Un análisis integrado entre la calidad de vida y las necesidades de apoyo de personas adultas con discapacidad intelectual en Chile / An integrated analysis between the quality of life and the support needs of adults with intellectual disabilities in Chile

El paradigma de apoyos y el de calidad de vida se han transformado en guías fundamentales para los avances en el ámbito de la discapacidad intelectual (DI). Con base en una muestra de 93 personas adultas con DI, se analiza, desde un enfoque cuantitativo no experimental, la relación entre la calidad de vida y las necesidades de apoyo, aplicando la escala INICO-FEAPS y la escala de Intensidad de Apoyos (SIS) para cada constructo. Los principales resultados evidencian que existe una relación fuerte e indirecta entre calidad de vida y necesidades de apoyos, y también la relevancia de analizar dichos resultados desde variables como grado de discapacidad, sexo o nivel socioeconómico. La discusión permite inferir la necesidad de discutir nuevas estrategias en torno a categorías como el grado de discapacidad, la autodeterminación e inclusión social, como elementos facilitadores de la calidad de vida y apoyos desde un enfoque integral que contribuya al desarrollo de estrategias de programas sociales para la población con DI. (AU)

The support paradigm and the quality of life paradigm have become fundamental guides for progress in the field of Intellectual Disability (ID). Based on a sample of 93 adults with ID, the relationship between Quality of Life and Support Needs is analyzed from a non-experimental quantitative approach, applying the INICO-FEAPS scale and the SIS Support Intensity scale for each construct. The main results show that there is a strong and indirect relationship between quality of life and support needs, and the relevance of analyzing these results from variables such as the degree of disability, sex or socioeconomic level. The discussion allows us to infer the need to discuss new strategies around categories such as the degree of disability, self-determination and social inclusion, as facilitating elements of quality of life and supporting a comprehensive approach that contributes to the development of social program strategies for the population with ID. (AU)

Un análisis integrado entre la calidad de vida y las necesidades de apoyo de personas adultas con discapacidad intelectual en Chile / An integrated analysis between the quality of life and the support needs of adults with intellectual disabilities in Chile

El paradigma de apoyos y el de calidad de vida se han transformado en guías fundamentales para los avances en el ámbito de la discapacidad intelectual (DI). Con base en una muestra de 93 personas adultas con DI, se analiza, desde un enfoque cuantitativo no experimental, la relación entre la calidad de vida y las necesidades de apoyo, aplicando la escala INICO-FEAPS y la escala de Intensidad de Apoyos (SIS) para cada constructo. Los principales resultados evidencian que existe una relación fuerte e indirecta entre calidad de vida y necesidades de apoyos, y también la relevancia de analizar dichos resultados desde variables como grado de discapacidad, sexo o nivel socioeconómico. La discusión permite inferir la necesidad de discutir nuevas estrategias en torno a categorías como el grado de discapacidad, la autodeterminación e inclusión social, como elementos facilitadores de la calidad de vida y apoyos desde un enfoque integral que contribuya al desarrollo de estrategias de programas sociales para la población con DI. (AU)

The support paradigm and the quality of life paradigm have become fundamental guides for progress in the field of Intellectual Disability (ID). Based on a sample of 93 adults with ID, the relationship between Quality of Life and Support Needs is analyzed from a non-experimental quantitative approach, applying the INICO-FEAPS scale and the SIS Support Intensity scale for each construct. The main results show that there is a strong and indirect relationship between quality of life and support needs, and the relevance of analyzing these results from variables such as the degree of disability, sex or socioeconomic level. The discussion allows us to infer the need to discuss new strategies around categories such as the degree of disability, self-determination and social inclusion, as facilitating elements of quality of life and supporting a comprehensive approach that contributes to the development of social program strategies for the population with ID. (AU)

Red and green defocus curves and duochrome test in different age groups / Curvas de desenfoque rojo y verde y prueba de duocromo en diferentes grupos de edad

