Reasons for Surgical Attrition Among Nonmetastatic Upper Gastrointestinal Cancer Patients: A Single Institutional Experience.

INTRODUCTION: Upper gastrointestinal (UGI) cancers require multidisciplinary treatment, but surgery provides the only potentially curative option. We sought to understand reasons for attrition before surgery within our regional hospital network. METHODS: We performed chart reviews of patients (age 18-80) with stage I-III UGI cancers (gastroesophageal junction, gastric, and hepatopancreatobiliary adenocarcinomas) in our multihospital cancer registry from 2015 to 2021. Our primary outcome was reasons for surgical attrition. Univariable analysis identified factors related to surgical attrition and the Kaplan-Meier method estimated overall survival based on surgery receipt. RESULTS: Seven hundred and ninety-two patients were included in our analysis, of whom 107 (13.5%) did not undergo curative surgery. Reasons for not undergoing surgery included medical comorbidities (30.8%), patient preference/nonmedical barriers (24.3%, which included: not interested without further explanation, worried about complications, nonadherence to appointments, insurance issues, did not wish for blood transfusion, lack of social support, preferring home care, and worried about recurrence), psychosocial (5.6%), progression while on neoadjuvant therapy or waiting for transplant (15.0% and 7.5%), poor performance status (3.7%), side effects of neoadjuvant therapy (3.7%), and death unrelated to treatment or unknown cause (9.4%). Nonsurgical management was not associated with race, socioeconomic status, or distance traveled for care. Survival was greatly improved for patients who underwent surgery (158 vs. 63 weeks, p < 0.05). CONCLUSION: Nearly one in seven patients (18-80 years old) with UGI cancers evaluated at our academic cancer center did not undergo surgical resection. Reasons for surgical attrition included potentially modifiable issues, and addressing these barriers could help overcome inequities in cancer treatment and survival.

A Qualitative Assessment of Reasons for Living and Dying in the Context of Feeling Trapped Among Adults in the United Kingdom.

OBJECTIVE: Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals' self-described RFL and RFD in the context of suicidal thinking and behaviors. METHOD: Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses. RESULTS: The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self. CONCLUSIONS: Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.

The study highlights the complex co-existence of reasons for dying and reasons for living.Reasons for living and dying should be explored in parallel in a therapeutic setting.The relative value placed on RFL/RFD by the individual should also be considered.

The First- and Second-Order Ethical Reasons Approach: The Case of Human Challenge Trials.

At the height of the Covid pandemic, there was much discussion in the literature about using human challenge trials (HCTs) to expedite the development of effective Covid-19 vaccines. Historically, reluctance to fully accept HCTs has largely been due to potential conflicts with the principle of nonmaleficence in bioethics. Only a few commentators have explored this topic in depth. In this paper, we claim that to address ethical concerns regarding HCTs, two types of ethical reasons should be identified and investigated: first-order reasons that can be given to claim that a practice in itself is in direct conflict with the principles of bioethics; and second-order reasons that take into consideration how a practice is carried out and its consequences. We argue that understanding these ethical reasons is crucial for guiding the implementation of HCTs. We investigate a first-order reason against HCTs when the practice is in conflict with the principle of nonmaleficence, and when it is not. Following this argument and assuming there is no first-order reason based on nonmaleficence that hinders using HCTs, we argue there may be second-order reasons to guide implementation of this practice, such as difficulty in obtaining informed consent; protection of the weaker party; and trust in the scientific enterprise.

Brief communication: reasons for non-adherence of co-trimoxazole prophylaxis therapy among people living with HIV in a resource-limited setting, Northern Ethiopia.

This study aimed to assess the prevalence and reasons for nonadherence to cotrimoxazole prophylaxis therapy. A cross-sectional study was conducted among people living with HIV attending Ayder Comprehensive Specialized Hospital. Data were collected through interviews and reviews of medical records. Binary logistic regression was employed to analyze factors associated with CPT nonadherence. Approximately two-thirds (65.5%) of the participants were non-adherent to co-trimoxazole prophylaxis therapy. The main reasons for non-adherence were side effects, pill fatigue and forgetfulness. Strategies to improve adherence to co-trimoxazole prophylaxis therapy should focus on the combined patient, clinical and medication related issues of people living with HIV.

