bluuebunny/crossref_metadata_2025 huggingface dataset:
Updating and calibrating the Real‐World Progression In Diabetes (RAPIDS) model in a non‐Veterans Affairs population
Authors: Basu Anirban , Montano‐Campos Felipe , Huang Elbert S. , Laiteerapong Neda , Barthold Douglas
Published: September 2024

Objectives

To present the Real‐World Progression In Diabetes (RAPIDS) 2.0 Risk Engine, the only simulation model to study the long‐term trajectories of outcomes arising from dynamic sequences of glucose‐lowering treatments in type 2 diabetes (T2DM).

Research Design and Methods

The RAPIDS model's risk equations were re‐estimated using a Least Absolute Shrinkage and Selection Operator (LASSO)‐based regularization of features that spanned baseline data from the last two quarters of current time and interactions with age. These equations were supplemented with estimates for the impact of dipeptidyl peptidase‐4 inhibitors, glucagon‐like peptide‐1 receptor agonists, and sodium‐glucose cotransporter‐2 inhibitor classes of drugs as monotherapies and their combinations with metformin based on newer trial data and comprehensive meta‐analyses. The probabilistic RAPIDS 2.0 model was calibrated (N = 25 000) and validated (N = 263 816) using electronic medical records (EMR) data between 2008 and 2021 from a national network of US healthcare organizations.

Results

The EMR‐based cohort had a mean age of 61 years at baseline, with 50% women, 70% non‐Hispanic White individuals and 20% non‐Hispanic Black individuals, and was followed for 17.5 quarters (range: 3–50). The final RAPIDS 2.0 risk engine accurately predicted the long‐term trajectories of all nine biomarkers and nine outcomes in the hold‐out validation sample. Similar accuracies in predictions were observed in each of the 14 subgroups studied.

Conclusion

The RAPIDS 2.0 model demonstrated valid long‐term predictions of outcomes in individuals with T2DM in the United States as a function of dynamic sequences of treatment use patterns. This highlights its potential to project long‐term comparative effectiveness between alternative sequences of glucose‐lowering treatment uses in the United States.
The association of type 2 diabetes‐related characteristics with fracture risk at different sites
Authors: van Hulten Veerle , Souverein Patrick C. , Starup‐Linde Jakob , Viggers Rikke , Klungel Olaf H. , Vestergaard Peter , Brouwers Martijn C. J. G. , van den Bergh Joop P. , Driessen Johanna H. M.
Published: September 2024

Aim

To determine the association of diabetes‐related characteristics with fractures at different sites in individuals with type 2 diabetes (T2D).

Materials and Methods

We conducted a cohort study using the Clinical Practice Research Datalink (CPRD) GOLD. Patients aged over 30 years with T2D were identified within the CPRD. Patients were followed from the start of diabetes treatment until the end of data collection, death, or the occurrence of a fracture. Cox proportional hazards models were used to estimate the hazard ratios for the association of the individual characteristics (diabetes duration, glycated haemoglobin [HbA1c] level, and microvascular complications) with fracture risk, adjusted for demographics, comorbidities and comedication.

Results

A diabetes duration of >10 years was associated with an increased risk of any fracture and major osteoporotic fractures (MOFs), while a diabetes duration of >8 years was associated with an increased hip fracture risk, compared to a duration <2 years. An HbA1c level <6% was associated with an increased fracture risk compared to HbA1c values of 6% to <7%. The presence of one or two microvascular complications was associated with an increased risk of any fracture and MOFs and the presence of two microvascular complications was associated with an increased hip fracture risk, compared to no microvascular complications.

Conclusion

In conclusion, our study shows that a diabetes duration of 10 years or more, strict glycaemic control resulting in HbA1c levels below 6%, and/or the presence of at least one microvascular complication increased the risk of any fracture, hip fractures, MOFs, and humerus fractures, but not ankle, scapula or skull fractures.
Beneficial effect of oral semaglutide for type 2 diabetes mellitus in patients with metabolic dysfunction‐associated steatotic liver disease: A prospective, multicentre, observational study
Authors: Arai Taeang , Atsukawa Masanori , Tsubota Akihito , Oikawa Tsunekazu , Tada Toshifumi , Matsuura Kentaro , Ishikawa Toru , Abe Hiroshi , Kato Keizo , Morishita Asahiro , Tani Joji , Okubo Tomomi , Nagao Mototsugu , Iwabu Masato , Iwakiri Katsuhiko
Published: September 2024

Aims

To evaluate the efficacy and safety of oral semaglutide for type 2 diabetes mellitus (T2DM) in patients with metabolic dysfunction‐associated steatotic liver disease (MASLD).

Materials and Methods

This was a single‐arm, multicentre, prospective study. Among 80 consecutive patients with MASLD and T2DM who newly received oral semaglutide, 70 completed 48‐week oral semaglutide treatment as scheduled and were included in an efficacy analysis. Dose adjustments of oral semaglutide were determined by each physician while monitoring efficacy and adverse events.

