Correction: Schuderer et al. Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions. J. Clin. Med. 2023, 12, 5206.

In the original publication by Schuderer et al., there was a mistake in Table 1 as published [...].

Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions.

In microvascular head and neck reconstruction, various factors such as diabetes, alcohol consumption, and preoperative radiation hold a risk for flap loss. The primary objective of this study was to examine the vessel morphology of both recipient and donor vessels and to identify predictors for changes in the diameters of H.E.-stained specimens associated with flap loss in a prospective setting. Artery and vein samples (N = 191) were collected from patients (N = 100), with sampling from the recipient vessels in the neck area and the donor vessels prior to anastomosis. External vessel diameter transverse (ED), inner vessel diameter transverse (ID), thickness vessel intima (TI), thickness vessel media (TM), thickness vessel wall (TVW), and intima-media ratio (IMR) for the recipient (R) and transplant site (T) in arteries (A) and veins (V) were evaluated using H.E. staining. Flap loss (3%) was associated with increased ARED (p = 0.004) and ARID (p = 0.004). Preoperative radiotherapy led to a significant reduction in the outer diameter of the recipient vein in the neck (p = 0.018). Alcohol consumption (p = 0.05), previous thrombosis (p = 0.007), and diabetes (p = 0.002) were associated with an increase in the total thickness of venous recipient veins in the neck. Diabetes was also found to be associated with dilation of the venous media in the neck vessels (p = 0.007). The presence of cardiovascular disease (CVD) was associated with reduced intimal thickness (p = 0.016) and increased total venous vessel wall thickness (p = 0.017) at the transplant site. Revision surgeries were linked to increased internal and external diameters of the graft artery (p = 0.04 and p = 0.003, respectively), while patients with flap loss showed significantly increased artery diameters (p = 0.004). At the transplant site, alcohol influenced the enlargement of arm artery diameters (p = 0.03) and the intima-media ratio in the radial forearm flap (p = 0.013). In the anterolateral thigh, CVD significantly increased the intimal thickness and the intima-media ratio of the graft artery (p = 0.01 and p = 0.02, respectively). Patients with myocardial infarction displayed increased thickness in the A. thyroidea and artery media (p = 0.003). Facial arteries exhibited larger total vessel diameters in patients with CVD (p = 0.03), while facial arteries in patients with previous thrombosis had larger diameters and thicker media (p = 0.01). The presence of diabetes was associated with a reduced intima-media ratio (p < 0.001). Although the presence of diabetes, irradiation, and cardiovascular disease causes changes in vessel thickness in connecting vessels, these alterations did not adversely affect the overall success of the flap.

Workforce participation, health and wealth inequality among older Australians between 2001 and 2015.

BACKGROUND: Australians born in 2012 can expect to live about 33 years longer than those born 100 years earlier. However, only seven of these additional years are spent in the workforce. Longer life expectancy has driven policies to extend working life and increase retirement age; the current Australian policy, which has increased the eligibility for the pension from 65 to 67 by 2023, assumes that an improvement in longevity corresponds with an improvement in healthy life expectancy. However, there is mixed evidence of health trends in Australia over the past two decades. Although some health outcomes are improving among older age groups, many are either stable or deteriorating. This raises a question of how health trends intersect with policy for older Australians aged from 50 to 70. This paper considers the interplay between older workers' health and workforce participation rates over the past 15 years when extended workforce participation has been actively encouraged. METHODS: We compared health and economic outcomes of the older people in following years with the base year (start of the study period), adjusting for some key socio-economic characteristics such as age, sex, ethnicity, education and equivalized household income by applying the Random effects estimator with maximum likelihood estimation technique. RESULTS: We find that regardless of increasing longevity, the health of older adults aged between 50 and 70 has slightly deteriorated. In addition, health gaps between those who were working into their older age and those who were not have widened over the 15-year period. Finally, we find that widening health gaps linked to workforce participation are also accompanied by rising economic inequality in incomes, financial assets and superannuation. With the exception of a small group of healthy and very wealthy retirees, the majority of the older Australians who were not working had low incomes, assets, superannuation, and poor health. CONCLUSIONS: The widening economic and health gap within older population over time indicates a clear and urgent need to add policy actions on income and health, to those that seek to increase workforce participation among older adults.

Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam.

OBJECTIVES: To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice. METHODS: An improvement bundle aligned to the QS was deployed using plan-do-study-act methodology in a 600 bed hospital in northern Vietnam from July 2018 to April 2019. Proposed care improvements included CURB65 score guided hospitalization, timely diagnosis and inpatient antibiotic treatment review to limit the spectrum and duration of IV antibiotic use. Interviews with medical staff were conducted to better understand the barriers for QS implementation. RESULTS: The study found that improvements were made in CURB65 score documentation and radiology results available within 4 h (P < 0.05). There were no significant changes in the other elements of the QS studied. We documented institutional barriers relating to the health reimbursement mechanism and staff cultural barriers relating to acceptance and belief as significant impediments to implementation of the standards. CONCLUSIONS: Interventions led to some process changes, but these were not utilized by clinicians to improve patient management. Institutional and behavioural barriers documented may inhibit wider national uptake of the QS. National system changes with longer term support and investment to address local behavioural barriers are likely to be crucial for future improvements in the management of CAP, and potentially other hospitalized conditions, in Vietnam.