Determining the Failure Rate of Direct Restorations-Chart Review versus Electronic Health Record Reports.

Amalgam and composite restorations are used to treat minor dental issues. University of Michigan, School of Dentistry Electronic Health Record (EHR) reports show a 2.31% failure rate for amalgam and 1.14% for composite. Our study aims to determine the true failure rates through manual EHR chart reviews. Patient data from the University of Michigan School of Dentistry were utilized-216 amalgam restorations from 2020 to 2022 and 350 composite restorations in 2021 were searched. We defined failure and retreatment as replacing a restoration with the same material and failure and alternate treatment as replacing restoration with an alternative treatment within one year. The failure rate refers to a combination of replacement with the same and alternative treatment material within one year. For Amalgam: 1.85% failed and were retreated; 7.87% failed and were received an alternate treatment. Composite: 9.71% failed and retreated; 2.86% failed and received alternate treatment. In total anterior composite: 10.5% retreated, 2.6% failed; posterior composite: 9.1% retreated, 3.0% failed. Our study revealed higher restoration failure rates than the reports extracted in the EHR. This highlights the need to foster a culture of precise documentation to align EHR reports with hand-search findings.

Standardized Reasons for Consultations on a French Telemedicine Platform.

Thirteen standardized reasons for e-visits were implemented in March 2024 on a French telemedicine platform to improve the analysis of needs in telemedicine, educate patients on what is possible in e-visit and adapt the offer. Patients could select 1 to 3 reasons for consultations among a list of 13 reasons. Our aim was to evaluate their impact on use of e-visits. The main reasons for consultations in teleconsultations were more linked to acute care, specifically involving a large majority of upper respiratory tract infections, back pain, and urinary tract infections. They were mostly concordant with the physician's conclusion and they may have simplified the preparation of the e-visits.

My Reasons for Living: A Descriptive Study of the Motives for Not Committing Suicide Among Patients Diagnosed With Schizophrenia.

Background and objective Reasons for Living (RFL) constitute a construct that enables identifying the reasons for not committing suicide. These reasons are based on significant aspects of life, on the commitment to some ideals which may inhibit the impulse of committing suicide. The present study aimed to explore the RFL in a sample of patients with chronic schizophrenia; analyze the association of RFL with the duration of illness, previous suicide attempts, hospitalizations, and schooling; and describe the potential differences between male and female patients in this context. Materials and methods A total of 94 patients with schizophrenia were assessed. The Reasons for Living Inventory (RFLI) was applied and a structured interview for clinical and sociodemographic data was performed to gather data. Frequencies and descriptive statistics were calculated, and Spearman's correlation analysis was employed. Results The mean score among the sample was 3.9, with 3.8 as the cut-off point under which the presence of suicide risk is significant. The RFLs indicated as most important by patients were those in the domains of Survival and Coping Beliefs and Responsibility to Family. Non-significant differences were observed between groups. An association was observed in terms of age, duration of illness, number of hospitalizations, and RFLI scores. Conclusions The sample in the present study obtained high scores in the RFL domain of Survival and Coping Beliefs and low scores in the domain of Fear of Suicide, reflecting a specific response pattern that contrasts with other high suicidal-risk populations. We suggest that this construct could represent a protective factor for schizophrenia patients, including chronic patients with previous suicide attempts and high hospitalization rates, which were common variables observed in our clinical sample.

Patterns of Dietary Supplement Use among GBT2Q Men and Non-Binary Individuals in Canada.