Results

Significant improvements in body weight, liver enzymes, lipid profile, and glycaemic control were found at 48 weeks compared with baseline values (all p < 0.01). Controlled attenuation parameter values significantly decreased from baseline to 48 weeks (p < 0.01). Changes in alanine aminotransferase concentrations (r = 0.37, p < 0.01) and controlled attenuation parameter values (r = 0.44, p < 0.01) were significantly correlated with changes in body weight. Liver fibrosis markers, such as type IV collagen 7S, Wisteria floribunda agglutinin‐positive Mac‐2‐binding protein, fibrosis‐4 index, and liver stiffness measurement, significantly decreased from baseline to 48 weeks (all p < 0.01). The most common adverse events were Grades 1–2 transient gastrointestinal symptoms, such as nausea (23 patients, 28.8%), dyspepsia (12, 15.0%) and appetite loss (4, 5.0%).

Conclusions

Oral semaglutide treatment for T2DM in patients with MASLD leads to an improvement in liver steatosis and injury, surrogate markers of fibrosis, diabetic status, and lipid profile, and reduces body weight.
The use of composite endpoints in cardiovascular outcome trials for diabetes: A review of 22 randomized clinical trials published since 2008
Authors: Kafai Yahyavi Sam , Kristensen Peter Lommer , Hjorthøj Carsten , Hansen Katrine Bagge , Krogh Jesper
Published: September 2024

Aim

To describe the use of composite endpoints (CEs) in cardiovascular outcome trials (CVOTs) of type 2 diabetes and to evaluate the significance of the individual outcomes included within these CEs from the perspectives of both patients and clinicians. Secondary objectives were to estimate the gradient of treatment effects and events across outcomes.

Materials and Methods

Eligible studies were randomized controlled trials assessing CV outcomes for patients with diabetes from 2008 and onwards. Trials were identified by searching the reports from the CVOT Summit of the Diabetes & CV Disease EASD (European Association for the Study of Diabetes) Study Group. The individual outcomes comprising the CE were compared for differences in importance for patients and clinicians, proportion of events, and effect size.

Results

We included 22 trials randomizing a mean of 8098 patients to an active intervention or a comparator group for an average of 33 months (standard deviation 16). All primary outcomes were CEs, and from a patient perspective there was no gradient of importance across outcomes in 22 of 22 (100%) CEs, while the gradient was small in 22 of 22 (100%) from a clinician perspective. The gradient of effect was moderate to large in 9 of 18 (50%) reporting studies, while assessment of events was available in 15 of 22 studies (68%), finding that three of 15 (20%) had a gradient of effect of more than 5% points between included outcomes. In 10 of 22 (45%) trial reports, the results were not clearly presented as based on a CE.

Conclusions

To avoid misinterpretation, clinicians and regulatory authorities should be careful when interpreting the results of trials, of which the main outcomes are CEs.
Is cardiac function associated with the clinical course of disease in patients with gout? A prospective study
Authors: Dong Yanni , Li Yiming , Liu Caijie , Guo Yingnan , Feng Yanhong
Published: September 2024

Objective

To analyze the function of the left heart in patients with different courses of gout, the independent influencing factors for left heart functional changes, and interactions between left atrial and left ventricular functions.

Methods

Patients with gout (n = 171) were selected; 87 patients with a disease course <10 years were included in Group I, and 84 patients with a disease course ≥10 years were included in Group II. Ninety‐four healthy volunteers comprised the control group.

Results

The intergroup differences in cardiac strain parameters were statistically significant (p < .05). Moreover, the differences gradually declined with disease progression. Multivariate logistic regression analysis showed that uric acid was an independent predictor of decreased left ventricular global longitudinal strain (LVGLS). Moreover, LVGLS had a positive effect on the left atrial systolic rate (LASr) and the left atrial systolic contraction time (LASct) but no interaction with the left atrial systolic contraction duration (LAScd).

Conclusion

The course of the disease significantly affected the function of the left heart in gout patients, and uric acid was observed to be an independent predictor of decreased LVGLS in gout patients.
Stronger aggregation reduces temperature sensitivity of soil organic carbon decomposition in croplands
Authors: Ma Chong , Duan Xun , Qiao Hang , Hu Yajun , He Xunyang , Wu Jinshui , Su Yirong , Chen Xiangbi
Published: September 2024

The temperature sensitivity (Q10) of soil organic C (SOC) decomposition is an important parameter to predict C dynamics under climate change. Given that SOC is mainly protected by aggregates and minerals, differentiating the Q10 of the two C fractions helps to explain bulk soil C dynamics. In the present study, we collected agricultural soils from adjacent paddy and upland areas in mid‐temperate (Mollisols) and subtropic (Ultisols) regions of China. We employed density fractionation to separate aggregate‐protected and free mineral‐associated C fractions of soil samples and determined the Q10 of SOC and the two C fractions at 15 and 25°C incubated conditions. Results showed that the Q10 of SOC for Mollisols were lower than that for Ultisols, with an exception of aggregates in upland soils. Aggregate‐protected C had lower Q10 than free mineral‐associated C, except in the upland Mollisols. The Q10 of SOC was negatively correlated with the proportion of C protected in aggregates, whereas it was positively correlated with the proportions of mass or C of free minerals. Given that the mass and C proportion of aggregates in bulk soils of Mollisols were 271% and 80% higher than of Ultisols, respectively, the SOC of Mollisols exhibited lower Q10 than Ultisols. Therefore, stronger soil aggregation and higher proportion of aggregate‐protected C contributed to the lower temperature sensitivity of SOC in Mollisols. Consequently, agricultural practices aimed at promoting soil aggregation will alleviate SOC loss under future global warming scenarios.
Tree species identity affects soil P bioavailability by altering labile organic P after tree mixing in subtropical China
Authors: Deng Piaoyun , Zhou Yunchao , Tang Fenghua , Chen Wensha
Published: September 2024

