Profile of paediatric occupational therapy practice in Eastern Mediterranean countries.

BACKGROUND: Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries. AIMS/OBJECTIVES: This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists' usage of evidence-based practice in their practice. MATERIAL AND METHODS: We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children. RESULTS: The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice. CONCLUSION: Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist. SIGNIFICANCE: Within the EM region, knowledge regarding therapists' practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey.

BACKGROUND: College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. OBJECTIVE: As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. METHODS: The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. RESULTS: More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=-5.97, P<.001) and perceived efficacy (t411=-4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (ß=3.81, P<.001), self-tracking health practices (ß=2.22, P=.03), and eHealth literacy (ß=24.29, P<.001). CONCLUSIONS: Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students.

Influential factors on disease activity in Crohn's disease and their Roc curve evaluation: a cross-sectional study.

OBJECTIVE: This study aims to investigate the factors influencing disease activity in patients with Crohn's disease (CD) and provide insights and references for the management and prevention of CD. METHODS: We recruited CD patients who met the inclusion and exclusion criteria and were treated at the First Affiliated Hospital of Soochow University from November 2022 to June 2023. Generalized linear mixed models were used to analyze the factors affecting disease activity in CD patients. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of these factors for disease activity. RESULTS: A total of 268 CD participants aged 18 to 65 were included in the study, with over 68% of them in remission or experiencing mild disease activity, indicating relatively good disease control. The results of the generalized linear mixed models showed that older age, absence of diabetes, high levels of physical activity, and a low dietary inflammatory index (DII) were protective factors for lower disease activity in CD patients (p < 0.05). ROC curve analysis demonstrated that physical activity level, age, and DII all had ROC areas greater than 0.6 in predicting disease activity in CD patients (p < 0.05). CONCLUSION: The factors influencing the disease activity of CD patients are numerous and should be given attention. CD patients who are younger, have low levels of physical activity, high DII, and have diabetes are at a higher risk of increased disease activity. By reducing or avoiding the mentioned risk factors and leveraging protective factors, it is possible to mitigate the disease activity of CD to some extent.

Burden of Wilson Disease among patients and care partners in the United States: results from a cross-sectional survey.

OBJECTIVE: This study assessed the burden of Wilson Disease (WD) among patients and care partners (WD-CPs) in the US and compared it to a US general population of adults (GPs) and care partners (GP-CPs). METHODS: This cross-sectional, self-reported survey included patients with WD and WD-CPs aged ≥18 years recruited through the Wilson Disease Association (WDA), while data for GPs and GP-CPs were obtained from the 2022 National Health and Wellness Survey. GPs and GP-CPs were propensity score matched (3:1) with WD patients and WD-CPs for demographics and health characteristics. Bivariate analysis evaluated differences in comorbidity burden and health-related outcomes of the WD cohorts compared to matched GP cohorts. RESULTS: Thirty-seven patients with WD and 53 WD-CPs completed the survey. Most patients reported some treatment burden (73.3%), experienced sleep problems (60%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared with matched GPs, patients with WD had a significantly higher mortality risk (p < .001) and reported greater rates of chronic liver disease, cirrhosis (both, p < .001), migraines (p = .032), non-alcoholic steatohepatitis (p = .004), sleep problems (p = .009) and HCP visits (p = .002). Most WD-CPs (75.5%) reported high burden of caring (mean ZBI-12 score, 26.5) and more negative impact on esteem than GP-CPs. CONCLUSION: This study highlights the burden of WD experienced by patients and WD-CPs, with patients experiencing high treatment burden, comorbidity burden and healthcare resource utilization, and WD-CPs experiencing high impact of caring, including impact on employment and self-esteem.