There is a lack of research regarding dietary supplement (DS) use among Gay, Bisexual, Transgender, Two-Spirit, Queer (GBT2Q) men and non-binary individuals, despite the higher prevalence of body image issues and societal pressure within this community. This study aimed to investigate patterns and predictors of DS use in this population, including types of DS used, sources of information, and reasons for DS use. A validated and anonymous online questionnaire was completed by 204 participants (52.5% men, 43.1% gay, mean age 29.34 + 6.77 years) across Canada, who were consuming DS at the time of the study. Analyses included descriptive statistics to characterize the sample based on gender, sexuality, age, ethnicity, and other demographic attributes, using Pearson's chi-square tests and multi-way cross-tabulation analyses. Additionally, regression analyses, including binary and logistic regressions, were employed to identify predictors of DS use. Data analysis concluded that vitamins/minerals (92.2%), proteins (84.3%) and carbohydrates (75.5%) were the most consumed types of supplements. Identifying as certain genders and sexualities was significantly associated with supplement preferences, such that men reported higher use of amino acids (p = 0.033) and non-vitamins/mineral antioxidants compared to individuals identifying as other genders (p = 0.006). Moreover, bisexual participants consumed amino acids (p = 0.043) and carbohydrates (p = 0.026) more frequently when compared to non-bisexual participants. The most listed reason for DS use was to improve immunity (60.3%), with health care professionals being listed as the source of information by most participants (51.0%). Findings from this study can serve as a foundation for further research in this area and can guide the formulation and implementation of adequate policies targeting this underserved population.

Do Reasons Matter? Navigating Parents' Reasons in Healthcare Decisions for Children.

Bioethics has dedicated itself to exploring and defending both reasons for and against certain aspects of clinical care, biomedical research and health policy, including what decisions must be made, who should make them, and how they should be made. In pediatrics, it's widely acknowledged that parents' reasons may matter pragmatically; attending to parents' reasons is important if we want to work with families. Yet the conventional view in pediatric ethics is that parents' reasons are irrelevant to whether a decision is permissible or impermissible according to accepted ethical standards. In this paper, we explore whether parents' reasons matter ethically and, if so, in what way and for whom. First, we clarify what we mean by 'reasons.' Second, we provide an overview of how reasons are typically treated in medical decision-making and pediatric ethics. Third, we analyze a hypothetical pediatric case to illustrate how changing reasons can transform ethical analyses, including by contributing to where and how clinicians and ethicists draw the boundaries intrinsic to common pediatric ethical frameworks. We push back against the conventional view and argue that parents' reasons matter ethically in several ways. We call for further research on the role of parents' reasons in clinical ethics deliberation.

Self-compassion and reasons individuals stop eating: An exploratory investigation.

BACKGROUND: Self-compassion is a prevalent factor that has been explored in eating behaviour and weight loss literature. The present study explored the potential relationship between self-compassion and reasons individuals stop eating. METHOD: Two hundred and eighty-three participants were recruited from social media platforms and a research participation scheme at a university in the West Midlands, UK, and completed questionnaires on self-compassion and reasons individuals stop eating. RESULTS: The findings suggested that self-compassion was negatively associated with decreased food appeal, self-consciousness, and decreased food priority, whilst being positively associated with physical satisfaction. CONCLUSION: Self-compassion plays a prevalent role in the reasons individuals stop eating, and future research should continue exploring the effect of self-compassion on eating behaviour regulation.

Reasons influencing the nurses' prioritization process while preventing and managing delirium: findings from a qualitative study.