Purpose: To compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in different age groups. Methods: 12 elderly (ELD: 59.3 ± 3.9 years) and 8 young (YG: 22.1 ± 1.1 years) subjects were recruited. An optometric assessment with the DT was carried out to obtain the subjective refraction at distance. DCs at distance on green, white, and red backgrounds were measured and the following parameters were deduced: dioptric difference between red-green, green-white, red-white focal positions (minima of the DCs), best corrected visual acuity (BCVA), and widths of the DCs for red, green, and white. Results: The DC difference between the green-white focal positions (mean ± standard deviation) was -0.12±0.17 diopters (D) (ELD, p = 0.012) and -0.11±0.12 D (YG, p = 0.039), while the red-white difference was not statistically significant. The DC red-green difference was 0.20±0.16 D (ELD, p = 0.002) and 0.18±0.18 D (YG, p = 0.008). The ELD BCVA with green background was significantly worse than BCVA with red (p = 0.007) and white (p = 0.007). The mean value of the DC's width in ELD for green (1.01±0.36 D) was higher than for red (0.77±0.21 D) and for white (0.84±0.35 D), but with no statistical significance. Conclusion: Both age groups showed a slight focusing preference for red when using white light. Moreover, ELD showed a worse BCVA with a green compared to a red background. Despite these results deduced by DC analyses, these aspects do not compromise the possibility of using the DT in clinical practice both in the young and in the elderly. Furthermore, the difference of about 0.20 D between red-green DC in both groups confirms the clinical appropriateness of the widespread use of 0.25 D step as the standard minimum difference in power between correcting lenses.(AU)

Study of stereopsis using a depth sensation detection platform equipped with computer vision technology (DALE3D) / Estudio de estereopsis mediante una plataforma de detección de sensaciones de profundidad equipada con tecnología de visión por ordenador (DALE3D)

Background and objectives: The invention described herein is a prototype based on computer vision technology that measures depth perception and is intended for the early examination of stereopsis. Materials and methods: The prototype (software and hardware) is a depth perception measurement system that consists on: (a) a screen showing stereoscopic models with a guide point that the subject must point to; (b) a camera capturing the distance between the screen and the subject's finger; and (c) a unit for recording, processing and storing the captured measurements. For test validation, the reproducibility and reliability of the platform were calculated by comparing results with standard stereoscopic tests. A demographic study of depth perception by subgroup analysis is shown. Subjective comparison of the different tests was carried out by means of a satisfaction survey. Results: We included 94 subjects, 25 children and 69 adults, with a mean age of 34.2 ± 18.9 years; 36.2 % were men and 63.8 % were women. The DALE3D platform obtained good repeatability with an interclass correlation coefficient (ICC) between 0.94 and 0.87, and coefficient of variation (CV) between 0.1 and 0.26. Threshold determining optimal and suboptimal results was calculated for Randot and DALE3D test. Spearman's correlation coefficient, between thresholds was not statistically significant (p value > 0.05). The test was considered more visually appealing and easier to use by the participants (90 % maximum score). Conclusions: The DALE3D platform is a potentially useful tool for measuring depth perception with optimal reproducibility rates. Its innovative design makes it a more intuitive tool for children than current stereoscopic tests. Nevertheless, further studies will be needed to assess whether the depth perception measured by the DALE3D platform is a sufficiently reliable parameter to assess stereopsis.(AU)

Binocular vision parameters and visual performance in bilateral keratoconus corrected with spectacles versus rigid gas-permeable contact lenses / Parámetros de visión binocular y rendimiento visual en queratocono bilateral corregido con gafas versus lentes de contacto rígidos permeables al gas

Purpose: To analyze binocular vision of individuals aged 18 to 35 years diagnosed with keratoconus, utilizing spectacles and rigid gas-permeable (RGP) contact lenses. Research was led by the Universidad Autónoma de Aguascalientes, México and Fundación Universitaria del Área Andina Pereira, Colombia. Methods: A single center, prospective non-randomized, comparative, interventional, open-label study, in which the differences in binocular vision performance with both spectacles and RGP contact lenses was carried out from December 2018 to December 2019. Sampling was performed according to consecutive cases with keratoconus that met the inclusion criteria until the proposed sample size was reached. Results: Rigid gas-permeable (RGP) contact lenses notably enhanced distance and near visual acuity in keratoconus patients compared to spectacles. Visual alignment analysis shows exophoria at both distances and is slightly higher with RGP contact lenses. The difference was statistically significant (p<0.05), with 82.5 % presenting compensated phoria with spectacles and pnly 42.50% with RGP contact lenses. Stereoscopic vision improved while wearing RGP contact lenses (42.59 %), although accommodation and accommodative flexibility remained within normal ranges. Conclusions: Patients with keratoconus fitted with RGP contact lenses have improved binocular vision skills such as visual acuity, stereopsis, and accommodative flexibility. However, even when the vergence and motor system is decompensated with respect to normal ranges, the range between break and recovery points for both fusional reserves and the near point of convergence (NPC) improves with the use of RGP contact lenses, giving indications of an adaptive condition of the motor system from the medium to the long term.(AU)