Converting monocultures to mixed plantations has been emphasized to improve ecosystem productivity and services. However, the impact of tree species identity on phosphorus (P) bioavailability in acidic soils in subtropical China, where P is relatively scarce, is not fully understood. This study explored the changes in soil biologically‐based P fractions and the effect of mineral and microbial properties on P transformation after mixing five broadleaved trees (Bretschneidera sinensis, Manglietia conifera, Cercidiphyllum japonicum, Michelia maudiae and Camellia oleifera) individually with coniferous trees (Pinus massoniana). The results showed that most mixed plantations significantly increased pH and citric acid and decreased exchangeable Fe3+ and Al3+ and the activation of Fe and Al oxides compared with monospecific plantations, which significantly reduced P precipitation and adsorption. Mixed planting significantly increased phosphatase activity and altered the community composition of P‐mobilizing bacteria carrying phoD and pqqC genes, which contributed to organic P mineralization and inorganic P (Pi) desorption. Mixed planting increased microbial biomass and the relative rate of microbial biomass P turnover. Labile organic P (Enzyme‐P) was a potentially significant source of soluble Pi (CaCl2‐P) among the biologically‐based P fractions, plus microbial biomass P. Overall, introducing broadleaved species, especially in species (e.g. Cercidiphyllum japonicum, Michelia maudiae and Camellia oleifera) with relatively high litter quality and belowground secretions (e.g. citric acid, phosphatase), significantly increased the solubilization of recalcitrant Pi (HCl‐P), desorption of chemisorbed Pi (Citrate‐P) and accumulation and mineralization of Enzyme‐P, thereby increasing the available P pools. Redundancy analysis demonstrated that P fractions were mainly driven by phosphatases, exchangeable cations, floor fresh litter lignin/N and citric acid. Altogether, we highlight the importance of choosing tree species mixtures that have synergistic or complementary effects when constructing mixed plantations in order to alleviate soil P limitations.
Education for fatigue management in people with multiple sclerosis: Systematic review and meta‐analysis
Authors: Wendebourg Maria Janina , Poettgen Jana , Finlayson Marcia , Gonzalez‐Lorenzo Marien , Heesen Christoph , Köpke Sascha , Giordano Andrea
Published: September 2024

Background and Purpose

Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS‐related fatigue.

Methods

This was a systematic review and meta‐analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue.

Results

In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS‐related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy‐conservation‐based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow‐up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference −0.28; 95% confidence interval −0.53 to −0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference −0.21; 95% confidence interval −0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long‐term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses.

Conclusion

Educational interventions for people with MS‐related fatigue may be effective in reducing fatigue in the short term. More research is needed on long‐term effects and the importance of specific intervention components, delivery and context.
Analysis of fracture modes and acoustic emission characteristics of low‐frequency disturbed coal rock bodies with different cyclic amplitudes
Authors: Liang Bin , Wang Dong , Jiang Yujing , Luan Hengjie , Liu Jiankang , Wang Jianlong
Published: September 2024

Frequent mining operations significantly disturb the security of deep weakly cemented rock roadways in western mining areas, constituting one of the primary causes of deformation, instability, and failure within the coal‐rock body. In this paper, dynamic uniaxial compression tests of soft rock‐coal combinations under low‐frequency disturbance with different cyclic amplitudes were conducted based on acoustic emission to elucidate fracture modes. The findings are as follows: Different cycle amplitudes manifested significant degradation effects on the soft rock‐coal combination. With increasing cycle amplitude, the proportion of tensile cracks initially decreased before subsequently increasing, demonstrating a general upward trajectory. The sudden increase in the acoustic emission RA value, the large decrease in the b‐value, and AE counts reaching the peak mean that failure and destabilization of the specimen begin to occur. The results of this study will furnish theoretical direction for dynamic disaster monitoring and early warning in soft rock mines located in western mining regions.
Feeding habits of splendid alfonsino Beryx splendens in the vicinity of Kuroshio, the south of Japan
Authors: Kodama Taketoshi , Ishii Koichi , Horii Sachiko , Gonda Natsuki , Yonezawa Junji , Ando Kazuto , Takahashi Kazutaka
Published: September 2024