BACKGROUND: Nurses play an important role in the prevention and management of delirium episodes. However, some studies have reported that not all interventions recommended are applied due to time and resource constraints, resulting in patients receiving less care than required because other patients and/or interventions are prioritised. The concept of prioritization is part of the broader concept of decision-making as the ability to choose between two or more alternatives to ensure patient safety. Understanding the reasons influencing the prioritization process in patients at risk or with delirium may inform interventions to prevent and/or minimise the unfinished nursing care. AIM: The purpose of this study was to explore the reasons that inform the prioritisation process among nurses when they are challenged to make decisions for patients at risk and with delirium. METHODS: A descriptive qualitative study performed according to the COnsolidated criteria for Reporting guidelines, in 2021. An intentional sample of nurses working full-time with older patients in medical, geriatric, and post-acute care facilities affiliated with the National Health System was involved. Semi-structured interviews were conducted and narratives thematic analysed. RESULTS: A total of 56 nurses (55.4% in internal medicine, 26.8% in geriatrics and 17.8% in post-acute/intermediate care) participated with an average age of 31.6 years. The reasons informing the prioritisation process while providing preventive or managerial interventions towards a patient at risk of or with delirium are set at three levels: (1) unit level, as reasons belong to the inadequacy of the 'Environment', the 'Human Resources', and the 'Organisation and Work Processes', (2) nurse's level, as issues in 'Competencies' and 'Attitudes' possessed, and (3) patient level, due to the 'Multidimensional Frailty'. CONCLUSION: Nurses caring for patients at risk of and with delirium face several challenges in providing care. To prioritise preventive and managerial interventions, it is essential to implement multilevel and multifaced organizational and educational strategies.

Characterizing zero-dose and under-vaccinated children among refugees and internally displaced persons in the Democratic Republic of Congo.

BACKGROUND: The Democratic Republic of Congo (DRC) has one of the highest numbers of un and under-vaccinated children as well as number of refugees and internally displaced persons (IDPs) in the world. This study aims to determine and compare the proportion and characteristics of zero-dose (ZD) and under-vaccinated (UV) children among refugees and IDPs in the DRC, as well as the reasons for incomplete vaccination schedules. METHODS: Data from a rolling vaccination coverage survey conducted from September 10, 2022, to July 03, 2023, among refugees and IDPs in 12 provinces of the DRC. ZD was defined as a child aged 12-23 months who had not received any dose of pentavalent vaccine DTP-Hib-Hep B (by card or recall) and UV as a child who had not received the third dose of pentavalent vaccine. The proportions of non and under-vaccination and the associated factors using a logistic regression model are presented for ZD and UV children. The reasons for non-vaccination of these children are described using the WHO-Immunization behavioral and social-drivers-conceptual framework and compared using Pearson's Chi2 test. RESULTS: Of 692 children aged 12 to 23 months included in the analysis, 9.3% (95% CI: 7.2-11.7%) were ZD and 40.9% (95% CI: 95%: 37.2-44.6%) UV. The Penta1/Penta3 drop-out rate was 34.9%. After adjustment, ZD children had a significant history of home or road birth. And UV children were significantly associated with mothers/caregivers being under 40, uneducated, farmers, ranchers, employed, rural residents, as well as with home or road births. Reasons linked to people's perceptions and feelings were cited much more often for ZD (50.0%) than for UV (38.3%). Those related to social reasons were cited much more often by ZD (40.6%) than by UV (35.7%). Reasons related to "programmatic and practical issues" were cited less for ZD (90.5%) than for UV (97.1%). CONCLUSIONS: ZD and UV children represent significant proportions in refugee and IDPs sites in the DRC. However, the proportion of ZD is less than for the entire country, while the proportion of UV is comparable, reflected in a very high drop-out rate. Similarly to studies in the general population in DRC, the reasons for ZD children were mainly linked to challenges in caregiver motivation to vaccinate, while for UV children, they were more often linked to pro-grammatic and practical problems of the health system.