Revisión narrativa del modelo de desarrollo positivo para adultos emergentes chilenos / A narrative review of the positive development model for Chilean emerging adults / Revisão narrativa do modelo de desenvolvimento positivo para adultos emergentes chilenos

Introducción: El desarrollo positivo es un estadio de ajuste psicosocial que acentúa las potencialidades y los recursos entre jóvenes y sus contextos próximos. En Australia, se desarrolló el primer modelo de desarrollo positivo para adultos emergentes, el cual consta de cinco componentes (competencia social, satisfacción con la vida, confianza y tolerancia con los otros, confianza hacia autoridades e instituciones, acción y compromiso cívico), pero no ha sido investigado en Chile. Objetivo: Analizar la evidencia disponible en la literatura científica sobre los cinco componentes del modelo de desarrollo positivo en adultos emergentes universitarios de Chile. Materiales y métodos: Revisión narrativa de la literatura publicada entre 2013 y 2023, en bases de datos Web of Science, Scopus, SciELO, Redalyc y Dialnet. Resultados: Se obtuvieron 83 artículos, de los cuales 53 cumplieron los requisitos de inclusión; en su mayor parte fueron estudios cuantitativos (81,13%) y en español (75,47%). Se evidenció una disparidad en la cantidad de estudios por temática; se encuentra mayor investigación en satisfacción con la vida y acción y compromiso cívico. Conclusiones: Existen brechas en la literatura científica chilena en el estudio del desarrollo positivo; además de que se discuten particularidades idiosincrásicas y desafíos asociados a la etapa de adultez emergente.

Introduction: Positive development is a stage of psychosocial adjustment that accentuates the potentials and resources of young people and their close contexts. The first positive development model for emerging adulthood was developed in Australia, which includes five components: social; life satisfaction; trust and tolerance of others; trust in the authorities and institutions; and action and civic engagement. However, this model has not been investigated in Chile. Objective: To analyze the evidence available in the scientific literature on the five components of the positive development model in emerging adults universities. Materials and methods: A narrative review of the literature published between 2013 and 2023 in the Web of Science, Scopus, SciELO, Redalyc, and Dialnet databases was conducted. Results: 83 articles were selected, of which 53 met the inclusion criteria; most of them were qualitative studies (81.13%) and in Spanish (75.47%). There is an evident disparity in terms of the number of studies and topics, e.g., there is more research on life satisfaction and civic action and commitment. Conclusions: There are gaps in the Chilean scientific literature in the study of positive development. In addition, idiosyncratic particularities and challenges associated with the stages of emerging adulthood are discussed.

Introdução: O desenvolvimento positivo é uma fase de ajustamento psicossocial que acentua o potencial e os recursos dos jovens e dos seus contextos imediatos. Na Austrália, foi desenvolvido o primeiro modelo de desenvolvimento positivo para adultos emergentes, que consiste em cinco componentes (social, satisfação com a vida, confiança e tolerância com os outros, confiança nas autoridades e instituições, ação e envolvimento cívico), mas ainda não foi investigado no Chile. Objetivo: Analisar as evidências disponíveis na literatura científica sobre os cinco componentes do modelo de desenvolvimento positivo em adultos universitários emergentes no Chile. Materiais e métodos: Revisão narrativa da literatura publicada entre 2013 e 2023, nas bases de dados Web of Science, Scopus, SciELO, Redalyc e Dialnet. Resultados: foram obtidos 83 artigos, dos quais 53 atenderam aos requisitos de inclusão; A maioria deles eram estudos quantitativos (81,13%) e em espanhol (75,47%). Ficou evidente uma disparidade no número de estudos por tema; Há mais pesquisas sobre satisfação com a vida e ação e compromisso cívico. Conclusões: Existem lacunas na literatura científica chilena no estudo do desenvolvimento positivo; Além disso, são discutidas particularidades e desafios idiossincráticos associados à fase da idade adulta emergente.

