Climate change and marine cargo insurance - A global survey of insurers' perceptions.

The increasing frequency of climate-related hazards poses a significant risk to supply chains and marine insurance companies, which are already grappling with complex and interdependent global operations. Through a survey, this research examines the perceptions of an international cohort of marine insurers regarding their organization's participation in the Supply Chain Risk Management (SCRM) framework for climate change. In addition, the influence of respondents' experience levels and the World Bank's country classifications by income level are investigated. A repeated measures analysis of variance (ANOVA) is conducted to examine the effect of the SCRM framework's steps on perception, revealing significant variations among the steps and identifying gaps for improvement. While experience levels do not significantly affect involvement in the SCRM framework, distinct patterns emerge within each experience group, highlighting nuanced risk management practices. Comparing perceptions across World Bank income level categories reveals that higher country income levels generally correlate with higher average perception scores, indicating a potential association with greater awareness and management of climate change risks. The research also highlights the need for comprehensive involvement in all steps of the SCRM framework. Addressing climate change and building resilient supply chains requires a multi-faceted approach that includes enhanced risk management practices, and to this end, the authors' present areas for future research.

Deepfake: definitions, performance metrics and standards, datasets, and a meta-review.

Recent advancements in AI, especially deep learning, have contributed to a significant increase in the creation of new realistic-looking synthetic media (video, image, and audio) and manipulation of existing media, which has led to the creation of the new term "deepfake." Based on both the research literature and resources in English, this paper gives a comprehensive overview of deepfake, covering multiple important aspects of this emerging concept, including (1) different definitions, (2) commonly used performance metrics and standards, and (3) deepfake-related datasets. In addition, the paper also reports a meta-review of 15 selected deepfake-related survey papers published since 2020, focusing not only on the mentioned aspects but also on the analysis of key challenges and recommendations. We believe that this paper is the most comprehensive review of deepfake in terms of the aspects covered.

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey.

Introduction: Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data. Methods: Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant. Results: The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use. Conclusion: Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

Prevalence, mortality and risk factors for self-reported COPD among smokers and never smokers, NHANES 1999-2018.

INTRODUCTION: Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences. METHODS: This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates. RESULTS: Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts. CONCLUSIONS: The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.

Prioritisation of early pregnancy risk factors for stillbirth: An international multistakeholder modified e-Delphi consensus study.

OBJECTIVE: To identify and prioritise early pregnancy risk factors for stillbirth to inform prognostic factor and model research. STUDY DESIGN: We used a modified e-Delphi method and consultation meeting to achieve consensus. Risk factors for early, late and stillbirth at any gestation identified from an umbrella review of risk factors for stillbirth were entered into a two-stage online Delphi survey with an international group of stakeholders made up of healthcare professionals and researchers. The RAND/ University of California at Los Angeles appropriateness method was used to evaluate consensus. Responders voted on a scale of 1-9 for each risk factor in terms of importance for early, late, and stillbirth at any gestation. Consensus for inclusion was reached if the median score was in the top tertile and at least two thirds of panellists had scored the risk factor within the top tertile. RESULTS: Twenty-six risk factors were identified from an umbrella review and presented to stakeholders in round 1 of our e-Delphi survey. Round 1 was completed by 68 stakeholders, 79% (54/68) of whom went on to complete the second round. Seventeen risk factors were discussed at the consensus meeting. From the twenty-six risk factors identified, fifteen of these were prioritised for stillbirth at any gestation, eleven for early stillbirth, and sixteen for late stillbirth, across three domains of maternal characteristics, ultrasound markers and biochemical markers. The prioritised maternal characteristics common to early, late, and stillbirth at any gestation were: maternal age, smoking, drug misuse, history of heritable thrombophilia, hypertension, renal disease, diabetes, previous stillbirth and multiple pregnancy. Maternal BMI, access to healthcare, and socioeconomic status were prioritised for late stillbirth and stillbirth at any gestation. Previous pre-eclampsia and previous small for gestational age baby were prioritised for late stillbirth. Of the ultrasound markers, uterine artery Doppler pulsatility index and congenital fetal anomaly were prioritised for all. One biochemical marker, placental growth factor, was prioritised for stillbirth at any gestation. CONCLUSIONS: Our prioritised risk factors for stillbirth can inform formal factor-outcome evaluation of early pregnancy risk factors to influence public health strategies on prevention of such risk factors to prevent stillbirth.