The Democratic Republic of Congo (DRC) has one of the highest numbers of un and under-vaccinated children as well as number of refugees and internally displaced persons (IDPs) in the world. This study aims to determine and compare the proportion and characteristics of zero-dose (ZD) and under-vaccinated (UV) children among refugees and IDPs in the DRC, as well as the reasons for incomplete vaccination schedules. Data from a rolling vaccination coverage survey conducted from September 10, 2022, to July 03, 2023, among refugees and IDPs in 12 provinces of the DRC. ZD was defined as a child aged 12­23 months who had not received any dose of pentavalent vaccine DTP-Hib-Hep B (by card or recall) and UV as a child who had not received the third dose of pentavalent vaccine. The proportions of non and under-vaccination, the associated factors and reasons for non-vaccination are presented for ZD and UV children. Of 692 children aged 12 to 23 months included in the analysis, 9.3% (95% CI: 7.2­11.7%) were ZD and 40.9% (95% CI: 95%: 37.2­44.6%) UV. The Penta1/Penta3 drop-out rate was 34.9%. After adjustment, ZD children had a significant history of home or road birth. And UV children were significantly associated with mothers/caregivers being under 40, uneducated, farmers, ranchers, employed, rural residents, as well as with home or road births. Reasons linked to people's perceptions and feelings were cited much more often for ZD (50.0%) than for UV (38.3%). Those related to social reasons were cited much more often by ZD (40.6%) than by UV (35.7%). Reasons related to "programmatic and practical issues" were cited less for ZD (90.5%) than for UV (97.1%). ZD and UV children represent significant proportions in refugee and IDPs sites in the DRC. However, the proportion of ZD is less than for the entire country, while the proportion of UV is comparable, reflected in a very high drop-out rate. Similarly to studies in the general population in DRC, the reasons for ZD children were mainly linked to challenges in caregiver motivation to vaccinate, while for UV children, they were more often linked to pro-grammatic and practical problems of the health system.

Health status and visit reasons for children attending the Pediatric Dentistry department in damascus university, damascus, Syria: A retrospective study.

Objectives: This study aimed to discuss the health status and treatment requirements of children visiting the Department of Pediatric Dentistry at the Faculty of Dentistry. Materials and Methods: A retrospective study included the records of patients attending the Department of Pediatric Dentistry, from November 29, 2021, to December 14, 2023. Results: The study reviewed 2417 patient records, excluding 312. The majority of patients were primary school children aged 6 - <12, primarily from Rif-Dimashq governorate. About 18 % displayed negative behavior during examinations, and 8 % had special health care needs. The most frequent type of disability was medical disabilities, followed by neurological disorders, with percentages of 40.2 % and 28.9 %, respectively. Dental caries were the primary reason for visits, with a mean of 3.94 ± 3.13. A negative association was found between the number of decayed teeth and the following: age classification, visit year, and Salviov-Tinawi scale. The percentage of males who came for cosmetic problems was higher than females at 57.2 % and 42.8 %, respectively. Conclusions: The Department of Pediatric Dentistry at the Faculty of Dentistry, Damascus University, is a public dental clinic that is visited by patients from all governorates, providing free specialized treatments. Clinical relevance: Unmet dental needs are a significant issue for both healthy children and those with special health care needs. The Department of Pediatric Dentistry serves as a research and educational center, offering comprehensive dental treatments to children from all socioeconomic backgrounds. Therefore, understanding the dental needs of children is crucial for providing effective support.

Unraveling retraction dynamics in COVID-19 research: Patterns, reasons, and implications.

Amid the COVID-19 pandemic, while the world sought solutions, few scholars exploited the situation for personal gains through deceptive studies and manipulated data. This paper presents the extent of 400 retracted COVID-19 papers listed by the RetractionWatch database until the month of February 2024. The primary purpose of the research was to analyze journal quality and retractions trends. Evaluating the journal's quality is vital for stakeholders, as it enables them to effectively address and prevent such incidents and their future repercussions. The present study found that one-fourth of publications were retracted within the first month of their publication, followed by an additional 6% within six months of publication. One third of the retractions originated from Q1 journals, with another significant portion coming from Q2 (29.8%). An analysis of the reasons for retractions indicates that a quarter of retractions were attributed to multiple causes, predominantly associated with publications in Q2 journals, while another quarter were linked to data issues, primarily observed in Q1 publications. Elsevier retracted 31% of papers, with the majority published as Q1, followed by Springer (11.5%), predominantly as Q2. The study also examined author contributions, revealing that 69.3% were male, with females (30.7%) mainly holding middle author positions.

Self-Concordance Theory and the Goal-Striving Reasons Framework and Their Distinct Relationships With Hedonic and Eudaimonic Well-Being.