Australian parents' work-family conflict: accumulated effects on children's family environment and mental health.

PURPOSE: Many parents struggle to balance their work and family responsibilities. Yet, little research in the field of social psychiatry has explored the emergence of work-family conflict (WFC) as an important social determinant of mental health, particularly for children. The current study used longitudinal Australian population-based data to investigate the impact of parents' accumulated experiences of work-family conflict on children's mental health. Levels of parent psychological distress, marital satisfaction and parenting irritability were examined as potential explanatory factors within the family environment. METHODS: The study used five waves of data from the Australian Longitudinal Study of Australian Children (LSAC), a representative community sample of Australian children and their parents. Analyses were restricted to coupled, employed mothers (1903) and fathers (1584) who reported their WFC levels in all five waves. Structural Equation Modelling (SEM) was used to examine the association between accumulated experiences of work-family conflict across all time-points (AWFC) and children's mental health at wave 5. Family environment factors were assessed as possible explanatory mediators. RESULTS: There was a significant association between AWFC and children's mental health at wave 5. Parent psychological distress, marital satisfaction and parenting irritability were all found to significantly explain this association (accounting for 66% of the total effect). CONCLUSIONS: Children whose parents have ongoing or accumulated difficulties managing their work and family responsibilities are more likely to have poorer mental health. This has important implications for family-friendly work arrangements and demonstrates the need to further understand the intergenerational impacts of parents' jobs on their children's psychological wellbeing.

Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital.

This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.

Drivers of Overweight/Obesity in 4-11 Year Old Children of Australians and Immigrants; Evidence from Growing Up in Australia.

Despite high overweight/obesity rates in children of Australian immigrants, the risk factors are unknown. We investigated behavioural risk factors and their association with overweight/obesity in 4-11 year-old children by immigrant status. We conducted cross-sectional and longitudinal analysis of 8 years data from the longitudinal study of Australian children. Immigrant children from low-and-middle-income-countries had higher overweight/obesity rates across all ages. These children had higher vegetables and sugar-sweetened-beverages intake, higher sedentary activities and lower organized-sports participation than immigrant children from high-income-countries or Australian-children. Organized-sports participation and screen-time converged to the Australian norms in 10-11 year-old boys, but not in girls. Preference for sedentary activities and screen-time explained the differences in overweight/obesity by maternal immigrant status in boys but not in girls. The difference in drivers of overweight/obesity amongst immigrant children from low-and-middle-income-countries suggest more nuanced age, sex and culturally sensitive preventive health messages for immigrants.

Parents' transitions into and out of work-family conflict and children's mental health: Longitudinal influence via family functioning.

The demands arising from the combination of work and family roles can generate conflicts (work-family conflicts), which have become recognized as major social determinants of mothers' and fathers' mental health. This raises the question of the potential effects on children. The current study of 2496 Australian families (7652 observations from children aged 4-5 up to 12-13 years) asks whether changes in children's mental health corresponds with changes in mothers' and fathers' work-family conflicts. Using longitudinal random-effect structural equation models, adjusting for prior child mental health, changes in work-family conflict were examined across four adjacent pairs of biennial data waves. Children's mental health deteriorated when their mother or father experienced an increase in work-family conflict, but improved when parents' work-family conflict reduced. Results held for mothers, fathers and couples, and the key pathways appear to be changes in children's relational environments. These results contribute new evidence that conflicts between the work-family interface are powerful social determinants of mental health which have an intergenerational reach.

Hour-glass ceilings: Work-hour thresholds, gendered health inequities.

Long workhours erode health, which the setting of maximum weekly hours aims to avert. This 48-h limit, and the evidence base to support it, has evolved from a workforce that was largely male, whose time in the labour force was enabled by women's domestic work and care giving. The gender composition of the workforce has now changed, and many women (as well as some men) combine care-giving with paid work, a change viewed as fundamental for gender equality. However, it raises questions on the suitability of the work time limit and the extent it is protective of health. We estimate workhour-mental health thresholds, testing if they vary for men and women due to gendered workloads and constraints on and off the job. Using six waves of data from a nationally representative sample of Australian adults (24-65 years), surveyed in the Household Income Labour Dynamics of Australia Survey (N = 3828 men; 4062 women), our study uses a longitudinal, simultaneous equation approach to address endogeneity. Averaging over the sample, we find an overall threshold of 39 h per week beyond which mental health declines. Separate curves then estimate thresholds for men and women, by high or low care and domestic time constraints, using stratified and pooled samples. We find gendered workhour-health limits (43.5 for men, 38 for women) which widen further once differences in resources on and off the job are considered. Only when time is 'unencumbered' and similar time constraints and contexts are assumed, do gender gaps narrow and thresholds approximate the 48-h limit. Our study reveals limits to contemporary workhour regulation which may be systematically disadvantaging women's health.