Yield of skeletal surveys in national network of child abuse pediatricians: Age is key.

BACKGROUND: Skeletal surveys (SS) are recommended for the evaluation of suspected physical abuse in children <2 years old. No guidelines exist for SS completion in children between 2 and 5 years old. OBJECTIVE: To determine rates of SS completion by age and examine variables associated with occult fracture identification in older children. PARTICIPANTS AND SETTING: Observational cross-sectional multi-center study of 10 US pediatric centers 2/2021-9/2022 including children <6 years old evaluated for physical child abuse. METHODS: The principal outcome is occult fracture identified on SS. Non-parametric tests were conducted from comparison between age groups and those with and without occult fractures. RESULTS: The rate of SS completion declined with increasing age from a high of 91 % in infants <6 months old to 7 % in children 5-5.9 years old. The proportion of SS with occult fractures also decreased with age. Of 450 children 2-5 years old with a SS, 20 [4 % (95 % CI: 3-8 %)] had an occult fracture. The rate of occult fractures among children 2-5 years old who were diagnosed with abuse and not admitted to the hospital was 0.3 % (95 % CI 0-0.6 %)]. Over 30 % of children 2-5 years old were diagnosed with child abuse by a child abuse pediatrician without completion of a SS. CONCLUSION: In children 2-5 years of age being evaluated for physical abuse, use of SS and the rate of occult fractures is low. The number of SS performed in children in this age group could potentially be decreased by up to 60 % by limiting SS to children admitted to the hospital.

Quantification of household food waste in Greece to establish the 2021 national baseline and methodological implications.

The aim of this study was to present the national-level quantification of household food waste in Greece for 2021, in alignment with the legal framework of the European Union (EU) for measuring and reporting food waste. An online diary survey was conducted in spring 2021, utilizing pre-tested semi-structured food waste logs. Descriptive statistics were employed to analyze food waste levels and generalized estimating equations (GEE) were performed to assess the influence of diary duration on food waste levels. The final representative sample consisted of 1,133 households. At the national level, the average per-capita annual total food waste generation rate was 86.5 ± 64.5 kg. The predominant share of food waste (47 %) was inedible plant-derived parts, reflecting underlying consumption patterns, whereas 40 % was once-edible food parts. Particularly, vegetables, fruits, and bakery products were the most discarded once-edible food items. Moreover, no statistically significant difference was found between food waste levels across the diary entries, with reporting periods varying from one day to one week. This study marks the first implementation of the EU legislation for household food waste measurement and reporting in Greece. Moreover, the study results indicate that the utilization of diaries with shorter reporting periods than one week, with a sufficiently large sample, may be an appropriate method for measuring nationwide levels, enhancing compliance while mitigating social desirability bias and reducing attrition. Future research should delve into the behaviors driving food waste, motives for prevention in different geographic and cultural contexts, and optimal diary reporting durations.

Medical Home Access Among Children with Obesity: The Role of Family-Centered Communication.

