, item 9 do Inventário de Depressão de Beck para ideação suicida, pergunta autorreferida para uso de álcool e drogas ilícitas e item 3 do PHQ-9 para qualidade do sono. Resultados: A média de idade dos participantes foi de 44,54 (desvio padrão ­ DP=12,63) anos, e a maioria era do sexo masculino (n=342; 75%). Quanto à frequência de transtornos psiquiátricos identificados, 49,6% (n=226) dos participantes apresentaram sintomas depressivos, 29,8% (n=136) exibiram ideação suicida, 55,7% (n=254) informaram uso de álcool semanalmente, 34,2% (n=156) informaram usar drogas ilícitas semanalmente e 62,3% (n=284) tinham problemas com sono. Conclusões: A prevalência de condições que afetam a saúde mental entre os participantes é alta. Estes resultados poderão auxiliar profissionais de saúde na elaboração de estratégias de prevenção e tratamento nessa população, pouco estudada.

Introduction: The present study aims to describe the most prevalent mental health conditions in the homeless population in a large Brazilian urban center. Objective: To describe the most prevalent mental health conditions in the population of homeless people in a large Brazilian urban center. Methods: This is a cross-sectional study carried out in the central and periphery regions of São Paulo, state of São Paulo, Brazil. For the description of psychiatric disorders, the following instruments were used: Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, item 9 of the Beck Depression Inventory for suicidal ideation, the self-reported question for the use of alcohol and illicit drugs, and item 3 of the PHQ-9 for sleep quality. Results: The mean age of participants was 44.54 (Standard Deviation=12.63) years, and most were men (n=342; 75%). Regarding the frequency of the identified psychiatric disorders, 49.6% (n=226) of the participants had depressive symptoms, 29.8% (n=136) had suicidal ideation, 55.7% (n=254) reported weekly alcohol use, 34.2% (n=156) reported using illicit drugs weekly, and 62.3% (n=284) had sleep problems. Conclusions: The prevalence of conditions that affect mental health among participants is high. These results may help health professionals to develop prevention and treatment strategies for this understudied population.

Introducción: El presente estudio tiene como objetivo describir las condiciones de salud mental más prevalentes en la población sin hogar en un gran centro urbano brasileño. Objetivo: Describir las condiciones de salud mental más prevalentes en la población de personas sin hogar en un gran centro urbano brasileño. Métodos: Se trata de un estudio transversal realizado en las regiones central y periférica de São Paulo, SP, Brasil. Para la descripción de los trastornos psiquiátricos se utilizó el Cuestionario de Salud del Paciente - 9 (PHQ-9) para síntomas depresivos, el ítem 9 del Inventario de Depresión de Beck para ideación suicida, la pregunta autorreportada para uso de alcohol y drogas ilícitas y ítem 3 del PHQ-9 para la calidad del sueño. Resultados: La edad media de los participantes fue de 44,54 (DE=12,63) años, y la mayoría eran hombres (n=342; 75%). En cuanto a la frecuencia de los trastornos psiquiátricos identificados, el 49,6% (n=226) de los participantes presentaba síntomas depresivos, el 29,8% (n=136) tenía ideación suicida, el 55,7% (n=254) refería consumo semanal de alcohol, el 34,2% (n=156) refirió consumir drogas ilícitas semanalmente y el 62,3% (n=284) presentaba problemas de sueño. Conclusiones: La prevalencia de condiciones que afectan la salud mental entre los participantes es alta. Estos resultados pueden ayudar a los profesionales de la salud a desarrollar estrategias de prevención y tratamiento para esta población poco estudiada.

General Worker's Sleep Disturbances and the Degree of Cold-Heat Symptoms: a national cross-sectional survey.

Objectives: Few studies have examined the impact of healthy sleep among general workers on individuals and society. Therefore, the status and risk factors of sleep disturbances among general workers were investigated. In addition, this study assessed the degree to which cold and heat symptoms are associated with sleep disturbances. Methods: A nationwide cross-sectional study was conducted through an online questionnaire focused on sleep disturbances of the general public in 2021. The degree of cold-heat pattern Identification (CHPI) of the general public was also surveyed. Descriptive statistics and multivariate logistic regression were used to derive the study results. Results: Data from 2,822 workers out of 3,900 valid questionnaires were analyzed. Approximately half of the respondents (49.93%) had sleep disturbances. Among the types of work, self-employed, two-shift work, and working more than 53 hours were associated with sleep disturbances. Sleep disturbances were positively associated with six cold and heat symptoms three cold symptoms (coldness of the abdomen, coldness of body, and pale face) and three heat symptoms (body feverishness, feverishness of the limbs, and drinking cold water). Conclusion: Customized policies to maintain healthy work are needed for self-employed work, two-shift work, and long working hours, which are risk factors for workers' sleep disturbances. In addition, medical personnel can effectively diagnose and treat sleep disturbances considering the worker's cold and heat symptoms.

Consequences of how third sector organisations are commissioned in the NHS and local authorities in England: a mixed-methods study.