The impact of drought on the association between food security and mental health in a nationally representative Australian sample.

BACKGROUND: The association between food insecurity and mental health is established. Increasingly, associations between drought and mental health and drought and food insecurity have been observed in a number of countries. The impact of drought on the association between food insecurity and mental health has received little attention. METHODS: Population-based study using data from a nationally representative panel survey of Australian adults in which participants report behaviour, health, social, economic and demographic information annually. Exposure to drought was modelled using annual rainfall data during Australia's 'Big Dry'. Regression modelling examined associations between drought and three indicative measures of food insecurity and mental health, controlling for confounding factors. RESULTS: People who reported missing meals due to financial stress reported borderline moderate/high distress levels. People who consumed below-average levels of core foods reported more distress than those who consumed above the average level, while people consuming discretionary foods above the average level reported greater distress than those consuming below the threshold. In all drought exposure categories, people missing meals due to cost reported higher psychological distress than those not missing meals. Compared to drought-unadjusted psychological distress levels, in most drought categories, people consuming higher-than-average discretionary food levels reported higher levels of distress. CONCLUSIONS: Exposure to drought moderates the association between measures of food insecurity and psychological distress, generally increasing the distress level. Climate adaptation strategies that consider social, nutrition and health impacts are needed.

Synthesis of water-dispersible zinc oxide quantum dots with antibacterial activity and low cytotoxicity for cell labeling.

Typical photoluminescent semiconductor nanoparticles, called quantum dots (QDs), have potential applications in biological labeling. When used to label stem cells, QDs may impair the differentiation capacity of the stem cells. In this study, we synthesized zinc oxide (ZnO) QDs in methanol with an average size of ∼2 nm. We then employed two different types of polyethylene glycol (PEG) molecules (SH-PEG-NH2 and NH2-PEG-NH2) to conjugate ZnO QDs and made them water-dispersible. Fourier transform infrared spectroscopy spectra indicated the attachment of PEG molecules on ZnO QDs. No obvious size alteration was observed for ZnO QDs after PEG conjugation. The water-dispersible ZnO QDs still retained the antibacterial activity and fluorescence intensity. The cytotoxicity evaluation revealed that ZnO QDs at higher concentrations decreased cell viability but were generally safe at 30 ppm or below. Cell lines of hepatocytes (HepG2), osteoblasts (MC3T3-E1) and mesenchymal stem cells (MSCs) were successfully labeled by the water-dispersible ZnO QDs at 30 ppm. The ZnO QD-labeled MSCs maintained their stemness and differentiation capacity. Therefore, we conclude that the water-dispersible ZnO QDs developed in this study have antibacterial activity, low cytotoxicity, and proper labeling efficiency, and can be used to label a variety of cells including stem cells.

Transparent nanocomposites of high refractive index based on epoxy resin and TiO2 nanoparticle.

A stepwise sol-gel method for the synthesis of stable colloidal TiO2 using hydrolysis and condensation reactions of titanium tetraisopropoxide (TTP) was investigated. The surface modification was carried out using 3-glycidoxypropyltrimethoxysilane (GPTMS). The particle size range of the modified TiO2 observed by TEM was 3-8 nm. The nanocomposites based on an epoxy resin and the modified TiO2 showed strong UV absorption, but maintained high transmittance within the visible region. TEM images of the nanocomposites confirmed the homogenous and fine dispersion of the TiO2 nanoparticles in the epoxy resin. The refractive index of the nanocomposites increased linearly with increasing TiO2 content. With 60% TiO2 by weight, the transmittance and refractive index of the nanocomposite were 98.4% and 1.657, respectively.

Preparation and characterization of the transparent hybrids of silicone epoxy resin and titanium dioxide nanoparticles via sol-gel reactions.

In order to prepare transparent hybrid films of high refractive index, nanoparticles of TiO2 were prepared and dispersed in a silicone epoxy (SE) resin synthesized from diphenyl silane diol and [2-(3,4-epoxycyclohexyl)ethyl] trimethoxysilane by sol-gel reactions. It was found that amorphous TiO2 nanoparticles of about 5 nm modified with hexahydro-4-methyl phthalic anhydride [HMPA] were dispersed in the SE resin without agglomerations. The refractive index of the hybrids increased linearly with increasing the TiO2 contents. The hybrid containing 30 wt% of the TiO2 particles showed light transmittance of 94% at 450 nm and refractive index of 1.63. The fine dispersion of the TiO2 nanoparticles was attributable to the sol-gel reactions between the SE resin and TiO2 nanoparticles and the modification of the TiO2 particles with HMPA.