Gut contents and nitrogen isotope ratio (δ15N) analyses were conducted on splendid alfonsino Beryx splendens collected in the vicinity of Kuroshio from May 2015 to November 2016 (n = 708) to identify their feeding habits in the Western North Pacific. Micronektonic fish, shrimp, and squid were the dominant prey species, with the Decapoda Acanthephyra quadrispinosa, Prehensilosergia prehensilis, Cephalopoda Enoploteuthis chunii, Chiroteuthis calyx, Teleostei Sigmops gracilis, and Gonostoma elongatum. These micronektons are common in the Kuroshio Current; thus, B. splendens is a possible opportunistic feeder. Gut content weight (GCW), occurrence (%O) of fish and squid, and δ15N were significantly increased with the fork length (FL) of B. splendens. Only the %O of shrimp does not show a significant relationship with the FL of B. splendens. These indicated the ontogenetic shift of dominant prey from shrimp to fish. Fattened specimens could also prey on a greater number of fish. The seasonality of GCW and %O values was high in spring and autumn and low in summer and winter. This seasonality indicated that the feeding habits of B. splendens are controlled by primary productivity in the surface layer and/or by maturity. When the Kuroshio flowed in the north of Hachijojima Island, the GCW was significantly increased, and some organisms, including C. calyx, G. elongatum, and S. gracilis, were preyed on more. While the offshore area of the Kuroshio has low productivity, B. splendens can actively prey in this area, indicating that it is an important feeding ground for this species.
Survey of General Practitioner Perspectives on Endometriosis Diagnosis, Referrals, Management and Guidelines in New Zealand
Authors: Ellis Katherine , Meador Alina , Ponnampalam Anna , Wood Rachael
Published: September 2024

Introduction

There is a growing body of literature concerning endometriosis patients' perspectives on the healthcare system and endometriosis care in New Zealand. However, there is little research available on the perspectives of general practitioners (GPs) internationally, and none currently in New Zealand. The purpose of this study is to address New Zealand GPs' understanding of and approach to endometriosis diagnosis, referrals, management and guidelines.

Methods and Materials

An online, anonymous survey was shared with 869 GP clinics and completed by 185 New Zealand‐based GPs regarding their awareness and application of the inaugural 2020 ‘Diagnosis and Management of Endometriosis in New Zealand’ guidelines, their perception of their endometriosis knowledge, the diagnostic value they assign to symptoms, the treatments they recommend and the reasons they refer patients to specialist gynaecologists. Differences between groups were conducted using Chi‐squared tests, and text answers were assessed thematically using inductive, semantic coding.

Results

All 185 GPs had gynaecology consults, and 73% had gynaecology consults every week. Despite 65% being aware of the 2020 guidelines, only 35% overall had read them. Only 52% of GPs considered themselves to know enough about endometriosis for their routine practice. The most common treatment to be considered first line was intrauterine contraceptive devices (IUDs; 96%), whereas the most common alternative treatment recommended was exercise (69%). The most common reason for referral to specialist care was the failure of all attempted treatments (84%).

Conclusions

Many of the study's results align with current New Zealand and international endometriosis guidelines, particularly the prioritisation of progestin‐only therapies, the reduced emphasis on surgical treatment as the first line and the low rates of alternative treatment recommendations. This study also highlights the need to improve awareness of inappropriate GP recommendations, including long‐term treatment with prescription‐only pain relief such as codeine and pregnancy for symptomatic relief.

Patient or Public Contribution

Two of the authors involved in the design and conduct of the study, data interpretation and manuscript preparation have sought care for endometriosis.

Trial Registration

NA
Fermented fruits and legumes in Africa: production factors and health benefits
Authors: Ashaolu Tolulope Joshua
Published: September 2024

Fermentation is an age‐long food processing tool used to preserve and develop functional foods and beverages. Fruits in particular have a very short shelf life due to their high water activity, favourable to microbial decomposition and spoilage, while legumes are protein‐rich crops that require improved protein digestibility. These are some standout reasons for applying this tool to develop fermented fruit‐ and legume‐based products. From multifarious fruit‐based beers, non‐alcoholic beverages and alcoholic drinks to legume‐based condiments and meals, fermentation has been used over time in Africa to enhance the food security, safety, nutrition, healthfulness and livelihoods of the people. As the nutrition and economic prospects of African fermented fruit‐ and legume‐based products are huge not only to the African continent but globally (as African diasporans and their interracial friends, spouses and relatives are notably consuming them), they are fraught with opportunities and challenges. This review describes the production factors (including raw material selection, processing techniques, environmental conditions and the role of microorganisms) and health benefits of these African fermented products. Safety concerns, fermentation challenges and other considerations are also discussed. Further studies targeting fermentation and production of novel, healthy and safer fruit‐ and legume‐based African food products are warranted due to their potential positive contribution to African and global hunger and malnutrition issues.
Factors influencing the reporting of medication errors and near misses among nurses: A systematic mixed methods review
Authors: Braiki Raouaa , Douville Frédéric , Gagnon Marie‐Pierre
Published: September 2024

Aim

This study aimed to systematically review empirical evidence on factors influencing nurses to report medication errors and near misses.

Background

There is underreporting of medication errors among nurses, in particular among novice and beginner nurses. To improve quality of care, factors influencing the reporting of medication errors and near misses should be documented.