Background: As a matter of policy, voluntary, community and social enterprises contribute substantially to the English health and care system. Few studies explain how the National Health Service and local authorities commission them, what outputs result, what contexts influence these outcomes and what differentiates this kind of commissioning. Objectives: To explain how voluntary, community and social enterprises are commissioned, the consequences, what barriers both parties face and what absorptive capacities they need. Design: Observational mixed-methods realist analysis: exploratory scoping, cross-sectional analysis of National Health Service Clinical Commissioning Group spending on voluntary, community and social enterprises, systematic comparison of case studies, action learning. Social prescribing, learning disability support and end-of-life care were tracers. Setting: Maximum-variety sample of six English local health and care economies, 2019-23. Participants: Commissioning staff; voluntary, community and social enterprise members. Interventions: None; observational study. Main outcome measures: How the consequences of commissioning compared with the original aims of the commissioners and the voluntary, community and social enterprises: predominantly qualitative (non-measurable) outcomes. Data sources: Data sources were: 189 interviews, 58 policy and position papers, 37 items of rapportage, 692,659 Clinical Commissioning Group invoices, 102 Freedom of Information enquiries, 131 survey responses, 18 local project group meetings, 4 national action learning set meetings. Data collected in England during 2019-23. Results: Two modes of commissioning operated in parallel. Commodified commissioning relied on creating a principal-agent relationship between commissioner and the voluntary, community and social enterprises, on formal competitive selection ('procurement') of providers. Collaborative commissioning relied on 'embedded' interorganisational relationships, mutual recognition of resource dependencies, a negotiated division of labour between organisations, and control through persuasion. Commissioners and voluntary, community and social enterprises often worked around the procurement regulations. Both modes were present everywhere but the balance depended inter alia on the number and size of voluntary, community and social enterprises in each locality, their past commissioning experience, the character of the tracer activity, and the level of deprivation and the geographic dispersal of the populations served. The COVID-19 pandemic produced a shift towards collaborative commissioning. Voluntary, community and social enterprises were not always funded at the full cost of their activity. Integrated Care System formation temporarily disrupted local co-commissioning networks but offered a longer-term prospect of greater voluntary, community and social enterprise influence on co-commissioning. To develop absorptive capacity, commissioners needed stronger managerial and communication capabilities, and voluntary, community and social enterprises needed greater capability to evidence what outcomes their proposals would deliver. Limitations: Published data quality limited the spending profile accuracy, which did not include local authority commissioning. Case studies did not cover London, and focused on three tracer activities. Absorptive capacity survey was not a random sample. Conclusions: The two modes of commissioning sometimes conflicted. Workarounds arose from organisations' embeddedness and collaboration, which the procurement regulations often disrupted. Commissioning activity at below its full cost appears unsustainable. Future work: Spending profiles of local authority commissioning; analysis of commissioning in London and of activities besides the present tracers. Analysis of absorptive capacity and its consequences, adjusting the concept for application to voluntary, community and social enterprises. Comparison with other health systems' commissioning of voluntary, community and social enterprises. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128107) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 39. See the NIHR Funding and Awards website for further award information.

National Health Service commissioners and local councils often buy health and care services from voluntary, community and social enterprises. This study aimed to explore how commissioners and voluntary, community and social enterprises worked together and where improvements could be made. We talked to commissioners and voluntary, community and social enterprises in six areas across England and focused on services for learning disabilities, social prescribing and end-of-life care. We analysed National Health Service financial accounts to see how much the National Health Service was spending on services provided by voluntary, community and social enterprises. We surveyed how commissioners and voluntary, community and social enterprises were using information and knowledge to make decisions. We organised events bringing together commissioners and voluntary, community and social enterprises to share knowledge and experience. We found there were two ways commissioners bought services from voluntary, community and social enterprises. One was commodified (a buying-and-selling model), the other collaborative (based on working together). Both were happening at the same time in all the areas of the study, but usually one of them was more present than the other. We saw a general move towards collaboration, but some areas were further along with this than others. Various things helped commissioners and voluntary, community and social enterprises collaborate, such as: paying voluntary, community and social enterprises enough for their services; having people and networks that encouraged others to work with voluntary, community and social enterprises; and including voluntary, community and social enterprises in making decisions about health and care. Commissioners and voluntary, community and social enterprises might therefore lean further towards working together to see how collaborative commissioning can be further developed; how to make contract prices cover voluntary, community and social enterprises' costs; how to enable longer-term contracts; and how to enable less hurried, more considered ways of renewing contracts (e.g. by putting draft contract specifications out to pre-tender consultation). The new Integrated Care Systems in local areas could encourage all this to happen, but pressures elsewhere in the health and care sector might make it more difficult.

Trends in Adolescent Depression Screening Outcomes Over the COVID-19 Pandemic at a Large, Integrated Health Care System in Southern California.