Predictors of transition to schizophrenia and other long-lasting non-affective psychoses in first-episode patients with acute and transient psychotic disorders: A validation study

Background and objectives Almost half of the individuals with a first-episode of psychosis who initially meet criteria for acute and transient psychotic disorder (ATPD) will have had a diagnostic revision during their follow-up, mostly toward schizophrenia. This study aimed to determine the proportion of diagnostic transitions to schizophrenia and other long-lasting non-affective psychoses in patients with first-episode ATPD, and to examine the validity of the existing predictors for diagnostic shift in this population. Methods We designed a prospective two-year follow-up study for subjects with first-episode ATPD. A multivariate logistic regression analysis was performed to identify independent variables associated with diagnostic transition to persistent non-affective psychoses. This prediction model was built by selecting variables on the basis of clinical knowledge. Results Sixty-eight patients with a first-episode ATPD completed the study and a diagnostic revision was necessary in 30 subjects at the end of follow-up, of whom 46.7% transited to long-lasting non-affective psychotic disorders. Poor premorbid adjustment and the presence of schizophreniform symptoms at onset of psychosis were the only variables independently significantly associated with diagnostic transition to persistent non-affective psychoses. Conclusion Our findings would enable early identification of those inidividuals with ATPD at most risk for developing long-lasting non-affective psychotic disorders, and who therefore should be targeted for intensive preventive interventions. (AU)

Effects of antipsychotics on amino acid levels in patients with first-episode schizophrenia: A prospective study

Background and objectives Alterations in the molecular mechanisms of specific amino acids (AAs) may be implicated in the pathophysiology of schizophrenia (SZ). However, little is known about antipsychotic drugs influence on levels of AAs. This study aimed to further explore antipsychotics' effects on AAs and serum lipid levels in first-episode SZ. Methods Eighty subjects with the International Classification of Diseases, Tenth Edition (ICD-10) criteria-defined SZ were enrolled. The levels of 31 AAs were measured in plasma samples using ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Results Ten AAs (i.e., citrulline, sarcosine, tyrosine, leucine, proline, hydroxyproline, kynurenine, tryptophan, valine and isoleucine) were observed to be higher and three AAs (i.e., GABA, aminobutyric acid and asparaginic acid) were lower in 80 patients with first-episode SZ after various antipsychotics treatment. In addition, there were 1 out of 31 AAs altered after olanzapine treatment and there were only 2 out of 31 AAs altered after risperidone treatment. Furthermore, serum triglyceride (TG) was markedly upregulated after olanzapine treatment, while Apolipoprotein A1 (ApoA1) was generally upregulated after risperidone treatment in patients with first-episode SZ. Conclusions Taken together, antipsychotic treatment can affect the plasma levels of AAs in patients with first-episode SZ, and olanzapine and risperidone have differential effects on the levels of AAs. (AU)

Feature variability determines specificity and transfer in multiorientation feature detection learning.

Historically, in many perceptual learning experiments, only a single stimulus is practiced, and learning is often specific to the trained feature. Our prior work has demonstrated that multi-stimulus learning (e.g., training-plus-exposure procedure) has the potential to achieve generalization. Here, we investigated two important characteristics of multi-stimulus learning, namely, roving and feature variability, and their impacts on multi-stimulus learning and generalization. We adopted a feature detection task in which an oddly oriented target bar differed by 16° from the background bars. The stimulus onset asynchrony threshold between the target and the mask was measured with a staircase procedure. Observers were trained with four target orientation search stimuli, either with a 5° deviation (30°-35°-40°-45°) or with a 45° deviation (30°-75°-120°-165°), and the four reference stimuli were presented in a roving manner. The transfer of learning to the swapped target-background orientations was evaluated after training. We found that multi-stimulus training with a 5° deviation resulted in significant learning improvement, but learning failed to transfer to the swapped target-background orientations. In contrast, training with a 45° deviation slowed learning but produced a significant generalization to swapped orientations. Furthermore, a modified training-plus-exposure procedure, in which observers were trained with four orientation search stimuli with a 5° deviation and simultaneously passively exposed to orientations with high feature variability (45° deviation), led to significant orientation learning generalization. Learning transfer also occurred when the four orientation search stimuli with a 5° deviation were presented in separate blocks. These results help us to specify the condition under which multistimuli learning produces generalization, which holds potential for real-world applications of perceptual learning, such as vision rehabilitation and expert training.