Self-concordance theory and the goal-striving reasons framework both measure the quality of people's reasons for their goal pursuits. Both have provided substantial evidence for their predictive power for people's well-being. However, it remains unclear which of the two goal-reason models is the better predictor for different forms of well-being. The paper analyses the distinct relationships of the two models in relation to hedonic well-being (Subjective Well-Being, Life Satisfaction, Affect Balance) and indicators of eudaimonic well-being (Basic Need Satisfaction, Purpose and Self-Acceptance). The findings are based on a cross-sectional, correlative research design based (N = 124). Using multiple regression analyses the results show that the goal-striving reasons framework is overall more strongly associated with hedonic and eudaimonic well-being. However, the differences for hedonic well-being as well as for self-acceptance and purpose are much larger than they are for the three basic needs of autonomy, competence, and relatedness. Here, self-concordance achieves nearly similar correlations to the goal-striving reasons framework. The findings have implications for theory and practice as they highlight the theoretical differences between the two goal-reasons models but also help to decide which Positive Psychology Interventions are most suitable to increase which form of well-being.

Reasons for disposal and cull cow value of Holstein cows compared with Holstein, Jersey, Montbeliarde, Normande, and Viking Red crossbred cows.

Cull cows from dairy farms in the United States account for 10% of the beef market; however, few studies have evaluated the effects of crossbreeding on reasons for disposal and cull value of dairy cows. The objective of the study was to compare reasons for disposal and cull cow value of Holstein and crossbred cows (n = 1,292) in an experimental dairy herd at the University of Minnesota West Central Research and Outreach Center, Morris, Minnesota. Cows were Holstein (n = 272), 1964 genetic control Holstein (n = 161), 3-breed crossbred cows (n = 538) composed of the Montbéliarde, Viking Red, and Holstein (MVH) breeds, and 3-breed crossbred cows (n = 321) composed of the Normande, Jersey, and Viking Red (NJV) breeds. The 1964 genetic control Holsteins cows originated from a design initiated at the University of Minnesota for comparison of the1964 Holstein and contemporary Holstein cows selected for production across time. Records spanned from January 2010 to December 2023. Reasons for disposal were recorded in PCDart Herd Management Software, and cull value and body weight were from receipts from livestock cull markets. For all cows, the primary reason for disposal was for reproduction (44.4%), mastitis (18%), other reasons (14.6%), died (10.3%), dairy purposes (8.4%), and low production (4.3%). Independent variables for statistical analysis of cull value were the fixed effects of body weight at time of culling, DIM at culling (0 to 49 DIM, 50 to 99 DIM, 100 to 149 DIM, 150 to 199 DIM, 200 to 249 DIM, 250 to 299 DIM, 300 to 350 DIM, and 350+ DIM), year (2010 to 2023), season (spring, summer, autumn, winter), parity (1, 2, 3, 4, 5+), primary reason for culling, breed group and sire breed group nested within breed group. Least squares means for bodyweight at culling was 558 kg for Holsteins, 543 kg for 1964 Holsteins, 551 kg for MVH crossbred cow, and 499 kg for NJV crossbred cows. For the analysis across time, 2014 had the highest cull value ($1,126.98) and 2020 had the lowest gross cull value ($515.21). Cows culled greater than 300 DIM had the highest cull value and cows culled less than 50 DIM had the lowest cull value. Cows culled during the spring and summer had higher cull value compared with cows culled during the autumn and winter. The Holstein cows ($730.04) had lower gross value compared with 1964 Holsteins ($804.38) cows and MVH ($767.39) cows. The NJV ($771.39) cows were not different from crossbreds sired by Montbeliarde, Viking Red, and Holstein bulls. Results for comparisons of breed group are from one experimental herd, so inferences to the wider dairy cow population should be undertaken with caution. In summary, dairy producers may receive greater cull value from crossbred cows compared with Holstein cows.

An Analysis of Referrals Done by Primary Care Centers to Tertiary Care Institutions.