PURPOSE: Little is known about changes in depression screening outcomes among adolescents in primary healthcare across the COVID-19 pandemic. We describe trends in depression screening outcomes within a large integrated health care system in Southern California. METHODS: Retrospective electronic health record data from preventative healthcare visits of 11-12-year-olds and 13-17-year-olds screened for depression from March 1, 2017, to August 31, 2022, were extracted in 6-month blocks. The percentages of screens meeting "threshold depression" were reported overall, and by sex, race or ethnicity, and median household income quintiles. We used Poisson regression to estimate rate ratios of threshold depression in 3 winter blocks (September to February) comparing lockdown (2020), reopening (2021) to a pre-COVID (2019) period, and reopening relative to lockdown. Disparities in trends by sex, race, or ethnicity and household income were tested using interaction terms. RESULTS: Of 735,333 visits with complete screening (183,550 for 11-12-year-olds and 551,783 for 13-17-year-olds), 4.6%, 6.5%, and 7.4% of 11-12-year-olds had "threshold depression" during winter blocks of pre-COVID, lockdown and reopening, respectively. The corresponding rates were 5.8%, 8.5%, and 9.8% for 13-17-year-olds. The rates were higher during lockdown and reopening relative to pre-COVID and higher during reopening relative to lockdown for both age groups (all p-values <.001). Trends differed by sex in both age groups (p-values <.001) and by race or ethnicity (p = .001) in the 13-17-year age group. DISCUSSION: Californian adolescents demonstrated an increase in threshold depression since COVID lockdown starting March 2020 with further increase observed during reopening in September 2021. Future studies are needed to determine the long-term trends.

Mental Health Literacy Among Urban and Rural Residents of Guangdong Province, China.

Purpose: The study aims to understanding the mental health literacy level of urban and rural residents in Guangdong Province, the first major province in China, and its influencing factors is crucial. Methods: A multi-stage stratified equal-volume random sampling method was adopted in October-December 2022 to select permanent residents aged 18 years and above in Guangdong Province for the questionnaire survey, which consisted of a general demographic information questionnaire and a national mental health literacy questionnaire. Rao-Scott χ²-test with correction based on sampling design, independent samples t-test and binary multivariate logistic regression analysis were performed. Results: A total of 51744 individuals completed the questionnaire, including 31822 urban residents and 19200 rural residents. The rate of achievement of mental health literacy was 13.6% among urban residents, which was significantly higher compared to the rate of 8.6% among rural residents. Logistic regression analysis showed that female, higher education, being mental worker, being a retiree, having a higher monthly household income, maintaining a regular diet, and using electronic products for 2-6 hours per day were protective factors for mental health literacy attainment in urban residents, while having chronic diseases, being a smoker and having a history of drinking were identified as risk factors in urban residents. Among in rural residents, married, younger, higher education, being mental worker and using electronic products for 2-6 hours per day, maintaining a regular diet, and engaging in regular exercise were protective factors for achieving mental health literacy, while previous smoking was a risk factor. Conclusion: The study revealed a low level of mental health literacy among urban and rural residents of Guangdong Province, with a significant disparity between the two areas. These findings highlight the need for continuing efforts to increase the dissemination of mental health knowledge in rural communities and improve levels of mental health literacy.

Perceived Prevalence, Awareness and Attitude towards Counterfeit Medicines among Community Pharmacists of Kathmandu Valley: A Descriptive Cross-sectional Study.

INTRODUCTION: Counterfeit medicines are a significant problem globally. In a developing country like Nepal, community pharmacists play an important role in dispensing medicines. The study was done to assess community pharmacists' perceived prevalence, awareness and attitude towards counterfeit medicines in Kathmandu valley.  Methods: A cross-sectional study design was used. Data was collected conveniently from Kathmandu, Bhaktapur, and Lalitpur districts in March 2022 after obtaining ethical clearance from Nepal Health Research Council (reference no. 2200) and taking written informed consent from Community Pharmacists.  Results: Among the 343 pharmacists who participated, 250 (72.89%) were from Kathmandu, 57 (16.62%) were from Lalitpur, and 36 (10.50%) from Bhaktapur. Most 252 (73.47%) were aged between 20 to 30 years, 222 (64.72%) were male, 239 (69.68%) had done a Diploma in Pharmacy, 201 (58.60%) had working experience of more than 5 years and 342 (99.71%) had done their education in Nepal. Their median perceived prevalence of counterfeit drugs was 10.00% but only 2.30% had clear knowledge of such practice. 332 (96.79%) believed that actions should be taken against community pharmacists dispensing counterfeit drugs, 325 (94.75%) believed that pharmacists who dispense counterfeit medicines are unprofessional; 338 (98.54%) stated that there should be strong law against counterfeit medicine sales. CONCLUSIONS: Median perceived prevalence of counterfeit medicines was 10.00% but only 2.30% were aware of counterfeit medicine dispensing. Out of 343 pharmacists, 332 (96.79%) mentioned that  action should be taken against those pharmacists knowingly dispensing counterfeit medicines and 338 (98.54%) stated that there should be strong law against counterfeit medicines.

Trend and determinants of unplanned pregnancy among expectant mothers in Ethiopia based on the Ethiopia Demographic and Health Survey (2000-2016) data: a cross-sectional study.