Multiple Causes of Death Associated with Pediatric Cardiopulmonary Arrest from 1996 to 2019 in Brazil. / Causas Múltiplas de Morte Associadas à Parada Cardiorrespiratória Pediátrica de 1996 a 2019 no Brasil.

BACKGROUND: In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents. OBJECTIVES: To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths. METHOD: Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC. RESULTS: From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases. CONCLUSION: Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.

FUNDAMENTO: Em pediatria, a parada cardiorrespiratória (PCR) está associada a alta mortalidade e graves sequelas neurológicas. Informações sobre as causas e mecanismos de morte abaixo de 20 anos poderiam fornecer subsídios teóricos para a melhoria da saúde de crianças e adolescentes. OBJETIVOS: Realizar uma análise populacional das taxas de mortalidade por causas primárias e múltiplas de morte abaixo de 20 anos, em ambos os sexos, no período de 1996 a 2019, no Brasil, e identificar a frequência com que a PCR foi registrada nas declarações de óbito (DOs) desses indivíduos e os locais de ocorrência dos óbitos, a fim de promover estratégias para melhorar a prevenção de mortes. MÉTODO: Estudo ecológico de séries temporais de óbitos em indivíduos menores de 20 anos, no período de 1996 a 2019, avaliando as taxas de mortalidade (TMs) e a mortalidade proporcional (MP) por causa básica de morte. Foram analisados os percentuais de PCR registrados em qualquer linha da DO e o local de ocorrência dos óbitos. Foram calculadas as TMs por 100 mil habitantes e a MP por causa básica de morte nos menores de 20 anos segundo sexo e faixa etária, os percentuais de óbito por causas básicas por faixa etária quando a PCR foi descrita em qualquer linha das Partes I e II da DO, e o percentual de óbitos por causas básicas segundo o local de ocorrência. Os dados foram retirados do DATASUS, IBGE e SINASC. RESULTADOS: De 1996 a 2019, ocorreram 2.151.716 óbitos de menores de 20 anos, no Brasil, gerando uma taxa de mortalidade de 134,38 por 100 mil habitantes. A taxa de óbito foi maior entre os recém-nascidos do sexo masculino. Do total de óbitos, 249.334 (11,6%) tiveram PCR registrada em qualquer linha da DO. Especificamente, a PCR foi registrada 49.178 vezes na DO na faixa etária entre 1 e 4 anos e em 88.116 vezes entre 29 e 365 dias, correspondendo, respectivamente, a 26% e 22% dos óbitos nessas faixas etárias. Essas duas faixas etárias apresentaram as maiores taxas de PCR registradas em qualquer linha da DO. As principais causas básicas de óbito quando a PCR foi registrada na sequência de óbitos foram doenças respiratórias, hematológicas e neoplásicas. CONCLUSÃO: As causas perinatais e externas foram as principais causas de morte, com maior TM nos menores de 20 anos no Brasil de 1996 a 2019. Quando consideradas as causas múltiplas de morte, as principais causas primárias associadas à PCR foram as doenças respiratórias, hematológicas e neoplásicas. A maioria dos óbitos ocorreu no ambiente hospitalar. Melhor compreensão da sequência de eventos nesses óbitos e melhorias nas estratégias de ensino em ressuscitação cardiopulmonar pediátrica são necessárias.

Association between telomere length and Plasmodium falciparum malaria endemicity in sub-Saharan Africans.