Wilson Disease (WD) is a rare genetic disorder that results from copper building up in the liver and the central nervous system. The management of WD has been consistent for the past 50 years. We surveyed patients with WD and family members of patients with WD ("care partners," hereby referred to as WD-CPs) residing in the US, to understand the burden of WD. We also used data from the 2022 National Health and Wellness Survey to compare patients with and WD-CPs to a sample of adults and care partners of adults in the general population (hereby referred to as GP and GP-CPs). The study found that the majority of the patients with WD reported some treatment burden (73.3%), experienced sleep problems (60.0%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared to GPs, patients with WD had a significantly higher risk of dying in the next 10 years and reported greater rates of other health conditions (chronic liver disease, cirrhosis, migraines, and non-alcoholic steatohepatitis), sleep problems, and visits to healthcare providers in the last 6 months. The majority of WD-CPs (75.5%) reported high burden of caring and more negative impact on their self-esteem than GP-CPs. Overall, this study highlights the burden of WD and suggests the need for more effective treatments that can reduce this burden.

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OBJECTIVES: To investigate the current status of delivery room transitional care management for very/extremely preterm infants in Shenzhen City. METHODS: A cross-sectional survey was conducted in November 2022, involving 24 tertiary hospitals participating in the Shenzhen Neonatal Data Network. The survey assessed the implementation of transitional care management in the delivery room, including prenatal preparation, delivery room resuscitation, and post-resuscitation management in the neonatal intensive care unit. Very/extremely preterm infants were divided into four groups based on gestational age: <26 weeks, 26-28+6 weeks, 29-30+6 weeks, and 31-31+6 weeks. Descriptive analysis was performed on the results. RESULTS: A total of 140 very/extremely preterm infants were included, with 10 cases in the <26 weeks group, 45 cases in the 26-28+6 weeks group, 49 cases in the 29-30+6 weeks group, and 36 cases in the 31-31+6 weeks group. Among these infants, 99 (70.7%) received prenatal counseling, predominantly provided by obstetricians (79.8%). The main personnel involved in resuscitation during delivery were midwives (96.4%) and neonatal resident physicians (62.1%). Delayed cord clamping was performed in 52 cases (37.1%), with an average delay time of (45±17) seconds. Postnatal radiant warmer was used in 137 cases (97.9%) for thermoregulation. Positive pressure ventilation was required in 110 cases (78.6%), with 67 cases (60.9%) using T-piece resuscitators and 42 cases (38.2%) using a blended oxygen device. Blood oxygen saturation was monitored during resuscitation in 119 cases (85.0%). The median time from initiating transitional care measures to closing the incubator door was 87 minutes. CONCLUSIONS: The implementation of delivery room transitional care management for very/extremely preterm infants in the hospitals participating in the Shenzhen Neonatal Data Network shows varying degrees of deviation from the corresponding expert consensus in China. It is necessary to bridge the gap through continuous quality improvement and multicenter collaboration to improve the quality of the transitional care management and outcomes in very/extremely preterm infants.

Assessment of Nursing Practice Environment and Its Influencing Factors: A Cross-Sectional Study at Shandong Province, Jinan.

Objective: To investigate the current nursing practice environment in Jinan, Shandong Province, and to identify the factors influencing the practice environment. Methods: This study is a cross-sectional study for nurses. From October to December 2022, using the clustering and stratified sampling methods, 2426 nurses from internal Medicine, Surgery, Obstetrics and Gynecology, Outpatient Department and Intensive Care Department of the Provincial Hospital of Shandong Medical University were selected and then investigated and analyzed using the revised Nurse Practice Environment Assessment Scale. Results: The overall mean evaluation of the practice environment scored 75.13±19.87, with a minimum value of 59.74 and a maximum value of 95.82. The items with higher scores were "the hospital has systematic training for new nurses", "the work system is perfect", and "the hospital can provide continuing education for nurses in accordance with the needs of their positions". The items with lower scores were "nurses enjoy legal benefits", "nurses have the opportunity to participate in hospital management decisions", and "nurses have the opportunity to participate in hospital internal management". The results of the multiple linear regression analysis of the factors influencing nurses' practice environment showed that gender, education, position, and years of work were independent influences on nurses' practice environment scores (p < 0.05), and they explained 48.127% of the variation in the total scores of the nurses' practice environment scale. The estimated values (ß) of sex, education, cheif nurse, nurses staff, work experience (year), and whether the only child variables were 3.141, 3.237, 2.713, 5.471, 2.074 and 0.732, respectively. Conclusion: The nurse practice environment still needs to be improved, mainly in terms of hospital management participation, human resource allocation and salary distribution system.