Method

A systematic mixed methods review was conducted. CINAHL, Cochrane Collaboration, Embase, Medline, PsycINFO and Web of Science databases were explored and analysed from December 1990 to December 2023. Two reviewers independently selected and extracted data using a standardized data extraction grid. Data were analysed using thematic analysis based on the adapted theory of planned behaviour.

Results

Forty‐two studies met the eligibility criteria. Principal factors influencing the reporting of medication errors and near misses among nurses were associated with perceived behavioural control, subjective norm and attitude. Few studies examined factors influencing reporting medication errors and near misses among novice and beginner nurses, and sociodemographic and professional factors.

Conclusion

To understand factors influencing reporting of medication errors and near misses, further studies should be conducted to investigate sociodemographic and professional factors.
Effect of Indo‐Mediterranean diet versus calorie‐restricted diet in children with non‐alcoholic fatty liver disease: A pilot randomized control trial
Authors: Deshmukh Aniket , Sood Vikrant , Lal Bikrant Bihari , Khanna Rajeev , Alam Seema , Sarin Shiv Kumar
Published: September 2024

Background

Dietary interventions and increased physical activity are the cornerstones for management of the paediatric non‐alcoholic fatty liver disease (NAFLD). Though, no specific diet has been proven superior, Indo‐Mediterranean diet (IMD) has shown promise in adult literature. Thus, we aimed to compare the effect of IMD and a standard calorie‐restricted diet (CRD) in Indian overweight children and adolescents with biopsy‐proven NAFLD.

Methods

Thirty‐nine consecutive biopsy‐proven NAFLD children between the ages of 8 and 18 years were randomized into either IMD or CRD for 180 days, and various parameters were evaluated at baseline and then after 180 days (NCT05073588).

Results

A total of 34 subjects (18 in IMD and 16 in CRD group) completed the study. There was a significantly higher decrease in controlled attenuation parameter (CAP) values (as a marker of hepatic steatosis; on transient elastography) (95% CI: 4.2–73.4, p = 0.042), weight (95% CI: 0.75–5.5, p = 0.046) and body mass index (BMI) (95% CI: 0.21–2.05, p = 0.014) (but not in Pediatric NAFLD Fibrosis Index or PNFI; as a marker of hepatic fibrosis) in IMD group compared to the CRD group. Liver stiffness measurement, serum cholesterol and low‐density lipoprotein levels and HOMA‐IR decreased only in the IMD group (p < 0.001). Our statistical model showed that delta‐Weight was the only independent variable associated with delta‐CAP.

Conclusion

Both IMD and CRD can improve the various anthropometric, clinical, imaging and biochemical parameters but IMD was superior to CRD in terms of reducing CAP values and weight/BMI over 180 days in overweight/obese NAFLD children.
Exploring the Pathways to Diagnosis for Men With Borderline Personality Disorder: A Qualitative Study
Authors: Broadbear J. H. , Bhagwandas M. G. , Crowley S. , Cheney L. , Rao S.
Published: September 2024

Borderline personality disorder (BPD) is often perceived as being more common in females, since women are more likely to seek help and be diagnosed. However, epidemiological studies have reported no sex differences in community prevalence. The purpose of this study was to learn from the narrative journeys of men who have received a diagnosis of BPD. Eight men participated, mean age 45.9 years (range 27–73 years). Recruitment was through clinician referrals at the study site and via social media and website advertising. Participants consented to a 60–90‐min semi‐structured interview via an audio‐visual digital platform. Audio recordings were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three themes were identified: (i) The Emergence of Symptoms, (ii) Reaching Crisis Point and (iii) Receiving a Diagnosis. Participants reported many adverse experiences during childhood and adolescence. Early symptoms were often exacerbated by emotionally invalidating caregiving. Participants reported seeking mental health support only after reaching a crisis point, which often arose following an employment‐related stressor. Participants typically initiated help‐seeking by consulting a General Practitioner. Long delays were reported from initial help‐seeking to being diagnosed with BPD; all expressed relief upon diagnosis. The findings highlight the deleterious consequences of emotional invalidation in participants' mental health and their capacity to access timely support. General Practitioners play a critical role in identifying probable symptoms of BPD in men and are the gateway to referral to psychiatrists and psychologists. It is vital that education is provided to assist their important work.
Evaluating Saudi Arabian nurses’ willingness to respond to nuclear and radiological disasters
Authors: Shubayr Nasser
Published: September 2024

Aim

We evaluated Saudi Arabian nurses’ willingness to engage in nuclear and radiological disaster response.

Background

In the face of rising nuclear and radiological threats, it is essential that nurses are fully prepared to handle the health consequences of such emergencies. As frontline responders, nurses play a critical role in managing high‐stakes situations, making their readiness a key factor in ensuring public safety during these crises.

Methods

A cross‐sectional survey was conducted among 612 registered nurses in Saudi Arabia. The survey used a structured questionnaire based on the theory of planned behavior, identifying behavioral intentions as the primary outcome and attitudes toward these behaviors, subjective norms, and perceived behavioral control as influencing factors. The data were analyzed using descriptive and inferential statistics.