OBJECTIVE: To investigate the trend and determinants of unplanned pregnancy among expectant women using the four Ethiopia Demographic and Health Survey (EDHS) data (2000-2016). DESIGN: Cross-sectional study. SETTING: Secondary data analysis using EDHS data. PARTICIPANTS: The number of weighted participants were 1451 in 2000, 1184 in 2005, 1205 in 2011 and 1135 in 2016. PRIMARY AND SECONDARY OUTCOME MEASURES: Unplanned pregnancy encompasses both mistimed (occurring earlier than desired) and unwanted (occurring when no further children are desired) forms of conception. Trend and multilevel logistic regression analyses were conducted. RESULTS: The rate of unplanned pregnancies in Ethiopia showed a significant decline, decreasing from 45.8% (95% CI 41.8 to 49.8) in 2000 to 29.7% (95% CI 25.3 to 34.4) in 2016, indicating an overall change of 16.1%. Several factors were positively linked to unplanned pregnancy, including being multipara (adjusted OR (AOR)=9.8; 95% CI 1.74 to 15.23) and grand multipara (AOR=12.2; 95% CI 1.62 to 19.3), expressing a lack of desire for additional children (AOR=2.82; 95% CI 1.30 to 6.12), unemployment (AOR=1.91; 95% CI 1.12 to 3.78) and being unmarried (AOR=7.23; 95% CI 4.71 to 15.5), whereas, women residing in the Afar (AOR=0.12; 95% CI 0.02 to 0.79) and Somalia (AOR=0.20; 95% CI 0.07 to 0.67) regions were associated with reduced likelihood of experiencing unplanned pregnancy. CONCLUSION: The study discovered that unplanned pregnancies in Ethiopia decreased significantly from 2000 to 2016. However, around one-third of pregnant women are still affected, indicating a high rate. To address this, policymakers and stakeholders should propose and implement targeted interventions on identified risk factors.

A Cross-Sectional Study of Peri-Implant Diseases in a Random Norwegian Population: Prevalence, Risk Indicators, and Clinical Validation of Patient-Reported Outcomes.

OBJECTIVES: The primary aim of this study was to investigate the prevalence of peri-implant diseases in a randomly selected Norwegian population. The secondary aims were to explore risk indicators for peri-implant diseases and to validate self-reported outcome measures from a survey with clinical parameters. MATERIAL AND METHODS: Patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire and invited to a clinical examination. A randomly selected subset of responders underwent a clinical examination (n = 242). Full mouth clinical and radiographic examinations were conducted. Multiple logistic regression was used to assess patient-related risk indicators for peri-implantitis. Self-reported data were compared with data from the clinical examination using Spearman correlation and binary logistic regression. RESULTS: The prevalence of peri-implantitis was 17.0% at patient level and 8.6% at implant level, according to the 2018 classification. Risk indicators for peri-implantitis included smoking and periodontitis in the adjusted model. The correlation was strong (r = 0.91, p < 0.001) between number of self-reported implants and clinical counts, whereas self-reported peri-implant inflammation was associated with peri-implantitis (OR 6.4 [95% CI 3.0, 13.7]). CONCLUSIONS: Smoking and periodontitis were identified as key risk indicators for peri-implantitis. Questionnaire data rendered clinically valid estimates of implant number, and self-reported peri-implant inflammation was associated with clinical peri-implantitis.

Substance use and risk of suicide among adults who sought mental health and addiction specialty services through a centralised intake process in Nova Scotia: a cross-sectional study.

OBJECTIVES: The objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to examine the relationship between substance use and suicide risk among this population. SETTING: MHA intake programme, a province-wide centralised intake process established in 2019 by the Department of Health and Wellness of Nova Scotia. PARTICIPANTS: We included 22 500 MHA intake clients aged 19-64 years old who contacted MHA intake from 2020 to 2021. PRIMARY OUTCOME MEASURES: During the intake assessment, clients were assessed for suicide risk (past suicide attempt, suicidal ideation during the interview or 2 weeks before the interview). RESULTS: The lifetime prevalence of suicide attempt was 25.25% in the MHA clients. The prevalence of mild and moderate/high suicide risk was 34.14% and 4.08%, respectively. Clients who used hallucinogens had the highest prevalence of mild and moderate/high suicide risk (61.3% and 12.9%, respectively), followed by amphetamine/methamphetamine (47.6% and 13.3%, respectively) and sedative/hypnotics (47.2% and 8.9%, respectively) users. Stimulant (aOR=1.84, 95% CI 1.23 to 2.75) and hallucinogen (aOR=3.54, 95% CI 1.96 to 6.43) use were associated with increased odds of moderate/high suicide risk compared with denying current use. Additionally, alcohol (aOR=1.17, 95% CI 1.06 to 1.30) and tobacco (aOR=1.20, 95% CI 1.10 to 1.30) use were associated with increased odds of mild suicide risk. CONCLUSION: Suicide behaviours were prevalent among clients seeking MHA services. Substance use is an important factor associated with suicide risk in this population. This result underscored the importance of considering substance use patterns when assessing suicide risk and highlighted the need for targeted interventions and preventive measures for individuals engaging in substance use. Future interventional studies are needed to identify and evaluate effective strategies for reducing substance use and suicide risk among clients of MHA central intake.

Dynamics of Spatiotemporal Variation of Groundwater Arsenic in Central Rift Vally of Ethiopia: A Serial Cross-Sectional Study.