Status and Influencing Factors of Social Media Addiction in Chinese Workers: Cross-Sectional Survey Study.

BACKGROUND: Social media addiction (SMA) caused by excessive dependence on social media is becoming a global problem. At present, most of the SMA studies recruit college students as research participants, with very few studies involving workers and other age groups, especially in China. OBJECTIVE: This study aims to investigate the current status of SMA among Chinese workers and analyze its influencing factors. METHODS: From November 1, 2022, to January 30, 2023, we conducted an anonymous web-based questionnaire survey in mainland China, and a total of 5176 participants completed the questionnaire. The questionnaire included the Social Networking Service Addiction Scale, Maslach Burnout Inventory-General Survey scale, Mindful Attention Awareness Scale, as well as questionnaires regarding participants' social media use habits and demographic information. RESULTS: Through strict screening, 3468 valid questionnaires were included in this study. The main findings of this study revealed the following: the average SMA score of workers was higher (mean 53.19, SD 12.04), and some of them (393/3468, 11.33%) relied heavily on social media; there were statistically significant differences in SMA scores among workers in different industries (F14,3453=3.98; P<.001); single workers (t3106=8.6; P<.001) and workers in a relationship (t2749=5.67; P<.001) had higher SMA scores than married workers, but some married workers (214/3468, 6.17%) were highly dependent on social media; the level of SMA among female workers was higher than that of male workers (t3466=3.65; P<.001), and the SMA score of workers negatively correlated with age (r=-0.22; P<.001) and positively correlated with education level (r=0.12; P<.001); the frequency of using social media for entertainment during work (r=0.33; P<.001) and the frequency of staying up late using social media (r=0.14; P<.001) were positively correlated with the level of SMA in workers; and the level of SMA in workers was significantly positively correlated with their level of burnout (r=0.35; P<.001), whereas it was significantly negatively correlated with their level of mindfulness (r=-0.55; P<.001). CONCLUSIONS: The results of this study suggest that SMA among Chinese workers is relatively serious and that the SMA problem among workers requires more attention from society and academia. In particular, female workers, young workers, unmarried workers, highly educated workers, workers with bad social media habits, workers with high levels of job burnout, and workers with low levels of mindfulness were highly dependent on social media. In addition, occupation is an important influencing factor in SMA. Thus, the government should strengthen the supervision of social media companies. Medical institutions should provide health education on SMA and offer intervention programs for those addicted to social media. Workers should cultivate healthy habits while using social media.

Effects of kratom on driving: Results from a cross-sectional survey, ecological momentary assessment, and pilot simulated driving Study.

OBJECTIVES: Despite widespread kratom use, there is a lack of knowledge regarding its effects on driving. We evaluated the self-reported driving behaviors of kratom consumers and assessed their simulated-driving performance after self-administering kratom products. METHODS: We present results from: 1) a remote, national study of US adults who regularly use kratom, and 2) an in-person substudy from which we re-recruited participants. In the national study (N = 357), participants completed a detailed survey and a 15-day ecological momentary assessment (EMA) that monitored naturalistic kratom use. For the remote study, outcomes were self-reported general and risky driving behaviors, perceived impairment, and driving confidence following kratom administration. For the in-person substudy, 10 adults consumed their typical kratom products and their driving performance on a high-fidelity driving simulator pre- and post-kratom administration was evaluated. RESULTS: Over 90% of participants surveyed self-reported driving under the influence of kratom. Most reported low rates of risky driving behavior and expressed high confidence in their driving ability after taking kratom. This was consistent with EMA findings: participants reported feeling confident in their driving ability and perceived little impairment within 15-180 min after using kratom. In the in-person substudy, there were no significant changes in simulated driving performance after taking kratom. CONCLUSIONS: Using kratom before driving appears routine, however, self-reported and simulated driving findings suggest kratom effects at self-selected doses among regular kratom consumers do not produce significant changes in subjective and objective measures of driving impairment. Research is needed to objectively characterize kratom's impact on driving in regular and infrequent consumers.