Leukocyte telomere length (LTL) varies significantly across human populations, with individuals of African ancestry having longer LTL than non-Africans. However, the genetic and environmental drivers of LTL variation in Africans remain largely unknown. We report here on the relationship between LTL, genetics, and a variety of environmental and climatic factors in ethnically diverse African adults (n = 1,818) originating from Botswana, Tanzania, Ethiopia, and Cameroon. We observe significant variation in LTL among populations, finding that the San hunter-gatherers from Botswana have the longest leukocyte telomeres and that the Fulani pastoralists from Cameroon have the shortest telomeres. Genetic factors explain ∼50% of LTL variation among individuals. Moreover, we observe a significant negative association between Plasmodium falciparum malaria endemicity and LTL while adjusting for age, sex, and genetics. Within Africa, adults from populations indigenous to areas with high malaria exposure have shorter LTL than those in populations indigenous to areas with low malaria exposure. Finally, we explore to what degree the genetic architecture underlying LTL in Africa covaries with malaria exposure.

Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021.

BACKGROUND: Sex and gender shape health. There is a growing body of evidence focused on comprehensively and systematically examining the magnitude, persistence, and nature of differences in health between females and males. Here, we aimed to quantify differences in the leading causes of disease burden between females and males across ages and geographies. METHODS: We used the Global Burden of Disease Study 2021 to compare disability-adjusted life-year (DALY) rates for females and males for the 20 leading causes of disease burden for individuals older than 10 years at the global level and across seven world regions, between 1990 and 2021. We present absolute and relative differences in the cause-specific DALY rates between females and males. FINDINGS: Globally, females had a higher burden of morbidity-driven conditions with the largest differences in DALYs for low back pain (with 478·5 [95% uncertainty interval 346·3-632·8] more DALYs per 100 000 individuals among females than males), depressive disorders (348·3 [241·3-471·0]), and headache disorders (332·9 [48·3-731·9]), whereas males had higher DALY rates for mortality-driven conditions with the largest differences in DALYs for COVID-19 (with 1767·8 [1581·1-1943·5] more DALYs per 100 000 among males than females), road injuries (1012·2 [934·1-1092·9]), and ischaemic heart disease (1611·8 [1405·0-1856·3]). The differences between sexes became larger over age and remained consistent over time for all conditions except HIV/AIDS. The largest difference in HIV/AIDS was observed among those aged 25-49 years in sub-Saharan Africa with 1724·8 (918·8-2613·7) more DALYs per 100 000 among females than males. INTERPRETATION: The notable health differences between females and males point to an urgent need for policies to be based on sex-specific and age-specific data. It is also important to continue promoting gender-sensitive research, and ultimately, implement interventions that not only reduce the burden of disease but also achieve greater health equity. FUNDING: Bill & Melinda Gates Foundation.

The association between health behaviours and academic performance moderated by trait mindfulness amongst university students: an observational study.

Objectives: To target health communication at less health-conscious groups, evidence on health behaviours' effects on non-health-related outcomes - such as academic performance - is necessary. Recent research has highlighted the associations of various health behaviours on academic performance of university students. However, there is a lack of research investigating the most predominant health behaviours simultaneously and their association with academic performance, as well as the factors that potentially influence the direction or strength of these associations. Therefore, this study investigated (I) which of the predominant health behaviours (physical activity, healthy diet, sleep, sedentary behaviour, alcohol consumption, smoking, drug use) are most associated with academic performance and (II) whether the personal resource of trait mindfulness moderates these associations. Methods: An online survey was conducted amongst university students during the 2021 summer semester. Group differences in academic performance regarding health behaviours were analysed using ANOVA (N = 1,049). A first linear regression model (N = 571), considering all selected health behaviours simultaneously, assessed their association with academic performance. A second model (N = 540) assessed interaction effects of health behaviours and trait mindfulness. Separate regressions assessed each interaction's association with academic performance. Results: Sleep, fruit and vegetable consumption, and gender were significantly associated with academic performance. The second model showed no significant interaction effects. Conclusion: Targeting sleep and fruit and vegetable consumption might be the most promising strategies for elevating students' academic performance, thereby enabling health communication strategies to reach groups driven by performance improvements rather than health benefits.

Young women's social support networks during pregnancy in Soweto, South Africa.