Results

Most respondents lacked specialized training and reported strong behavioral intentions. Attitude and perceived behavioral control were key drivers of these behavioral intentions, with less impact from subjective norms. Behavioral intentions were also shaped by education, the perceived likelihood of nuclear and radiological emergencies in their region, peer influence, perceived self‐efficacy, and family concerns. Younger and married nurses showed significantly stronger behavioral intentions.

Discussion

Although most nurses lacked specialized training, their strong engagement intentions and positive responses to active learning and training indicate a desire to close this gap through further education. However, inadequate institutional support, trouble communicating with family, and concerns about personal radiation exposure emerged as potential barriers.

Conclusion

Targeted educational initiatives and support systems are needed to enhance nurses’ confidence, competence, and willingness to engage in radiological and nuclear emergency scenarios.

Implications for nursing and health policy

Policymakers should prioritize the development of specialized training programs and support mechanisms for nurses, ensuring they are adequately prepared to respond effectively to increasing radiological and nuclear threats.
Continuous muscle pump activation by neuromuscular electrical stimulation of the common peroneal nerve in the treatment of patients with venous leg ulcers: A position paper
Authors: Stacey Michael C. , Sibbald R. Gary , Evans Robyn
Published: September 2024

The standard treatment for patients with confirmed Venous Leg Ulcers (VLUs) is compression therapy to improve the function of the calf muscle pump. There is a significant cohort of patients who are unable to tolerate optimal compression therapy or indeed any level of compression therapy. In addition, there is a cohort of patients who can tolerate compression whose ulcers show little or no evidence of healing. There is a need for ways to further improve calf muscle pump function and to improve venous ulcer healing in these patients. Published data were reviewed on the use of Muscle Pump Activation (MPA) using common peroneal nerve neuromuscular electrical stimulation (NMES) to improve calf muscle pump function. There is physiological evidence that MPA can improve calf muscle pump function and venous return in both control subjects and in patients with venous disease. The use of MPA has also been shown to improve venous flow volume and venous flow velocity on ultrasound scanning in patients with venous disease. MPA has been shown to improve microcirculation in the skin using Laser Doppler and laser Doppler Speckle Contrast Imaging, in both normal subjects as well as in patients with venous disease and VLU. A recent randomized controlled trial of MPA plus compression therapy compared with compression therapy alone, found significantly faster rates of healing with the use of MPA in addition to compression therapy. There are indications for the use of MPA as an adjunctive treatment to enhance calf muscle pump function in patients with VLU:

who cannot tolerate compression therapy

who can only tolerate suboptimal, low‐level compression

whose ulcer healing remains slow or stalled with optimal compression.
Association of alcohol consumption with hypertension or prehypertension in Chinese adolescent: A cohort study of the China Health and Nutrition Survey
Authors: Chen Meiqi , Liu Juan , Fan Menglin , Li Bin , Ren Yong , Xu Shaoyong
Published: September 2024

This study was conducted to investigate the association between alcohol consumption in adolescence and the risk of hypertension or prehypertension development in early adulthood. This cohort study included adolescent participants aged 12–18 years from the 2000–2011 China Health and Nutrition Survey. Cox proportional risk regression models were used to analyze the associations of the frequency of alcohol consumption, alcohol intake, and type of alcohol with the risk of developing hypertension or prehypertension. Restricted cubic spline analysis was used to assess the dose–response relationships for alcohol intake and their hazard ratios (HRs). A total of 1556 participants were included in the final analysis. Among the overall population, 448 (30.81%) and 35 (34.31%) participants developed hypertension or prehypertension, respectively. Compared with no alcohol consumption, alcohol consumption ≥ 2 times/week and consumption of ≥2 types of alcohol were associated with an increased risk of hypertension and prehypertension, with HRs of 1.97 (95% confidence interval [CI] 1.17–3.34; p = 0.011) and 1.77 (95% CI 1.01–3.09; p = 0.046), respectively. Alcohol intake of > 96 mL/week was associated with an increased risk of hypertension and prehypertension, with HRs of 2.09 (95% CI 1.12–3.90; p = 0.020) and 2.07 (95% CI 1.11–3.84; p = 0.021), respectively. The restricted cubic spline analysis showed that the risk of developing high blood pressure or prehypertension tends to increase with increasing alcohol consumption. Heavy alcohol consumption in adolescence increased the risk of developing hypertension and prehypertension in early adulthood.
Gandouling ameliorates liver injury in Wilson's disease through the inhibition of ferroptosis by regulating the HSF1/HSPB1 pathway
Authors: Zhao Chenling , Chen Jie , Tian Liwei , Wen Yuya , Wu Mingcai , Tang Lulu , Zhou An , Xie Wenting , Dong Ting
Published: September 2024