Perceptions of Quality of Interprofessional Collaboration, Staff Well-Being and Nonbeneficial Treatment: A Comparison between Nurses and Physicians in Intensive and Palliative Care.

This study assessed differences in interprofessional collaboration, perception of nonbeneficial care, and staff well-being between critical care and palliative care teams. In six German hospitals, a staff survey was conducted between December 2013 and March 2015 among nurses and physicians in intensive and palliative care units. To allow comparability between unit types, a matching was performed for demographic characteristics of staff. N = 313 critical care and 79 palliative care staff participated, of which 72 each were successfully matched. Critical care nurses perceived the poorest overall quality of collaboration compared with critical care physicians and palliative care physicians and nurses. They also reported less inclusive leadership from attendings and head nurses, and the least collaboration on care decisions with physicians. They were most likely to perceive nonbeneficial care, and they reported the lowest levels of job satisfaction and the highest intention to leave the job. In partial correlations, aspects of high-quality collaboration were associated with less perceived nonbeneficial care and higher staff well-being for both critical care and palliative care staff. Our findings indicate that critical care teams could improve collaboration and enhance well-being, particularly among nurses, by adopting principles of collaborative work culture as established in palliative care.

Digital health and cardiovascular healthcare professionals in Portugal: Current status, expectations and barriers to implementation.

INTRODUCTION AND OBJECTIVES: Digital health (DH) is a broad concept, bringing together technology and healthcare, that is playing an increasingly important role in the daily routine of healthcare professionals (HCPs) and promises to contribute to the prevention and treatment of cardiovascular disease. There are no solid data on the position of Portuguese HCPs toward the implementation of DH in cardiovascular medicine. This national cross-sectional study aims to provide a snapshot of DH implementation in Portuguese cardiovascular HCP routines and to identify both expectations and barriers to its adoption. METHODS: An 18-question survey was created specifically for this study and distributed to 1174 individuals on the Portuguese Society of Cardiology mailing list. RESULTS: We collected 117 valid responses (response rate 10%). Almost all participants had smartphones and laptops, and two-thirds had tablets. Electronic medical information systems were the most used DH tool (84% of respondents) and were considered the most important for improving cardiovascular care. Implantable technologies (sensors and devices), telemedicine and social media were used by more than two out of three respondents and considered «very important¼ or «extremely important¼ by most of them. Most participants showed positive expectations regarding the impact of DH in cardiovascular medicine: 78% agreed that DH could improve health outcomes, 64% that it promotes health literacy and 63% that it could decrease healthcare costs. The top-rated barriers were patients' inability to use smartphones, limited access to electronic devices, and lack of legal regulation of DH. CONCLUSION: Most Portuguese cardiovascular HCPs had at least three electronic devices (mainly smartphones, laptops and tablets) and showed positive expectations regarding DH's current and future impact on cardiovascular medicine. Patient DH literacy, technology adoption, and DH regulation were identified as the most important barriers to increasing the adoption of DH tools in cardiovascular medicine.

Research on factors influencing Chinese parents' support for death education: a cross-sectional survey.