BACKGROUND: Although studies from high-income countries have examined social support during pregnancy, it remains unclear what type of support is received by expectant mothers from low- and middle-income country settings. AIM: To explore young women's social support networks during pregnancy in Soweto, South Africa. SETTING: This study was undertaken in an academic hospital based in the Southwestern Townships (Soweto), Johannesburg, in Gauteng province, South Africa. METHODS: An exploratory descriptive qualitative approach was employed. Eighteen (18) young pregnant women were recruited using a purposive sampling approach. In-depth interviews were conducted, and data were analysed using inductive thematic analysis. RESULTS: Analysis of the data resulted in the development of two superordinate themes namely; (1) relationships during pregnancy and (2) network involvement. Involvement of the various social networks contributed greatly to the young women having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. CONCLUSION: Focusing on less-examined characteristics that could enhance pregnant women's health could help in the reduction of deaths that arise because of pregnancy complications and contribute in globally accelerating increased accessibility to adequate reproductive health.Contribution: This study's findings emphasise the necessity for policymakers and healthcare providers to educate the broader community about the importance of partner, family and peer support to minimise risks that may affect pregnancy care and wellbeing of mothers.

Specialties preference by gender among medical students at Sefako Makgatho Health Sciences University, South Africa.

BACKGROUND:  To determine the speciality preferences and the gender differences in the choice of speciality among medical students at Sefako Makgatho Health Sciences University, South Africa. METHODS:  This cross-sectional study was conducted among fourth- to sixth-year medical students. A structured self-administered questionnaire was used to collect the data. Data analysis was performed using STATA version 16 (StataCorp, College Station, TX, United States). RESULTS:  A total of 174 students participated (response rate of 74%). Their median age was 23 years with interquartile range of 2 years. More than half (57%) were females. About 83% had no previous qualifications. Most (89%) have shown interest in pursuing specialist training. Surgery, obstetrics and gynaecology and internal medicine were the most selected specialities, while family medicine, ophthalmology, forensic medicine, public health medicine, ear, nose and throat, and accident and emergency medicine were the least preferred. Males were more likely interested in surgery and internal medicine, while females preferred obstetrics and gynaecology. CONCLUSION:  The majority of the medical students intends to pursue their postgraduate medical training. Even though the results were not statistically significant, there are gender differences in speciality preferences. There is a need to develop and implement career guidance and recruitment plans to deal with specialities with poor recruitment and gender imbalance.Contribution: To deal with specialties with poor and gender imbalance, career guidance and recruitment plans must be developed and implemented.

Sociodemographics, behaviour and knowledge of first South African HPV-vaccine recipients.

BACKGROUND:  Infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer and is one of the most prevalent sexually transmitted infections worldwide. Primary prevention strategies target reducing HPV acquisition through vaccination, limiting exposure (e.g. delayed sexual debut, barrier contraception) and health education focusing on sexual behaviour and tobacco use. METHODS:  The ImmunoVACCS study, conducted from 2019 to 2022 in two provinces in South Africa, examined sociodemographic characteristics, sexual practices, and knowledge of cervical cancer and the HPV vaccine among young female vaccine recipients. It encompassed participants from the previously conducted vaccine implementation trials, VACCS 1 and VACCS 2 (2011-2014). Recruitment involved telephonic contact with eligible potential participants. Data were collected through self-administered questionnaires. RESULTS:  One hundred and eleven participants took part in the current study (median age: 20 years; age range: 16-22 years). Most sexually active participants had their first engagement in secondary school (96.2%), and 77.2% used contraception during their last sexual activity. Knowledge gaps were evident, with only 13.5% recognising cervical cancer's cervix origin and 3.6% attributing it to a virus. Despite this, 70.3% had heard of a vaccine for cervical cancer. Less than half knew about the importance of regular Pap smears (49.5%), vaccine protection (44.1%) or condom use (20.7%) against HPV and cervical cancer. CONCLUSION:  The current study demonstrates that young women still lack complete information on cervical cancer and its risk factors even after receiving health education linked with vaccination.Contribution: This study underscores the necessity of ongoing education about HPV, its risks and preventive measures among young women to combat cervical cancer.