Background: Arsenic is a well-known, highly poisonous metalloid that affects human health and ecosystems and is widely distributed in the environment. Nevertheless, data on the spatiotemporal distribution of arsenic in groundwater sources in Ethiopia are scarce. Objective: The principal aim of this study was to assess the extent of arsenic in groundwater sources and analyze the spatiotemporal variations in the central rift valley of Ethiopia. Methods: The study employed a serial cross-sectional study design and census sampling methods. The concentrations of arsenic in the groundwater samples were determined using inductively coupled plasma mass spectrometry (ICP-MS) at the Ethiopian Food and Drug Authority laboratory. Descriptive statistical analyses were performed using IBM SPSS version 29 software. Additionally, ArcGIS software was utilized to map the spatiotemporal distribution of arsenic. Furthermore, Minitab statistical software version 21.4 was employed to assess the correlation between spatiotemporal variations of arsenic concentrations in groundwater sources. Results: The mean values of arsenic in the groundwater samples were 11.2 µg/L during the dry season and 10.7 µg/L during the rainy season. The study results showed that 18 wells (42.2%) and 22 wells (48.8%) had higher arsenic concentrations (>10 µg/L) during the dry and rainy seasons, respectively. Thus, arsenic levels in 42.2% and 48.8% of the samples exceeded the maximum threshold limit set by WHO, USEPA, and Ethiopian standards (10 µg/L), respectively, during the dry and rainy seasons. Furthermore, our analysis revealed a significant positive correlation between arsenic in groundwater and well depth (r = .75, P < .001), indicating a strong association between higher arsenic concentrations and deeper wells. Similarly, we observed a substantial positive correlation between arsenic concentration in groundwater and season (r = .9, P < .001), suggesting notable variations in arsenic levels between dry and rainy seasons. Conclusions: The majority of the groundwater sources in the studied area are unfit for human consumption because they contain high amounts of arsenic, which poses a significant risk to human health. Moreover, the arsenic concentration varied spatially and temporally. Therefore, special attention is needed to reduce arsenic exposure and associated health risks.

Factors Influencing the Willingness of Clinical Nurses to Participate in Narrative Nursing: A Cross-Sectional Study.

AIMS: Narrative nursing (NN) is a crucial component of modern medical humanistic care. It involves utilising storytelling as a means to guide nurses in devising future interventions for patients, and help patients in reconstructing positive psychological defences. The willingness of clinical nurses to engage in narrative nursing holds significant implications for both effective communication and the overall quality of care. However, there is limited knowledge regarding clinical nurses' willingness to engage in narrative nursing. This study aims to investigate the participation willingness of Chinese nurses, identify its predictors and explore its corresponding reasons. DESIGN: A cross-sectional study. METHODS: Clinical nurses were enrolled in Hunan province, Central South, China, and a convenience sampling strategy was used. A structured questionnaire was distributed to clinical nurses by an online survey platform. Information on sociodemographic characteristics, willingness and possible influencing factors (experience, ability, perceptions on narrative nursing) was collected. Binary logistic regression was conducted to identify the predictors of willingness to participate in narrative nursing. RESULTS: A total of 2310 nurses were recruited, of which 2092 nurses completed the questionnaire (response rate: 90.6%). One thousand seven hundred and thirty-four nurses (82.9%) were willing to participate in NN, and 358 (17.1%) were not. Binary logistic regression analysis identified nine predictors of participants' willingness to participate, including working departments, professional title, working position, experience of received mobilisation and training of NN, understanding of related knowledge, NCS level, affirmation of NN and positive attitude towards clinical application (all p values < 0.05). These indicators explained 17.1% of the variances in the dependent variable (p < 0.001). CONCLUSION: A high proportion of nurses in Hunan province were willing to practice in clinic using NN. Willingness to participate may be increased by a focus on nurses with low professional titles, no administrative position and working in specialised departments, such as emergency departments, infectious departments, critical care units and operating theatres. IMPACT: The study identified a high proportion of nurses in Hunan Province who were willing to use NN. However, the figure was slightly lower than expected. Influencing factors were analysed to give insights for managers to develop more effective NN outreach programs. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Patient characteristics associated with frequent telehealth utilization in 2022: Evaluation of a national virtual integrated medical and behavioral health practice within the United States.

Objectives: As permanent telehealth policies are considered in the United States (U.S.), it is important to understand who uses telehealth most often following the pandemic. We described patients who used a national virtual care practice frequently, identified how they differed from patients who used it less often, and characterized the types of care frequent telehealth patients utilized. Methods: We used video visit data for commercially-insured patients, aged 18+, from a national virtual integrated medical and behavioral health practice in 2022 in the U.S. Patients were categorized into three groups: one visit ('minimal use'), two to four visits ('some use'), and five or more visits ('frequent use'). We compared patient and geographic characteristics between the three groups and estimated an ordinary least squares linear regression to identify predictors of 'frequent' use relative to 'minimal' or 'some' use. Results: The probability of being a frequent user declined with age (-0.4 percentage points (p.p.) per year; 95 % CI, -0.4 - -0.3), was higher for females (5.4 p.p.; 95 % CI, 4.1 - 6.7) and patients with greater clinical complexity (7.9 p.p. for highest relative to lowest quartile risk score; 95 % CI, 5.9 - 10.0), and lower for patients in the Northeast (-9.2 p.p.; 95 % CI, -15.5 - -2.9) or West (-3.2 p.p.; 95 % CI, -5.7 - -0.7) regions relative to the Southern region of the U.S. The five most common diagnoses were mental health conditions. Conclusions: Our results highlight the need for comprehensive telehealth policy that enables access, particularly for patients who rely on it as their primary source of care.