Objective: This study aims to explore the factors influencing Chinese parents' attitudes toward death education. Given the current lack of such education in China, this research is particularly significant. Death education is vital for shaping the values of young people and alleviating mental health issues, such as depression and suicidal tendencies. By identifying these influencing factors, this study seeks to provide guidance for policymakers and educators in promoting the development and widespread adoption of death education. Methods: To do so, a national cross-sectional quota sample of 12,435 Chinese parents was used. Borrowing from social-ecological theory, the researchers carried out multiple stepwise regression analyses to examine the individual, family, and social-level factors that shape the supportive attitudes of Chinese parents toward death education. Results: The findings revealed that at the individual level, parent (ß = 0.04, p < 0.001), education level (ß = 0.07, p < 0.001), and religious belief (ß = -0.02, p < 0.05) were significant predictors of Chinese parents' support for death education. Meanwhile, at the family and social level, average monthly household income (ß = 0.07, p < 0.001), family health (ß = 0.03, p < 0.05), family communication (ß = 0.02, p < 0.05), social support (ß = 0.15, p < 0.001), neighborhood relations (ß = 0.11, p < 0.001), and social network size (ß = 0.05, p < 0.001) were significant predictors of Chinese parents' supportive attitudes toward death education. Conclusion: Based on these findings, it is suggested that the relevant development, planning, publicity, and public welfare groups and government departments should promote death education, provide more social support, and encourage neighborhood harmony. As higher education and average monthly household income were found to significantly impact the support, the government should improve access to higher education and actively work to increase residents' income to facilitate the development of death education.

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria.

BACKGROUND: The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear. METHODS: This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice. RESULTS: The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes. CONCLUSIONS: According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services. TRIAL REGISTRATION: The study has not been registered as it did not include a direct medical intervention on human participants.

Variations in the Evaluation and Management of Vascular Rings: A Survey of American Clinicians.

Vascular rings are arterial malformations that lead to the compression of the trachea and/or esophagus. While "tight" rings often produce symptoms and require surgery, "loose" rings rarely produce symptoms. Given advances in fetal echocardiography, this diagnosis is now more often made prenatally. This poses a new conundrum in the management of asymptomatic patients, leading to practice variation and creating a target for clinical system improvement. Hence, we conducted this survey aiming to demonstrate the practice variation existing in current evaluation and management of these patients. An anonymous web-based survey was distributed to several listservs for pediatric cardiologists and pediatric cardiothoracic surgeons. Survey questions targeted respondent practice characteristics, testing obtained, and indications for testing or surgical referral. In total 61 responses were received, predominantly from pediatric cardiologists (95%) in the United States (97%). About 60% of clinicians reported frequently diagnosing patients with vascular rings by fetal echocardiogram, with only about 20% diagnosing them frequently on evaluation of symptoms. Computed tomography angiography and echocardiogram were the most common imaging modalities employed. Most clinicians obtained cross-sectional imaging at the time of diagnosis and referred to surgery once patients had at least occasional symptoms. Respondents demonstrated a low degree of agreement (Krippendorf's alpha 0.48). Few statistically significant patterns were identified between respondents based on their practice characteristics. This study identified significant variation between clinicians regarding the evaluation and management of vascular rings. Further research or expert opinions may help to standardize practice, saving costs and improving the quality of care for affected patients.

A Canadian survey of perceptions and practices related to ordering of blood tests in the intensive care unit.

PURPOSE: The ordering of routine blood test panels in advance is common in intensive care units (ICUs), with limited consideration of the pretest probability of finding abnormalities. This practice contributes to anemia, false positive results, and health care costs. We sought to understand practices and attitudes of Canadian adult intensivists regarding ordering of blood tests in critically ill patients. METHODS: We conducted a nationwide Canadian cross-sectional survey consisting of 15 questions assessing three domains (global perceptions, test ordering, daily practice), plus 11 demographic questions. The target sample was one intensivist per adult ICU in Canada. We summarized responses using descriptive statistics and present data as mean with standard deviation (SD) or count with percentage as appropriate. RESULTS: Over seven months, 80/131 (61%) physicians responded from 77 ICUs, 50% of which were from Ontario. Respondents had a mean (SD) clinical experience of 12 (9) years, and 61% worked in academic centres. When asked about their perceptions of how frequently unnecessary blood tests are ordered, 61% responded "sometimes" and 23% responded "almost always." Fifty-seven percent favoured ordering complete blood counts one day in advance. Only 24% of respondents believed that advanced blood test ordering frequently led to changes in management. The most common factors perceived to influence blood test ordering in the ICU were physician preferences, institutional patterns, and order sets. CONCLUSION: Most respondents to this survey perceived that unnecessary blood testing occurs in the ICU. The survey identified possible strategies to decrease the number of blood tests.