Objective: The American Academy of Pediatrics recommends all children receive care in a patient-centered medical home. With weight stigma potentially hampering family-centered communication in the care of children with overweight or obesity, we aimed to determine how children's weight status was associated with access to a medical home and its components. Methods: We analyzed 2016-2021 data on children age 10-17 years in the National Survey of Children's Health. Children's weight status was classified as underweight/normal weight, overweight, or obese, based on caregiver-reported height and weight. Outcomes included receiving care in a medical home and each category of the medical home definition (personal health care provider, usual source of health care, family/patient-centered care, care coordination, and assistance with referrals). Results: Based on the study sample (n = 105,111), we estimated that 16% of children were overweight and 16% were obese, while 42% had access to a patient-centered medical home. On multivariable analysis, obesity compared to normal weight was associated with lower access to a medical home (odds ratio: 0.87; 95% confidence intervals: 0.80, 0.95; p = 0.003) and, specifically, with lower access to family-centered care and assistance with care coordination. Conclusions: Children with obesity encounter barriers to accessing care meeting medical home criteria, with one plausible mechanism being that weight stigma disrupts family-centered communication. Lower access to care coordination among children with obesity may also indicate a need to improve the integration of obesity-related specialty care with pediatric primary care services.

Effects of Income on Subjective Well-Being in the Elderly: Complete Mediation Roles of Self-Rated Health and Psychological Capital.

Although income and living conditions of residents have greatly improved in recent years, people's subjective well-being does not seem to increase daily. This study aimed to explore income, self-rated health, and psychological capital on subjective well-being, using data from the China General Social Survey conducted in 2017. A total of 1136 elderly as subsamples data were selected from 12 582 participants, involving general sociodemographic characteristics, income, self-rated health, psychological capital, and subjective well-being. SPSS v26.0 macro was used for descriptive statistics, ANOVA and correlation analysis. PROCESS v3.4 macro was performed to examine multiple mediating effects of self-rated health and psychological capital. The elderly residing in urban (P = .016) and having completed 9-year compulsory education (P = .016) reported higher subjective well-being scores. The findings revealed that subjective well-being was positively associated with income, health, and psychological capital among the aged adults (all P < .001). Self-rated health and psychological capital played complete mediation roles between income and subjective well-being (Effect indirect = 0.040, 95% bootstrap CI [0.022, 0.060]; Effect indirect = 0.027, 95% bootstrap CI [0.013, 0.044], respectively). Collectively, our findings indicate that residing in rural and having lower education levels serve as negative predictors of subjective well-being among the elderly. Although income still affects the elderly's subjective well-being, self-rated health and psychological capital may be the crucial mediating factors. Therefore, it is of utmost importance to improve health conditions and positive psychological capital for subjective well-being of the older people.

Ecological and anthropogenic factors influencing the Summer habitat use of Bos gaurus and its conservation threats in Chitwan National Park, Nepal.

Background: Gaur (Bos gaurus) is listed as a vulnerable species in the IUCN Red List of threatened species due to the rapid population decline caused by human pressures in their habitats. To develop successful conservation plans, it is essential to understand the relationship between Gaur and their habitats. This study aimed to investigate the factors influencing Gaur habitat use and identify and rank conservation threats in Chitwan National Park, Nepal. Methods: Using line transect surveys, we recorded Gaur's presence via direct sightings and indirect signs (dung, footprints, horns) over an area of 176 km2 in July and August 2022. We used binary logistic regression models to determine the collected ecological and anthropogenic factors influencing the occurrence of Gaur and the relative whole-site threat ranking method to rank conservation threats. Results: The results revealed that the probability of Gaur occurrence increases with moderate to high canopy cover, riverine and Shorea robusta dominated forests, and nearest distance to road/path/firelines, while decreasing with the presence of predators. Uncontrolled fire, invasive species, human disturbances, and climate change were ranked as the most prevailing threats to Gaur in our study area. Conservation managers should implement effective habitat management interventions, such as construction of waterhole, firelines maintenance, grassland management, and control of invasive species in the potential habitats, to safeguard and maintain the sustainability of Gaur populations and associated herbivores. Future studies should consider larger geographical settings and multiple seasons, and habitat suitability assessments should be conducted to determine current and future suitable habitat refugia for Gaur and other threatened wildlife species at the landscape level.

Dataset on factors influencing pedestrian crosswalk usage behavior in high-density urban areas of a developing country.