The implementation of the guideline for the management of pediatric off-label use of drugs in China: a cross-sectional study.

Background: Previously, we developed the Guidelines for the Management of Pediatric Off-Label Use of Drugs in China in addressing the need for standardization of pediatric off-label drug use. As the implementation of recommendations in Guidelines among healthcare professionals is weak, it is important to identify barriers to guideline implementation for developing appropriate strategies for specific settings and target groups. This study aimed to assess the difficulty and urgency in implementing the recommendations in the Guideline, identifying the factors affecting the implementation of these recommendations to realize the clinical translation of the Guideline. Methods: A cross-sectional study was conducted from March 1 to June 17, 2022. Pediatricians, pharmacists, and health managers from all 31 mainland Chinese provinces were involved. The electronic questionnaires were distributed nationwide by The Clinical Pharmacology Group of the Pediatric Society of the Chinese Medical Association and the National Clinical Research Center for Child Health. Data analysis, including frequency, percentages, averages, and standard deviations was performed using Microsoft Excel 16.54. Chi-squared tests, multi-factor logistic regression, and linear regression were analyzed in SPSS 23.0. A Sankey diagram was constructed using R software. Results: A total of 869 valid questionnaires were collected from 491 participating organizations. More than half of the recommendations were implemented, and 12 recommendations were implemented more in tertiary hospitals than in secondary hospitals. The mean urgency scores of all 21 recommendations were over 5. The mean difficulty scores of all 21 recommendations were over 4. The percentage of the most urgent was 44.33%, and the least urgent was 1.45%. The most difficult portion was 12.03%, and the least difficult was 5.74%. Factors impacting the urgency and difficulty of guideline implementation were different, with common influences including the position, education level of clinicians and hospital level. Conclusions: The recommendations in the Guideline for the Management of Pediatric Off-Label Use of Drugs are considered highly urgent for implementation in China. Nevertheless, the study revealed challenges in applying all 21 recommendations within clinical practice. The key factors affecting implementation include the position, education, experience, and hospital level of healthcare professionals. It is recommended to facilitate implementing the recommendations by sharing experience across various hospital levels, starting from high-level hospitals and extending to primary healthcare settings. Moreover, adjustments to the professional structure within hospitals are needed to enhance the management of off-label drug use in pediatric patients.

Associations of serum 25-hydroxyvitamin D with hsCRP and other novel inflammatory biomarkers in children: a cross-sectional study.

OBJECTIVE: Previous studies have shown the anti-inflammatory effect of 25-hydroxyvitamin D (25(OH)D) and the crucial roles of high-sensitive C reactive protein (hsCRP) and novel inflammatory markers (red blood cell distribution width-platelet count ratio (RDWPCR), mean platelet volume-platelet count ratio (MPVPCR), neutrophil-lymphocyte ratio (NLR) and white blood cell-neutrophil ratios (WBCNR)) in several diseases, but scarce data explored the associations of 25(OH)D with hsCRP and novel inflammatory markers. This study aimed to investigate these associations in children. DESIGN: Cross-sectional study. SETTING: Children in China. PARTICIPANTS: 10141 children (mean age 14.6 months) were included. PRIMARY AND SECONDARY OUTCOME MEASURES: HsCRP, red blood cell distribution width, platelet count, mean platelet volume, neutrophil, lymphocyte and white blood cell were measured. RESULTS: Overall, serum 25(OH)D was inversely associated with hsCRP and novel inflammatory biomarkers. In multivariable analysis, serum 25(OH)D was inversely associated with hsCRP and novel inflammatory biomarkers (Q quartile (Q) 4 vs Q1: 1129.75 vs 2090.99 for hsCRP; 4246.94 vs 6829.89 for RDWPCR; 4863.57 vs 5545.66 for MPVPCR; 4345.76 vs 6507.46 for NLR; 2418.84 vs 2868.39 for WBCNR). Similar results also were observed in stratified analyses by sex (boys and girls). Moreover, serum 25(OH)D was inversely associated with elevated inflammation levels. After adjustment for other potential covariates, inverse associations between serum 25(OH)D and elevated inflammation levels were still observed. The corresponding ORs (95% CI) were 0.05 (0.04, 0.06) for hsCRP, 0.13 (0.11, 0.15) for RDWPCR, 0.74 (0.64, 0.85) for MPVPCR, 0.11 (0.09, 0.13) for NLR and 0.57 (0.49, 0.66) for WBCNR in the fourth quartile compared with the first quartile, respectively. CONCLUSIONS: Generally, the graded and inverse associations of serum 25(OH)D with hsCRP and four novel inflammatory markers (RDWPCR, MPVPCR, NLR and WBCNR) were observed. The present study provided further support for the anti-inflammatory effects of 25(OH)D.