RéSUMé: OBJECTIF: La prescription à l'avance de tests sanguins de routine est courante dans les unités de soins intensifs (USI), avec une prise en compte limitée de la probabilité de découverte d'anomalies avant le test. Cette pratique contribue à l'anémie, aux résultats faussement positifs et aux coûts des soins de santé. Nous avons cherché à comprendre les pratiques et les attitudes des intensivistes pour adultes au Canada en ce qui concerne la prescription d'analyses sanguines chez la patientèle gravement malade. MéTHODE: Nous avons mené un sondage transversal à l'échelle nationale au Canada en posant 15 questions évaluant trois domaines (perceptions globales, commande de tests, pratique quotidienne), ainsi que 11 questions démographiques. L'échantillon cible était composé d'un·e intensiviste par unité de soins intensifs pour adultes au Canada. Nous avons résumé les réponses à l'aide de statistiques descriptives et présenté les données sous forme de moyennes avec écarts type (ET) ou de dénombrements avec pourcentages, selon le cas. RéSULTATS: Sur une période de sept mois, 80 médecins sur 131 (61%) ont répondu dans 77 unités de soins intensifs, dont 50% en Ontario. Les répondant·es avaient une expérience clinique moyenne (ET) de 12 (9) ans, et 61% travaillaient dans des centres universitaires. Lorsqu'on leur a demandé ce qu'ils ou elles pensaient de la fréquence à laquelle des tests sanguins inutiles étaient prescrits, 61% ont répondu « parfois ¼ et 23% ont répondu « presque toujours ¼. Cinquante-sept pour cent étaient en faveur de la réalisation d'une formule sanguine complète un jour à l'avance. Seulement 24% des personnes interrogées estimaient que la prescription de tests sanguins à l'avance entraînait fréquemment des changements dans la prise en charge. Les facteurs les plus souvent perçus comme influençant la prescription d'analyses sanguines à l'unité de soins intensifs étaient les préférences des médecins, les habitudes institutionnelles et les ensembles d'ordonnances. CONCLUSION: La plupart des répondant·es à ce sondage ont l'impression que des tests sanguins inutiles sont prescrits aux soins intensifs. L'enquête a permis d'identifier des stratégies possibles pour réduire le nombre de tests sanguins.

Association of altitude and frailty in Chinese older adults: using a cumulative frailty index model.

Objective: The population is aging exponentially and the resulting frailty is becoming increasingly evident. We aimed to explore the association between altitude and frailty, and to identify associated factors for frailty. Methods: This is a community-based cross-sectional survey. 1,298 participants aged ≥60 years from three different altitudes were included in the study. To quantify frailty, we constructed a frailty index (FI) and a frailty score (FS). The FI was divided into non-frailty, prefrailty, and frailty. The Odds Ratios and confidence intervals (ORs, 95%CIs) were used to evaluate the association between altitude and FI and FS in multivariate ordinal logistic regression and linear regression. Results: There were 560 (53.1%) participants in the prefrailty and 488 (37.6%) in the frailty group. The FS increased with higher altitude (P for trend <0.001). Multivariate ordinal logistic regression analysis revealed an association between altitude and frailty, OR = 1.91 (95% CI: 1.38-2.64) in mid-high altitude and 2.49 (95% CI:1.40-4.45) in high altitude. The same trend of association was found in the univariate analysis. The FS increased by 1.69 (95% CI: 0.78-2.60) at mid-high altitude and 3.24 (95%CI:1.66-4.81) at high altitude compared to medium altitude. Conclusion: The study indicates that high altitude exposure is an associated factor for frailty in older adults. This association become stronger with higher altitudes. As a result, it is essential to conduct early frailty screening for residents living at high altitudes.