Ferroptosis, an iron‐dependent form of cell death, plays a crucial role in the progression of liver injury in Wilson's disease (WD). Gandouling (GDL) has emerged as a potential therapeutic agent for preventing and treating liver injury in WD. However, the precise mechanisms by which GDL mitigates ferroptosis in WD liver injury remain unclear. In this study, we discovered that treating Toxic Milk (TX) mice with GDL effectively decreased liver copper content, corrected iron homeostasis imbalances, and lowered lipid peroxidation levels, thereby preventing ferroptosis and improving liver injury. Bioinformatics analysis and machine learning algorithms identified Hspb1 as a pivotal regulator of ferroptosis. GDL treatment significantly upregulated the expression of HSPB1 and its upstream regulatory factor HSF1, thereby activating the HSF1/HSPB1 pathway. Importantly, inhibition of this pathway by NXP800 reversed the protective effects of GDL on ferroptosis in the liver of TX mice. In conclusion, GDL shows promise in alleviating liver injury in WD by inhibiting ferroptosis through modulation of the HSF1/HSPB1 pathway, suggesting its potential as a novel therapeutic agent for treating liver ferroptosis in WD.
Behavioral characteristics of toddlers later identified with an autism diagnosis, ADHD symptoms, or combined autism and ADHD symptoms
Authors: Davis Naomi O. , Lerebours Reginald , Aiello Rachel E. , Carpenter Kimberly L.H. , Compton Scott , Franz Lauren , Kollins Scott H. , Sabatos‐DeVito Maura , Spanos Marina , Dawson Geraldine
Published: September 2024

Background

Autism commonly co‐occurs with attention‐deficit/hyperactivity disorder (ADHD), but less is known regarding how ADHD symptoms impact the early presentation of autism. This study examined early behavioral characteristics of a community sample of toddlers later identified with autism diagnosis, ADHD symptoms, combined autism and ADHD symptoms, or neither condition.

Methods

Participants were 506 toddlers who were part of a longitudinal study of children's behavioral development. Parents completed questionnaires about their children's behavior at two time points. Four groups were identified based on study measures or medical record: autism diagnosis (n = 45), elevated ADHD symptoms (n = 70), autism and ADHD symptoms (n = 30), or neurotypical development (n = 361). Relationships between early parent report of autism‐ and ADHD‐related behaviors, social–emotional and behavioral functioning, and caregiver experience and subsequent group designation were evaluated with adjusted linear regression models controlling for sex.

Results

Significant group differences were found in measures of autism‐related behaviors, ADHD‐related behaviors, externalizing and internalizing behaviors, and parent support needs (p < .0001). Pairwise comparisons indicated toddlers later identified with combined autism diagnosis and ADHD symptoms had higher levels of autism‐related behaviors, externalizing and internalizing behaviors, and autism‐related parent support needs compared to the other groups. Toddlers with subsequent elevated ADHD symptoms or combined autism diagnosis and ADHD symptoms exhibited similar levels of ADHD‐related behaviors, while both groups displayed more ADHD‐related behaviors than toddlers subsequently identified with autism or those with neither condition.

Conclusions

In this community sample, toddlers for whom combined autism diagnosis and ADHD symptoms were subsequently identified showed a distinct presentation characterized by higher early autism‐related behaviors, broader behavioral concerns, and higher parent support needs. Presence of ADHD symptoms (alone or in combination with autism) was associated with higher parent‐reported ADHD‐related behaviors during toddlerhood. Results indicate that ADHD‐related behaviors are manifest by toddlerhood, supporting screening for both autism and ADHD during early childhood.
Medical director presence and time in U.S. nursing homes, 2017–2023
Authors: Goldwein Eric L. , Mollot Richard J. , Dellefield Mary Ellen , Wasserman Michael R. , Harrington Charlene A.
Published: September 2024

Background

Federal regulations require all nursing homes to have a medical director, where medical directors oversee resident medical care and develop, implement, and evaluate resident care policies and procedures that reflect current standards of practice.

Methods

This descriptive study examined medical director: (1) presence or absence and the amount of time spent from 2017 to 2023; (2) presence and time by ownership type; (3) variations in presence and time across states; and (4) overall CMS deficiencies for violations of medical director regulations. This study used federal Payroll‐Based Journal (PBJ) data on staffing positions for the period of 2017–2023, along with federal nursing home ownership data and deficiencies data for 2023.

Results

More than a third of U.S. nursing homes (36.1%) reported zero medical director presence in Quarter 1, 2023. Medical director presence fluctuated between 2017 and 2023 with a decline over the past 4 years. Among nursing homes reporting a medical director, the medical director was on payroll for an average 36 min per day or 4.2 h per week per facility, and less than 1 min per resident day. Medical director presence and time varied significantly by ownership type and state. For‐profit nursing homes reported a lower rate of medical director presence (61.4%) compared to non‐profit (71.3%) and government (66.5%) nursing homes and reported that medical directors spent less time in the facilities. Facilities seldom (0.2%) receive regulatory deficiencies for medical director requirements.

Conclusions

Though medical directors have a critical role in overseeing clinical care, some nursing homes report no medical director time and those that do report about 4 h per week. Together, these findings may indicate the need for improvement. More research is needed to understand these variations and the extent to which medical director regulations are being followed by nursing homes and enforced by regulators.
Is There an Increase in Possible Sleep Bruxism in Children Over Time? A Longitudinal Study
Authors: Soares Josiane Pezzini , Serra‐Negra Júnia Maria , da Silva Moro Juliana , Santos Pablo Silveira , Brancher Giana , Evangelista Maria Eduarda , Cardoso Mariane , Santana Carla Miranda , Bolan Michele
Published: September 2024

Background

Bruxism is a behaviour that has several consequences in an individual's life, especially when it starts in childhood. However, bruxism can be a potential protective factor, which is an attribute that reduces the chance of a negative health outcome.