Effects of colloidal nanosilica on the rheological properties of epoxy resins filled with organoclay.

The rheological properties of epoxy resins filled with organoclay and colloidal nanosilica were investigated by employing a parallel plate rheometer in flow mode at 25 degrees C. Shear thickening and shear thinning behaviors were observed in the epoxy resins filled with a mixture of organoclay and colloidal nanosilica. Minima were observed in the relaxation time of the systems consisting of epoxy resins filled with organoclay and colloidal silica as the content of colloidal nanosilica was increased. It seems that the colloidal nanosilica increased the mobility of the filled epoxy resins and reduced the interactions between the silicate layers in the systems.

Autoimmune hepatitis: effect of symptoms and cirrhosis on natural history and outcome.

Although the natural history of autoimmune hepatitis (AIH) has been characterized, little is known about patients who present asymptomatically. Consequently, whether they require immunosuppressive therapy with its associated complications is unclear. To compare the natural history of asymptomatic AIH with symptomatic AIH, a large cohort of patients from a single center was examined. All patients with a clinical diagnosis of AIH were reassessed using the revised criteria of the International Autoimmune Hepatitis Group. Liver histology, response to therapy, and survival were assessed. Patients asymptomatic at presentation (n = 31) had lower serum aminotransferase, bilirubin, and immunoglobulin G (IgG) values at baseline. Half of the asymptomatic patients received no therapy, and their survival was no different from that of the total cohort. Ten-year survival was 80.0% (62.5%-97.5%) in the asymptomatic group and 83.8% (75.1%-92.6%) in the symptomatic patients (P = NS). Survival to liver-related endpoints at 10 years was similar in both groups: 89.5% (75.7%-100%) asymptomatic and 83.8% (75.1%-92.6%) symptomatic patients (P = NS). Patients with cirrhosis at baseline had poorer 10-year survival (61.9% [CI 44.9%-78.9%]) than those without cirrhosis at presentation (94.0% [CI 87.4%-100%]) (P = .003) regardless of whether they presented with symptoms or whether they received immunosuppressive therapy. In conclusion, patients with AIH who are asymptomatic at presentation have a good prognosis and may not require immunosuppressive therapy. Cirrhosis on initial liver biopsy portends a poor prognosis in all patients with AIH.

A household survey on morbidity and treatment of acute respiratory infections in communities in Vietnam

<p><b>OBJECTIVE</b>To ascertain the extent of under-utilization and insufficiency or inappropriateness in provision of health services as one of the possible causes of high mortality from pediatric pneumonia in pilot areas in Vietnam.</p><p><b>METHOD</b>The household survey on morbidity and treatment of acute respiratory infections, simple cough, and cold and pneumonia, was conducted in two communities with 10% sampling of the child population.</p><p><b>RESULTS</b>Both under-treatment of "fast breathing", a proxy for pneumonia, and over-treatment of simple cough and cold with antimicrobials by health workers, mothers, and private practitioners were common.</p><p><b>CONCLUSIONS</b>A household survey on morbidity and treatment was found to be useful to clarify actual practices in the treatment of acute respiratory infections in the community, which cannot be obtained by mere interview with health workers or mothers. Since a change of knowledge did not automatically lead to change of practice, the training of health workers, health education of mothers and provision of antimicrobials at village health stations would not guarantee improved practice of health workers and mothers. Therefore, constant supervision for health workers, continued health education of mothers and involvement of private practitioners are needed to improve the situation.</p>

A Household Survey on Morbidity and Treatment of Acute Respiratory Infections in Communities in Vietnam

Objective: To ascertain the extent of under-utilization and insufficiency or inappropriateness in provision of health services as one of the possible causes of high mortality from pediatric pneumonia in pilot areas in Vietnam. Method: The household survey on morbidity and treatment of acute respiratory infections, simple cough, and cold and pneumonia, was conducted in two communities with 10% sampling of the child population. Results: Both under-treatment of “fast breathing”, a proxy for pneumonia, and over-treatment of simple cough and cold with antimicrobials by health workers, mothers, and private practitioners were common. Conclusions: A household survey on morbidity and treatment was found to be useful to clarify actual practices in the treatment of acute respiratory infections in the community, which cannot be obtained by mere interview with health workers or mothers. Since a change of knowledge did not automatically lead to change of practice, the training of health workers, health education of mothers and provision of antimicrobials at village health stations would not guarantee improved practice of health workers and mothers. Therefore, constant supervision for health workers, continued health education of mothers and involvement of private practitioners are needed to improve the situation.