Lived experiences of women with spontaneous abortion at a district hospital, South Africa.

BACKGROUND:  Spontaneous abortions occur in 12.5% of pregnancies and have a significant impact on the well-being of women. Dissatisfaction with health services is well-documented, but no studies have been conducted in district health services of the Western Cape. The aim was to explore the lived experiences of women presenting with spontaneous abortions to the emergency department at Helderberg Hospital. METHODS:  A descriptive phenomenological qualitative study used criterion-based purposive sampling to identify suitable participants. Data were collected through semi-structured individual interviews. Atlas-ti (version 22) software assisted with data analysis using the framework method. RESULTS:  A total of nine participants were interviewed. There were four main themes: a supportive environment, staff attitudes and behaviour, the impact of time, and sharing of information. The comfort, cleanliness and privacy of the environment were important. COVID-19 had also impacted on this. Showing interest, demonstrating empathy and being nonjudgemental were important, as well as the waiting time for definitive treatment and the time needed to assimilate and accept the diagnosis. In addition, the ability to give relevant information, explain the diagnosis and help patients share in decision-making were key issues. CONCLUSION:  This study highlighted the need for a more person-centred approach and managers should focus on changes to organisational culture through training and clinical governance activities. Attention should be paid to the physical environment, availability of patient information materials and sequential coordination of care with primary care services.Contribution: This study identifies issues that can improve person-centredness and women's satisfaction with care for spontaneous abortion.

Determinants of antiretroviral therapy adherence among transgender women in South Africa.

BACKGROUND:  Transgender women bear a huge burden of human immunodeficiency virus (HIV) in South Africa. However, they are not fully engaged in healthcare across the HIV continuum of care. In addition, transgender women face multiple facets of stigma and discrimination as well as socio-economic inequalities, which all have a negative impact on antiretroviral therapy (ART) adherence. OBJECTIVE:  The study aimed at exploring and describing the experiences of ART adherence of transgender women living with HIV in the Buffalo City Metro Municipality. METHODS:  The study employed an interpretative phenomenological analysis (IPA) design. Twelve participants were enrolled using a snowballing sampling technique. Data were collected using semi-structured interviews and analysed using an IPA framework. RESULTS:  While exploring determinants to ART adherence among transgender women living with HIV in Buffalo City Metro, two superordinate themes emerged: enablers to ART adherence and psychosocial factors promoting adherence. The study found that factors such as differentiated ART service delivery, ARV medicines-related factors, motivators for taking treatment and support systems facilitated ART adherence. CONCLUSION:  Emerging from this study is the need to scale up differentiated, person-centred ART service deliveries that will enhance access and adherence to treatment for transgender women.Contribution: This study provides unique insights on factors enhancing ART adherence among transgender women. There is a paucity of literature on access to HIV care services for key and vulnerable populations, and these findings will be shared in the country and in the region.

Epidemiological profile of neuroendocrine tumors in adults in Brazil.

Objective: Neuroendocrine tumors (NETs) are a set of diseases that originate from neuroendocrine cells, which comprises a diffuse endocrine system present in various organs of the body. These tumors are more frequent in the gastrointestinal tract (70%) and the bronchopulmonary system (20%-30%). A NET incidence rate of 1-5 per 100,000 inhabitants has been estimated for several European countries and the USA employing 20 years of data. However, no comprehensive studies on this rare neoplasm are available in Brazil. In this context, the aim of this study was to characterize the epidemiological NET profile in the country. Materials and methods: This is a retrospective descriptive observational study based on data from Hospital Cancer Records available at the Brazilian National Cancer Institute and the São Paulo Oncocentro Foundation. Demographic, clinical and treatmentrelated variables were analyzed from selected cases employing descriptive statistics. Results and Conclusion: A total of 15,859 cases were identified, most occurring in males (53.4%) and in individuals under 65 years old (63.3%). Small cell carcinoma was the most frequent histological type (46.7%). Bronchopulmonary tumors were the most frequent NETs, followed by pancreatic tumors, with cases mostly concentrated in high complexity centers in the Brazilian Southeast and treated mainly with surgery and chemotherapy, with over half of the patients diagnosed in advanced stages of the disease.

Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy.

Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LNgrowth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusion: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.