Objectives

To evaluate the incidence of sleep bruxism (SB) and dental wear in children and adolescents.

Materials and Methods

This longitudinal study began in 2014 and 2016 (baseline) with initial 1816 children followed for 5 and 3 years, respectively. The follow‐up data collection started in 2019. The diagnosis of SB was parents report (baseline) and self‐report (follow‐up) due to age groups of each phase, and questions related to symptoms of SB were collected. Five calibrated examiners (kappa >0.7) collected the clinical data. The clinical variables were dental erosion and dental wear. Contextual, individual, behaviour and clinical characteristics were collected. A multilevel logistic regression model was used to investigate the association of contextual, individual, behaviour and clinical characteristics with SB. Poisson regression for repeated measures was performed to evaluate the incidence of SB and dental wear (incidence rate ratio—IRR and confidence interval—95% CI).

Results

Two hundred and fifty‐three children and adolescents answered questionnaires and were clinically examined. The mean age of the follow‐up in 2019 was 11.25 years old (±2.19). There was no increase in the incidence of SB (95% CI: 0.74–1.35). Children/adolescents had a 2.2 higher risk to present dental wear (95% CI: 1.89–2.60). SB at the follow‐up was associated with the contextual variable, earache, erosion and awake bruxism.

Conclusions

In this population, children with SB remained with this behaviour and showed higher dental wear over the years.
Bridging oral health and nutrition: Assessing produce prescription programs in pediatric dental clinics serving low‐income communities
Authors: Houser Zachary L. , Lyden Elizabeth , Koukol Claire C. , Parks Courtney A.
Published: September 2024

Objectives

This study assesses the needs and feasibility of conducting a produce prescription (produce Rx) program in a pediatric dental clinic setting serving low‐income patients.

Methods

We conducted a cross‐sectional quantitative survey examining several household characteristics including demographics, benefits received, fruit and vegetable intake patterns, food security, feasibility of a produce Rx program, and respondents' answers to questions based on social cognitive theory constructs. The survey was administered at the University of Nebraska Medical Center (UNMC) pediatric dental clinic, a pediatric dental residency clinical training site. One hundred adult respondents with low income completed a 36‐item questionnaire during their child's dental appointment.

Results

Almost half of respondents reported experiencing food insecurity (45%). Respondents who were food insecure experienced higher levels of nutrition insecurity (p = 0.012), less confidence in choosing fruits and vegetables (FVs) (p = 0.026), difficulty in purchasing FVs in their neighborhood (p = 0.012), and more concern that FVs cost too much (p < 0.001) when compared to respondents who were food secure. Notwithstanding the barriers they face, almost all respondents reported that they eat FVs because of health benefits (95%) and to set a good example for their family (91%). Additionally, most respondents expressed an interest in produce Rx programs (80%) and nutrition education activities (81%).

Conclusions

This study demonstrated the potential for produce Rx program uptake in a pediatric dental clinic setting through positive caregiver‐reported need and interest. Future studies should explore how produce Rx programs can be adapted most effectively in this novel setting.
Sleep and cardiac autonomic modulation in older adults: Insights from an at‐home study with auditory deep sleep stimulation
Authors: Huwiler Stephanie , Ferster M. Laura , Brogli Luzius , Huber Reto , Karlen Walter , Lustenberger Caroline
Published: September 2024

The autonomic nervous system regulates cardiovascular activity during sleep, likely impacting cardiovascular health. Aging, a primary cardiovascular risk factor, is associated with cardiac autonomic disbalance and diminished sleep slow waves. Therefore, slow waves may be linked to aging, autonomic activity and cardiovascular health. However, it is unclear how sleep and slow waves are linked to cardiac autonomic profiles across multiple nights in older adults. We conducted a randomized, crossover trial involving healthy adults aged 62–78 years. Across 2 weeks, we applied auditory stimulation to enhance slow waves and compared it with a SHAM period. We measured sleep parameters using polysomnography and derived heart rate, heart rate variability approximating parasympathetic activity, and blood pulse wave approximating sympathetic activity from a wearable. Here, we report the results of 14 out of 33 enrolled participants, and show that heart rate, heart rate variability and blood pulse wave within sleep stages differ between the first and second half of sleep. Furthermore, baseline slow‐wave activity was related to cardiac autonomic activity profiles during sleep. Moreover, we found auditory stimulation to reduce heart rate variability, while heart rate and blood pulse wave remained unchanged. Lastly, within subjects, higher heart rate coincided with increased slow‐wave activity, indicating enhanced autonomic activation when slow waves are pronounced. Our study shows the potential of cardiac autonomic markers to offer insights into participants' baseline slow‐wave activity when recorded over multiple nights. Furthermore, we highlight that averaging cardiac autonomic parameters across a night may potentially mask dynamic effects of auditory stimulation, potentially playing a role in maintaining a healthy cardiovascular system.