The dataset consists of survey data on pedestrian crosswalk usage behavior in high-density urban areas of a developing country, specifically collected from Dhaka, the capital city of Bangladesh. Data were gathered through a questionnaire survey conducted at twelve key locations, covering eight attributes related to crosswalk behavior and the demographic details of respondents. The survey yielded 682 valid responses, focusing on factors such as the suitability of crosswalk locations, guard rails, and lighting. The dataset is structured to support analyses using supervised machine learning techniques, facilitating reproducibility, secondary analysis, and policy development for pedestrian safety improvements. Furthermore, the dataset can be reused for cross-validation of future studies, comparison with pedestrian behavior in similar urban settings, and the development of predictive models to enhance pedestrian infrastructure in other developing regions.

University students' cognitive flexibility and critical thinking dispositions.

The purpose of this study is to examine whether there are differences in critical thinking dispositions and cognitive flexibility among university students based on gender, grade level, and faculty. Additionally, the study will investigate the relationship between these two concepts and their predictive power. The study was conducted using a relational survey model and included 366 university students selected through maximum diversity sampling. The study involved university students from various faculties and grade levels. Data was collected through a personal information form, cognitive flexibility inventory, and critical thinking disposition scale. The data was analyzed using the SPSS 25 program. The results indicate that university students exhibit relatively high levels of cognitive flexibility and critical thinking tendencies. Above the medium level, there was a significant positive relationship between cognitive flexibility and critical thinking tendency. Cognitive flexibility was found to be a significant predictor of critical thinking dispositions, positively and significantly predicting critical thinking disposition and explaining 40% of it. Individuals with critical thinking tendencies exhibit cognitive flexibility, which is also associated with thinking critically. Therefore, cognitive flexibility and critical thinking are interrelated characteristics.

New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020.

Background: Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the first time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys. Methods: Consistent with previous national surveys, the 2020 survey used a stratified, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease Control and Prevention of China CDC. HBsAg positive subjects aged ≥15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals. Findings: HBsAg prevalence in 1-69-year-olds was 5.86%; in children 1-4 years of age, seroprevalence was 0.30%; 75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware; 38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals. Interpretation: The decline in HBsAg prevalence in the general population, from 9.72% in 1992 to 5.86% in 2020, and in 1-4-year-olds from 9.67% in 1992 to 0.30% in 2020, shows progress that continues on track toward WHO targets for prevention of new infections. Implementation of acceptable strategies to identify infected individuals and offer long-term medical monitoring and management will be important to prevent complications from hepatitis B infection and for meeting WHO cascade-of-care targets. Funding: The study was funded by the Major Science and Technology Special Project of China's 13th 5-Year Plan (grant no. 2017ZX10105015); Central finance-operation of public health emergency response mechanism of Chinese Center for Disease Control and Prevention (131031001000200001, 102393220020010000017).

Oral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019-2020 targeted preventative mass campaigns.

Background: In 2019-2020, preventative Oral Cholera Vaccine campaigns were conducted in 24/32 non-contiguous health areas of Goma, DR Congo. In August 2022, we measured coverage and factors potentially influencing success of the delivery strategy. Methods: We used random geo-sampled stratified cluster survey to estimate OCV coverage and assess population movement, diarrhea history, and reasons for non-vaccination. Results: 603 households were visited. Coverage with at least one dose was 46.4 % (95 %CI: 41.8-51.0), and 50.1 % (95 %CI: 45.4-54.8) in areas targeted by vaccination compared to 26.3 % (95 %CI: 19.2-34.9) in non-targeted areas. Additionally, 7.0 % of participants reported moving from outside Goma since 2019, and 5.4 % reported history of severe diarrhea. Absence and unawareness were the main reasons for non-vaccination. Conclusion: Results suggest that targeting non-contiguous urban areas had a coverage-diluting effect. Targeting entire geographically contiguous areas, adapted distribution, and regular catch-up campaigns are operational recommendations to reach higher coverages arising from the study.

Cannabis Use, Perspectives, and Experiences Among Patients Receiving Hemodialysis: A Descriptive Patient Survey.