Injury prevalence and associated factors among Japanese lacrosse collegiate athletes.

Context: Sports injuries have a substantial impact on athletes' performance and health. To reduce the risk of an injury occurring, the prevalence, localization, and severity need to be established. Objective: To examine the prevalence of sports injuries in collegiate lacrosse athletes. Design: Descriptive epidemiological study using online survey design. Setting: Japanese universities associated with UNIVAS. Participants: A total of 1,689 Japanese collegiate lacrosse athletes, 978 females and 701 males. Main outcome measures: Athletes were surveyed on the injuries within the previous year, their severity, localization, and onset characteristics. The support of an athletic trainer and its association with the odds of sustaining an injury was assessed. Factors related to injuries were explored. Results: One-year prevalence of injuries was 42%. Male sex, higher year at the university, and support from an athletic trainer were identified as factors related to higher odds of sustaining an injury and practicing at least 5 days per week was associated with lower odds of sustaining an injury. Conclusions: Male sex athletes, and athletes at the higher year at university are especially at risk of sustaining a lacrosse injury. The aspects of training (e.g., frequency, volume) should be investigated across the athlete development process to address these findings. Further investigation is needed to determine the extent to which the support of athletic trainers affects both the frequency and severity of injuries in lacrosse athletes.

Building citizen science intelligence for outbreak preparedness and response: a mixed-method study in nine countries to assess knowledge, readiness and feasibility.

INTRODUCTION: Citizen science (CS) is an emerging approach in public health to harness the collective intelligence of individuals to augment traditional scientific efforts. However, citizens' viewpoint, especially the hard-to-reach population, is lacking in current outbreak-related literature. We aim to understand the awareness, readiness and feasibility of outbreak-related CS, including digitally enabled CS, in low-income and middle-income countries. METHODS: This mixed-method study was conducted in nine countries between October 2022 and June 2023. Recruitment through civil society targeted the general population, marginalised/indigenous groups, youth and community health workers. Participants (aged ≥18 years) completed a quantitative survey, and a subset participated in focus group discussions (FGDs). RESULTS: 2912 participants completed the survey and 4 FGDs were conducted in each country. Incorporating participants' perspectives, CS is defined as the practice of active public participation, collaboration and communication in all aspects of scientific research to increase public knowledge, create awareness, build trust and facilitate information flow between citizens, governments and scientists. In Bangladesh, Indonesia, the Philippines, Cameroon and Kenya, majority were unaware of outbreak-related CS. In India and Uganda, majority were aware but unengaged, while in Nepal and Zimbabwe, majority participated in CS before. Engagement approaches should consider different social and cultural contexts, while addressing incentivisation, attitudes and practicality factors. Overall, 76.0% expressed interest in digital CS but needed training to build skills and confidence. Digital CS was perceived as convenient, safer for outbreak-related activities and producing better quality and quantity of data. However, there were concerns over non-inclusion of certain groups, data security and unclear communication. CONCLUSION: CS interventions need to be relatable and address context-specific factors influencing CS participation. Digital CS has the potential to facilitate collaboration, but capacity and access issues must be considered to ensure inclusive and sustainable engagement.

Aligning the principles and practice of research integrity and research fairness in global health: a mixed-methods study.

INTRODUCTION: In the past decade, global health research has seen a growing emphasis on research integrity and fairness. The concept of research integrity emerged in response to the reproducibility crisis in science during the late 2000s. Research fairness initiatives aim to enhance ownership and inclusivity in research involving partners with varying powers, decision-making roles and resource capacities, ultimately prioritising local health research needs. Despite extensive academic discussions, empirical data on these aspects, especially in the context of global health, remain limited. METHODS: To address this gap, we conducted a mixed-methods study focusing on research integrity and fairness. The study included an online frequency survey and in-depth key informant interviews with researchers from international research networks. The dual objectives were to quantify the frequency of practices related to research integrity and fairness and explore the determinants influencing these practices in global health. RESULTS: Out of 145 participants in the quantitative survey (8.4% response rate), findings indicate that global health researchers generally adhere to principles of research integrity and fairness, with variations in reported behaviours. The study identified structural, institutional and individual factors influencing these patterns, including donor landscape rigidity, institutional investments in relationship building, guidelines, mentoring and power differentials among researchers. CONCLUSION: This research highlights that, despite some variations, there is a substantial alignment between research integrity and fairness, with both sharing similar determinants and the overarching goal of enhancing research quality and societal benefits. The study emphasises the potential to explicitly recognise and leverage these synergies, aligning both agendas to further advance global health research.