Background and aim Primary care is an important element for every healthcare system around the world. Providing and optimizing the connection between the primary care centers and advanced clinical centers is a key concept for a well-functioning healthcare system. Our aim in this study was to analyze and review the referral data of primary care centers located in Ankara, Türkiye. Materials and methods We collected the entire referral data from the primary care centers, totaling 8,746 patients between January 1, 2019 and December 31, 2023 by using emergency medical services (EMS) transfer in Ankara. Demographic data, call reasons, transfer centers and transfer-related characteristics of the patients were recorded retrospectively, grouped by year, using EMS data. Results Our findings have shown that most of the referrals were made for Turkish citizens with 8,360 (95.6%) (p<0.001). Healthcare centers located in inner city had the most referrals made with 7,087 (81.0%) (p<0.001). Majority of the referrals were made by physicians in family healthcare centers with 6,583 (75.3%) (p<0.001) with chest pain being the most common diagnosis for referral initiation with 1,429 (16.3%) (p<0.001). This was followed by trauma, with 1,172 (13.4%) (p<0.001). Most common cause for trauma was falls with 613 (52.3%) (p<0.001). Conclusion Our data revealed important elements of local referral patterns. According to our data, majority of the referrals were made by inner city healthcare facilities. Family healthcare centers formed most of the referral requests. For this reason, strengthening these centers is important to prevent unnecessary resource use and delays.

Reasons for academic cheating in a cohort of nursing students in Saudi Arabia: a cross-sectional study.

This cross-sectional study investigated the reasons behind academic cheating in a cohort of nursing students in Saudi Arabia. The study involved 482 nursing students from two government universities in Riyadh. We used a newly developed self-reported questionnaire called the Reasons for Cheating Scale (RCS) to collect data. The highest-scoring reasons for academic cheating in the study population included the desire to obtain high grades, encouragement from friends to cheat, and the perception that exams were too difficult. Male students scored significantly higher than female students for reasons such as not understanding the course material, unclear test questions and instructions, pressure from families to excel, difficulty of the course material, and ignorance of effective study methods (P < 0.05). Age also had a role, as students aged 15-20 years had significantly higher scores for the item "Exams are too hard", whereas those aged ≥25 years had higher scores for "Difficulty of the course material" (P < 0.05). Additionally, students in the preparatory year had significantly higher scores than those in other years for reasons such as difficult exams, unclear test questions and instructions, fear of failing, difficulty of the course material, and the desire to please their families (P < 0.05). Overall, the desire to obtain high grades emerged as the main reason for academic cheating in our cohort of nursing students in Saudi Arabia. The findings suggest that sociodemographic characteristics, including sex, age, and academic year, should be considered when addressing the issue of cheating among nursing students.

Understanding the Reasons for Receiving HPV Vaccination among Eligible Adults in Italy.

BACKGROUND: This cross-sectional survey aimed to explore the reasons for receiving the HPV vaccination among eligible adults in Italy. METHODS: The survey was conducted from July 2023 to April 2024 in Naples, Southern Italy. RESULTS: A total of 282 questionnaires were collected. The majority of the respondents (73.2%) was aware that HPV vaccination was recommended and this was more likely among women, healthcare workers (HCWs) or students in health sciences, and those who had acquired information from physicians. The most frequently cited reasons for vaccinating were self-protection from the infection (77.6%) and from cervical/oral/penile/anal cancer (68.9%), knowing that the vaccination was free of charge (46.2%), awareness of the severity of the HPV disease (43%), to protect their partner (42.6%), and perception of being at risk (24.2%). Being HCWs or students in health sciences, believing that HPV infection could cause a serious disease, and having a higher number of oral intercourse experiences in the last year were significant predictors of the perception of being at risk. Female and Italian respondents were more likely to receive the HPV vaccination because it was effective in preventing cancer. CONCLUSIONS: Targeted educational programs and health interventions should be developed to ensure enhancing knowledge and fostering positive attitudes toward the HPV vaccination.