Background: Patients with chronic kidney disease experience high burden of symptoms, negatively affecting their quality of life. Medication therapy is often initiated to address these symptoms but is limited by variable efficacy and high pill burden. There is interest among clinicians and patients to explore cannabis and cannabinoids as an alternative treatment to manage symptoms related to kidney disease. Objective: The objectives were to characterize cannabis use among patients receiving maintenance hemodialysis (HD), to describe patient perspectives on cannabis, and to explore patient experiences with their kidney health care team related to cannabis. Design: This was a descriptive, cross-sectional paper-based patient survey. Setting/Participants: Patients receiving maintenance HD at Toronto General Hospital in the ambulatory setting between July and August 2020 were included. Methods: A 33-item questionnaire was developed to address the study questions based on existing cannabis questionnaires and input from kidney specialist physicians, pharmacists, kidney nurse practitioners, and patients. The questionnaire was distributed to patients during their in-center HD session. Patients who chose to participate in the study completed the questionnaire and returned it to the study team. Results: In total, there were 52 respondents, of which 11 (21%) reported cannabis use in the preceding 3 months, and 23 (44%) reported historical cannabis use. Baseline characteristics were similar between those who used cannabis and those who did not, with a possible trend of cannabis users being younger. The most commonly reported reasons for using cannabis were recreation and symptom management. Those who reported using cannabis for symptom management were doing so without medical authorization or documentation. Common symptoms that cannabis was used to self-treat were insomnia, anxiety, and/or non-neuropathic pain. Dried flower was the most common type of product used, and smoking was the most common route. Care gaps and opportunities to improve patient care related to cannabis use were identified, related to monitoring and management of adverse effects, management of drug interactions, harm reduction strategies, informed decision-making, and prescriber education. Limitations: The overall participation rate was low, at approximately 17%, possibly related to the COVID-19 pandemic, lack of interest, or fear of revealing cannabis use. Non-response bias is a possible limitation as this was a voluntary survey. The questionnaire was limited to multiple-choice and Likert scale questions, therefore limiting the depth of patient responses. Conclusions: Our study showed that cannabis use among patients receiving HD is common and comparable with the general population. Patients may be using cannabis to self-manage symptoms related to kidney disease, without the involvement of the health care team. Multiple opportunities to improve patient care related to cannabis use were identified.