Towards elimination of chronic viral hepatitis in French Polynesia: results from a national population-based survey.

Background: In French Polynesia, hepatitis B virus (HBV) infection appears as a major risk factor for hepatocellular carcinoma (HCC), which detection rate in the Austral archipelago is among the highest in the world. Through a nationally representative cross-sectional survey of the adult population, this study aimed at assessing the prevalence of HBV, but also hepatitis C virus (HCV), and hepatitis delta virus (HDV). Methods: A total of 1942 blood samples from participants aged 18-69 years were tested for anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, and HDV RNA. Complete genome sequencing of detected HBV strains was performed. Findings: Among participants, 315/1834, 582/1834, 33/1834, 0/1857, and 0/33 tested positive for anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, and HDV RNA, respectively. The population prevalence of HBsAg was estimated at 1.0% (95% CI: 0.6-1.7). All HBsAg carriers were born in French Polynesia before vaccination at birth became mandatory. In multivariate analyses, identified factors associated with HBsAg carriage included: the archipelago of residence (p < 0.0001), age (p < 0.0001), and education level (p = 0.0077). HBV genotypes B, C, and F were detected. Interpretation: French Polynesia has a low endemicity level of HBV and its population may be considered at low risk for HCV and HDV infection. However, prevalence of HBsAg was found concerning in Austral (3.8%; 95% CI: 1.9-7.5) and Marquesas (6.5%; 95% CI: 3.8-11) archipelagoes. In the Austral archipelago, the presence of genotype C may account for the elevated rate of HCC. Our findings warrant more efforts to improve access to detection, prevention and care to people born before the systematic vaccination policy application, and residing in higher-risk areas, to achieve HBV elimination in French Polynesia. Funding: Research Delegation of French Polynesia.

Association between urinary cobalt exposure and kidney stones in U.S. adult population: results from the National Health and Nutrition Examination Survey.

PURPOSE: Heavy metal exposure can cause impaired or reduced pathology in the kidneys, lungs, liver, and other vital organs. However, the relationship between heavy metal exposure and kidney stones has not been determined. The goal of this research was to determine the association between heavy metal exposure and kidney stones in a population of American adults in general. MATERIALS AND METHODS: We evaluated 29,201 individuals (≥20 years) from the National Health and Nutrition Examination Survey (NHANES). The association between heavy metal exposure and kidney stones was verified by multiple logistic regression and restricted cubic spline (RCS) regression. Dose-response curves were generated to analyze the relationship between heavy metal concentrations and the occurrence of kidney stones. Moreover, we used propensity score matching (PSM) to exclude the effect of confounding variables. RESULTS: After a rigorous enrollment screening process, we included 8518 participants. Logistic regression showed that urinary cadmium (U-Cd) and urinary cobalt (U-Co) concentrations were significantly different in the kidney stone group before PSM (p < 0.001). Dose-response curves revealed that the occurrence of kidney stones increased significantly with increasing U-Cd and U-Co concentrations. After adjustment for covariates, only biomarkers of U-Co were linked to the occurrence of kidney stones. When the lowest quartile was used as a reference, the 95% confidence intervals (95% CIs) for kidney stones across the other quartiles were 1.015 (0.767-1.344), 1.409 (1.059-1.875), and 2.013 (1.505-2.693) for U-Cos (p < 0.001). CONCLUSION: In the U.S. population, high U-Co levels are positively correlated with the potential risk of kidney stones.