Association Between Tongue Pressure and Prevalence of Mild Cognitive Impairment in Japan.

OBJECTIVE: Although it has been suggested that a decline in oral function is one of the potential risk factors affecting mild cognitive impairment (MCI), evidence is insufficient to draw clear conclusions. This Japanese cross-sectional study examined the association between tongue pressure (TP) and MCI in middle-aged and older adults aged 36-84 years. METHODS: Study participants were 1019 (368 men and 651 women). TP was evaluated using a TP measurement device. The maximum value of three measurements was used for analysis. MCI was defined as being present if a participant had a Japanese version of the Montreal Cognitive Assessment score of <26. Adjustment was made for age, smoking status, alcohol consumption, leisure-time physical activity, body mass index, hypertension, dyslipidemia, diabetes mellitus, history of depression, number of teeth, employment, education, and household income. RESULTS: The prevalence of MCI was 45.3%. Among women, compared with the lowest tertile of TP, the second and highest tertiles were significantly associated with a lower prevalence of MCI with a clear dose-response relationship; the adjusted odds ratio (95% confidence intervals) in the second and highest tertiles of TP were 0.54 (0.36-0.83) and 0.55 (0.36-0.84), respectively (p for trend = 0.005). In contrast, no statistically significant association was observed between TP and the prevalence of MCI among men. CONCLUSIONS: Our findings suggest that higher TP might be inversely associated with the prevalence of MCI in middle-aged and older Japanese women.

Determinants of Tangible Breastfeeding Support Among Health Workers: A Multicenter Cross-Sectional Study.

BACKGROUND: Breastfeeding is crucial in providing infants with needed nutrition and immunity to foster their healthy growth and development; yet, optimal support from health workers is critical for it to be successful. AIM: To determine factors influencing tangible breastfeeding support among health workers in Nigeria. METHODS: This cross-sectional study was conducted in Nigeria's six geopolitical zones between August 2022 and February 2023 among health workers (N = 2,922). Data were gathered through an interviewer-administered, validated questionnaire. Significant factors of tangible breastfeeding support were identified through multivariable logistic regression, and corresponding odds ratios with 95% confidence intervals were reported. RESULTS: The mean age of the health workers was 28.6 (SD = 9.3) years. Just 45% (1,316) achieved optimal scores for tangible breastfeeding support. Only 31.4% (918) of lactation support providers/specialists practice tangible breastfeeding support and half (50.6%, 1,479) had a favorable attitude towards providing tangible breastfeeding support. About two-fifths (39.3%, 1,148) engaged caregivers in reviewing breast milk storage procedures, whereas, 54.6% (1,595) and 78.0% (2,279) of health workers assisted with breast pumps and breastfeeding attachment respectively. The odds of having optimal tangible breastfeeding support were higher for health workers aged 52 years or older compared to those aged under 20 years (aOR 1.88, 95% CI [1.13, 3.12]), a positive attitude (aOR 1.43, 95% CI [1.22, 1.69]), availability of a breastfeeding champion (aOR 1.47, 95% CI [1.21, 1.79]), 1.69]), provision of breast-pump videos (aOR; 2.33, 95% CI [1.85, 2.95]), and hand-expression videos (aOR; 1.41, 95% CI [1.02, 1.79]). (duplication). CONCLUSION: Health workers' tangible breastfeeding support in Nigeria is suboptimal and is driven by age, service level, attitude, availability of breastfeeding champions, and appropriate practice aids. Targeted interventions to improve health workers' attitudes, technical skills, provision of aids, and task shifting to non-specialists are needed for optimal tangible breastfeeding support.

Associations between disability type and untreated dental decay among community dwelling US adults.

OBJECTIVE: Individuals with disabilities face elevated risks of adverse oral health outcomes compared with the general population, including worse periodontal health, increased edentulism, and untreated dental decay. Given the varied impacts of different disabilities on people's health and well-being, this study aims to investigate diverse associations between untreated decay and cognitive, physical, emotional, and sensory disabilities among US adults. METHODS: This cross-sectional study analyzed questionnaire and clinical examination data on 7084 adults (≥20 years) from the 2015-18 National Health and Nutrition Examination Survey cycles. Sociodemographics, oral health behaviors, health conditions, and disability were all examined. The prevalence of tooth decay was calculated as the proportion of adults with untreated decay. Survey-weighted multivariable logistic regression was used to assess associations between disability and untreated decay. RESULTS: In general, untreated decay was more than twice as prevalent in individuals with three or more disabilities as in those without any disabilities (34.5% vs. 13.2%, p < 0.001). After adjusting for confounders, lack of functional dentition was the most significant predictor of untreated decay prevalence (adjusted odds ratio: 2.97, 95% CI: 2.37-3.72). Other significant factors were younger age (20-44), non-Hispanic black race or ethnicity, low-income status, having an underlying chronic condition, not having a past-year dental visit, symptomatic dental visits, and current tobacco use. CONCLUSION: No associations were found between disability type (cognitive, emotional, physical, and sensory) and untreated decay among community-dwelling US adults. Several health-related, social, and behavioral factors emerged as primary predictors of untreated decay. Further research is needed to explore disability types and dental caries determinants.