Contexte: Les symptômes liés à l'insuffisance rénale représentent un lourd fardeau pour les patients qui en sont atteints, ce qui affecte négativement leur qualité de vie. Un traitement médicamenteux est souvent prescrit pour soulager les symptômes, mais il est limité par son efficacité variable et le nombre élevé de médicaments. Les patients et les cliniciens sont ouverts à explorer d'autres avenues pour gérer les symptômes de l'insuffisance rénale, notamment la consommation de cannabis et de cannabinoïdes. Objectifs: Caractériser la consommation de cannabis chez les patients recevant des traitements d'hémodialyse (HD) chronique; décrire les perspectives des patients sur le cannabis et examiner les expériences des patients avec leurs équipes de soins en lien avec la consommation de cannabis. Type d'étude: Enquête transversale descriptive sous forme d'un questionnaire papier remis aux patients. Cadre et sujets de l'étude: Les patients qui suivaient des traitements d'HD chronique en ambulatoire à l'Hôpital général de Toronto en juillet et août 2020. Méthodologie: Pour répondre aux objectifs de l'étude, un questionnaire en 33 points a été élaboré à partir de questionnaires existants sur la consommation de cannabis et des commentaires de néphrologues, pharmaciens, infirmières praticiennes en néphrologie et patients. Le questionnaire a été distribué aux patients pendant une séance d'HD en centre. Les personnes qui ont choisi de participer à l'étude l'ont rempli et l'ont renvoyé à l'équipe de recherche. Résultats: En tout, 52 personnes ont répondu au questionnaire, desquelles 11 (21%) ont déclaré avoir consommé du cannabis dans les trois mois précédents et 23 (44%) en avoir consommé dans le passé. Les caractéristiques initiales des consommateurs de cannabis étaient semblables à celles des personnes qui n'en consommaient pas; les consommateurs de cannabis ayant tendance à être plus jeunes. On consommait principalement du cannabis pour le côté récréatif et pour gérer les symptômes. Les personnes qui consommaient du cannabis pour gérer leurs symptômes le faisaient sans documentation ou indication médicale. Le cannabis était consommé pour l'auto-traitement de symptômes courants comme l'insomnie, l'anxiété et/ou la douleur non neurogène. Le plus souvent, le cannabis était fumé, et la fleur séchée était le produit le plus utilisé. Des lacunes dans les soins et des occasions d'améliorer les soins aux patients ont été identifiées en lien avec la consommation de cannabis, celles-ci concernaient la surveillance et la gestion des effets indésirables, la gestion des interactions médicamenteuses, les stratégies de réduction des risques, la prise de décisions éclairées et l'éducation des prescripteurs. Limites: Le taux de participation global a été faible (environ 17%), possiblement en raison de la pandémie de COVID-19, d'un manque d'intérêt ou de la réticence à révéler la consommation de cannabis. La participation était volontaire, un biais de non-réponse est donc possible. Le questionnaire n'était constitué que de questions à choix multiples et à échelle de Likert, ce qui limite la profondeur des réponses. Conclusion: Notre étude montre que la consommation de cannabis chez les patients sous HD est courante et comparable à celle de la population générale. Les patients peuvent consommer du cannabis pour soulager les symptômes liés à l'insuffisance rénale sans intervention de l'équipe de soins. Le sondage a permis d'identifier plusieurs occasions d'améliorer les soins aux patients en lien avec la consommation de cannabis.

Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study.

BACKGROUND: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. OBJECTIVE: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. METHODS: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. RESULTS: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child's birth. The majority of women (n=282-315, 82%-92%) "strongly agreed or agreed" that receiving information from CFHN via technology would be acceptable, and most (n=308) women "strongly agreed or agreed" with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). CONCLUSIONS: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days.

[Molecular profiling in biliary tract cancers: A national practice survey of French platforms]. / Portrait moléculaire dans les cancers des voies biliaires : enquête nationale de pratique auprès des plateformes françaises.

INTRODUCTION: Molecular profiling has become essential in the management of patients with biliary tract cancer (BTC). The aim of this study was to evaluate the practices of French genetics platforms in the management of BTCs. METHODS: A survey was developed by a multidisciplinary group and distributed to each of the 28 French genetics platforms over a one-month period. RESULTS: Twenty-one platforms answered the survey (75%). A majority (62%) had performed more than 50 analyses for BTCs over the last two years, with an average turnaround time for results evaluated between 11 and 15 days for 62% of them. Three quarters (76%) of the platforms performed both DNA and RNA analysis, while a quarter (24%) performed RNA analysis only. A commercial panel was used by 50% of platforms for DNA analysis, and 80% for RNA. Panels included between 10 and 50 genes for 76% of platforms. All responding platforms systematically tested for IDH1 mutations, FGFR2 fusions and BRAF mutations. A majority systematically tested for HER2 amplification, MSI status and TP53 mutation (88%, 81% and 69% respectively). DISCUSSION: This national survey of French genetics platforms shows good performance and compliance with recommendations for molecular analysis. However, many medical, financial and organizational obstacles remain upstream of these platforms.

Association between sleep duration and the risk of hyperhomocysteinemia among adults in the United States: National Health and Nutrition Examination Survey, 2005-2006.