Association of atherogenic index of plasma and triglyceride glucose-body mass index and sarcopenia in adults from 20 to 59: a cross-sectional study.

Background: The relationship between atherogenic index of plasma (AIP) and triglyceride glucose-body mass index (TyG-BMI) and sarcopenia has not been studied in the United States (US) population. Methods: This research included 4,835 people from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2018. The relationship between sarcopenia and TyG-BMI, as well as the AIP index, was examined through the utilization of restricted cubic spline (RCS) analysis, subgroup analysis, and multivariate logistic regression analysis. Diagnostic value of AIP and TyG-BMI for sarcopenia was compared by receiver operating characteristic (ROC) curves. Results: In this research, 428 people with sarcopenia were identified among the 4,835 subjects that were included in the experiment. AIP and sarcopenia were positively associated with an odds ratio (OR) of 1.58 and a 95% confidence interval (CI) of (1.07, 2.34) on fully adjusted multivariate logistic regression analysis. Similarly, TyG-BMI and sarcopenia were positively associated with an OR of 8.83 and a 95% CI of (5.46, 14.26). AIP and sarcopenia had a non-linear positive connection (P-value<0.001, P-Nonlinear=0.010), while TyG-BMI and sarcopenia had a linear positive correlation (P-value<0.001, P-Nonlinear=0.064), according to RCS analysis. Subgroup analyses showed a significant interaction between TyG-BMI and sarcopenia due to gender (P = 0.023). ROC curves showed that TyG-BMI (AUC:0.738, 95% CI: 0.714 - 0.761) was more useful than AIP (AUC:0.648, 95% CI: 0.622 - 0.673) in diagnosing sarcopenia. Conclusion: In US adults aged 20-59 years, our study revealed a correlation between elevated AIP and TyG-BMI levels and heightened sarcopenia risk. Moreover, TyG-BMI has better diagnostic validity than AIP.

Political Party Affiliation and COVID-19 Vaccination Status in Japan, 2022.

INTRODUCTION: An association has been reported between political affiliations and vaccination worldwide. In Japan, a significant proportion of the population are non-partisans, and major political parties advocate COVID-19 vaccination. The association between supporting political parties and COVID-19 vaccination coverage in Japan remains unclear. This study aims to investigate the relationship between political party affiliation and COVID-19 vaccination status in Japan.  Methods: This study utilized data from large-scale nationwide internet surveys conducted in Japan in 2022, with a sample size of 21,162 participants. The surveys collected information on participants' COVID-19 vaccination status and political party affiliation. The political parties included in the analysis were the Liberal Democratic Party, the Constitutional Democratic Party, the Komeito, the Japanese Communist Party, the Japan Innovation Party (Nippon Ishin no Kai), and the Reiwa Shinsengumi, as well as non-partisans. Logistic regression analysis was performed to examine the relationship between political partisanship and COVID-19 vaccine status. The analysis controlled for potential confounding variables such as age, gender, socioeconomic status, and geographic location. RESULTS: The odds of being unvaccinated were lower for supporters of large political groups (e.g. Liberal Democratic Party {OR 0.6; 95% CI, 0.5-0.7}), while higher for small political groups (e.g. Reiwa Shinsengumi {OR 2.6; 95% CI, 1.9-3.6}), in comparison with non-partisan. CONCLUSION: Political affiliation may be associated with vaccination disparities in Japan. Supporters of minor parties were more likely to be unvaccinated than those of the larger parties. However, this study has several limitations, including self-reporting bias and selection bias due to the Internet survey methodology.

Quantitative sensory testing and chronic pain syndromes: a cross-sectional study from TwinsUK.

OBJECTIVE: The chronic pain syndromes (CPS) include syndromes such as chronic widespread pain (CWP), dry eye disease (DED) and irritable bowel syndrome (IBS). Highly prevalent and lacking pathognomonic biomarkers, the CPS are known to cluster in individuals in part due to their genetic overlap, but patient diagnosis can be difficult. The success of quantitative sensory testing (QST) and inflammatory biomarkers as phenotyping tools in conditions such as painful neuropathies warrant their investigation in CPS. We aimed to examine whether individual QST modalities and candidate inflammatory markers were associated with CWP, DED or IBS in a large, highly phenotyped population sample. DESIGN: Cross-sectional study. SETTING: Community-dwelling cohort. PARTICIPANTS: Twins from the TwinsUK cohort PRIMARY AND SECONDARY OUTCOME MEASURES: We compared 10 QST modalities, measured in participants with and without a CWP diagnosis between 2007 and 2012. We investigated whether inflammatory markers measured by Olink were associated with CWP, including interleukin-6 (IL-6), IL-8, IL-10, monocyte chemoattractant protein-1 and tumour necrosis factor. All analyses were repeated in DED and IBS with correction for multiple testing. RESULTS: In N=3022 twins (95.8% women), no association was identified between individual QST modalities and CPS diagnoses (CWP, DED and IBS). Analyses of candidate inflammatory marker levels and CPS diagnoses in n=1368 twins also failed to meet statistical significance. CONCLUSION: Our findings in a large population cohort suggest a lack of true association between singular QST modalities or candidate inflammatory markers and CPS.