The study aimed to discuss the association between sleep duration and the risk of hyperhomocysteinemia (Hhcy). This cross-sectional study included 4173 adults (≥ 20 years) from the National Health and Nutrition Examination Survey 2005-2006. According to their sleep duration, participants were divided into five subgroups. Multivariate logistic regression analysis models and restrictive cubic spline regressions were used to explore the association between sleep duration and the risk of Hhcy. Compared with the participants who sleep 7 h, sleep deprivation (≤ 5 h) increased the risk of Hhcy, odds ratio (OR) 1.68 (95% confidence interval (CI) 1.06-2.68); Excessive sleep (≥ 9 h) also increased the risk of Hhcy, OR 1.86 (95% CI 1.09-3.14) after adjusting for a series of confounding factors in the entire population. The risk of Hhcy was distributed in a U-shape with sleep duration. Similar results were demonstrated in obese populations. The association between sleep duration and the risk of Hhcy is U-shaped. Both sleep deprivation and excessive sleep can increase the risk of Hhcy.

The influence of recipe disaggregation in dietary assessment: results from the national food consumption survey in Saint Kitts and Nevis.

It is not always the case that recipe disaggregation is performed in dietary surveys. This investigation aimed to assess the influence of recipe disaggregation in the 2020-2021 national dietary survey in Saint Kitts and Nevis, and provide recommendations for future assessments. A total of 1,004 individuals provided information on their food consumption obtained using 24-h dietary recalls, and 442 recipes were reported. Some recipes were reported as single ingredients at the data collection stage (n = 65). In most cases, the respondent provided a standard recipe without disaggregation (n = 377). A simple and pragmatic recipe disaggregation methodology was developed. The procedure of recipe disaggregation comprised nine steps, including identifying recipes, ingredients, quantities, conversion factors, and the presence of visible fluid, among others. Seventy-eight non-disaggregated standard recipes were post-disaggregated (21% of recipes) to identify ingredient weights. Either the chi-square or Fisher's exact tests were applied to assess the significance of differences in frequency of food group consumption before and after disaggregation. The proportion of consumers across the different food groups increased dramatically for some food groups after recipe disaggregation, with significant differences (all p < 0.01) for cereals and their products (81.3% before and 94.7% after), eggs and their products (21.7% before and 34.6% after), fats and oils (6.9% before and 44.5% after), fish, shellfish and their products (26.7% before and 38.5% after), meat and meat products (59.7% before and 71.4% after), milk and milk products (30.4% before and 46.1% after), pulses, seeds, nuts and their products (18.6% before and 49.2% after), spices and condiments (34.0% before and 68.5% after, and vegetables and their products (49.9% before and 76.6% after). Consequently, most of the reported intakes in grams were also influenced across all food groups. Recipes are an important source of food consumption, and their disaggregation should be carefully considered in dietary assessment.

Preferences for albumin use in adult intensive care unit patients with shock: An international survey.

INTRODUCTION: Use of albumin is suggested for some patients with shock, but preferences for its use may vary among intensive care unit (ICU) physicians. METHODS: We conducted an international online survey of ICU physicians with 20 questions about their use of albumin and their opinion towards a randomised trial among adults with shock comparing the use versus no use of albumin. RESULTS: A total of 1248 respondents participated, with a mean response rate of 37%, ranging from 18% to 75% across 21 countries. Respondents mainly worked in mixed ICUs and 92% were specialists in intensive care medicine. The reported use of albumin in general shock varied as 18% reported 'almost never', 22% 'rarely', 34% 'occasionally', 22% 'frequently' and 4% 'almost always' using albumin. In septic shock, 19% reported 'almost never', 22% 'rarely', 29% 'occasionally', 22% 'frequently' and 7% 'almost always' using albumin. Physicians' preferences were more consistent for haemorrhagic- and cardiogenic shock, with more than 45% reporting 'almost never' using albumin. While the reported use of albumin for other purposes than resuscitation was infrequent (40%-85% reported 'almost never' for five other indications), the most frequent other indications were low serum albumin levels and improvement of the efficacy of diuretics. Most respondents (93%) would randomise adult ICU patients with shock to a trial of albumin versus no albumin. CONCLUSIONS: In this international survey, the reported preferences for the use of albumin in adult ICU patients with shock varied considerably among surveyed ICU physicians. The support for a future randomised trial was high.