Item Questionnaire Research Articles

Nourishing the mind: how the EAT-Lancet reference diet (ELD) and MIND diet impact stress, anxiety, and depression

BackgroundPrevious studies have suggested a link between diet and mental health. However, there is a lack of evidence regarding the association between emerging diets such as the EAT-Lancet reference diet (ELD) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and mental health in different societies. This study aimed to determine the association between adherence to ELD and MIND diets and the risk of depression, anxiety, and stress.MethodsThis research involved 4579 participants from the PERSIAN Organizational Cohort Study in Mashhad (POCM). To assess dietary intake, a comprehensive 118-item semi-quantitative food frequency questionnaire (FFQ) was employed. The Planetary Health Diet Index (PHDI) was used to assess adherence to the ELD. Mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 items (DASS-21) questionnaire. Binary logistic regression was utilized to examine the relationship between these scores and mental health indicators.ResultsIn the adjusted model, the highest quartile of PHDI showed a 35% reduced risk of depression compared to those in the lowest quartile (OR: 0.653, 95% CI: 0.483–0.883; P = 0.008). However, compared to the reference quartile, participants in the highest quartile of MIND diet exhibited significantly lower risks of depression (OR: 0.611, 95% CI: 0.447–0.836; P = 0.005), anxiety (OR: 0.559, 95% CI: 0.418–0.746; P < 0.001), and stress (OR: 0.629, 95% CI: 0.419–0.944; P = 0.008).ConclusionsThe ELD and MIND diet were both associated with reduced odds of depression. Additionally, MIND diet was associated with decreased likelihood of anxiety and stress. However, no connection was observed between ELD and anxiety or stress. Further large-scale interventions are required to confirm these findings.Graphical Association between EAT-Lancet reference diet (ELD) and MIND Diet with Stress, Anxiety, and Depression. PHDI: planetary health diet index, MIND diet: Mediterranean-DASH Intervention for Neurodegenerative Delay diet

The effect of interprofessional education on the surgical team members' self-efficacy perception of interprofessional communication in the healthcare system.

The current study aimed to assess the effect of interprofessional education on participants' self-efficacy perception of interprofessional communication at different levels of a healthcare system (relationships in the interpersonal, interprofessional, and administration levels). This is a sequential explanatory mixed-method study. Learners include surgical residents, surgical technology nurses, and anesthesia nurses (n = 130) who participated in the intervention and control groups. The quasi-experimental study was conducted in the first step. The educational strategy was interprofessional education and the main teaching method was case-based learning. The self-efficacy perception of the participants was assessed by a 26-item questionnaire before and 1 month after the intervention. The descriptive tests (mean, SD, percentage), student t-tests, and ANOVA were analyzed. The participants' experiences were explored through semi-structured interviews. Qualitative content was analyzed by Lundman and Graneheim's approach. The results showed that the scores of the learners in the intervention group (4.05 ± 0.31) improved significantly compared to the control group (3.35 ± 0.37) (p = 0.0001). In the present study, the experiences of the participants were categorized into a theme "explicit and implicit confrontations with perceived distrust in the system" which includes two categories "failure to internalize professionalism among team members" and "dominance of a paternalistic culture within the health care system". The results showed the positive impact of interprofessional education interventions on participants' self-efficacy perception of interprofessional communication. The results showed that interprofessional education, with the participation of different professionals and managers at different levels of a healthcare system, improved the participants' perception of self-efficacy regarding interprofessional communication. The results showed the improvement in the participants' communication with team members and managers required to solve the perceived explicit and implicit confrontations in the surgical departments. The implementation of an interprofessional education strategy focused on interprofessional professionalism and collaboration principles in clinical activities, formal and informal education in the surgical department is recommended.

The development of the Negative Mental Imagery Questionnaire (MIQ-N).

Mental imagery plays a key role in the onset and maintenance of psychological disorders, and has become the target of psychological interventions for the treatment of several anxiety-related conditions. However, there are currently no transdiagnostic measures designed to assess the varied dimensions of mental imagery relevant to psychopathology. To develop and validate a new measure assessing the experiences and appraisals of negative mental imagery. The initial item pool was generated through a comprehensive literature review and interviews with subject-matter experts. An online community sample provided data for the exploratory (n=345) and confirmatory (n=325) factor analyses. The new 16-item Negative Mental Imagery Questionnaire demonstrated four subscales (Intrusiveness, Controllability, Beliefs about Mental Imagery, and Realness). Reliability and validity were good to excellent for both the full- and sub-scales. Appraisals of mental imagery captured by the new measure are consistent with previous research on mental imagery and psychopathology.

Pediatric Trauma Management in Switzerland: Insights from a Nationwide Survey.

To explore and analyze pediatric trauma care practices across designated pediatric trauma centers (PTCs) in Switzerland. The focus is on reception, trauma team activation (TTA), trauma team composition, patient volumes, and infrastructure. A national online survey was conducted among all eight PTCs in Switzerland with an 18- item questionnaire. The survey investigated organizational aspects, criteria for TTA, patient volume, and communication modalities in pediatric emergency departments (PEDs). All PTCs responded, revealing varied methods of TTA, and with reception of major trauma either within PEDs or at adjacent adult trauma facilities. Trauma team composition and activation criteria also differ among centers, with nonsurgeons often leading the teams and anesthesia as a default for airway management. TTA criteria vary widely, with the most common being the request of prehospital crew (62.5%) and physician discretion (50%). Trauma resuscitation is predominantly led by PED attendings (75%). The survey provides insights into the state of pediatric trauma care in Switzerland and emphasizes the importance of multidisciplinary teams and the variability in trauma management practices, which are often tailored to local circumstances. Despite the limitations of self-reported data and the small sample size due to the country's size, the results suggest that a national trauma registry would help to evaluate and optimize pediatric trauma care protocols.

Acceptability of dried blood spot collection by primary caregivers of Filipino patients with maple syrup urine disease (MSUD) and phenylketonuria (PKU).

MSUD and PKU require lifetime management hence, regular monitoring of amino acid levels is needed to achieve good metabolic control. Ideally, plasma amino acid analysis (PLAA) is used to monitor concentrations but is expensive and not widely available in local laboratories. The newborn screening program in the Philippines uses dried blood spot (DBS) analysis as an alternative where only trained healthcare providers are allowed to perform the collection at selected facilities. With the increasing number of patients, DBS monitoring has been noted to be delayed due to multiple factors. This issue became even more evident during the COVID-19 pandemic where high-risk patients need to travel outside for blood collection. The study used a cross-sectional study design to determine the primary caregivers' perspective on DBS self-sampling for patients with MSUD and PKU and the acceptability of the samples collected. This was done through a series of collection training, pre-/post- surveys, and 10-item questionnaire, and an in-depth 1-on-1 interview for thematic analysis. The acceptability of samples was processed and evaluated by the newborn screening laboratory. At-home DBS collection by primary caregivers was found to be acceptable. The provision of knowledge and routine collection training by the medical team aids in the increase of sample acceptability as well as a source of empowerment in being equipped to take care of their child. It is highly recommended that DBS samples collected by caregivers be considered acceptable for more time and cost-saving monitoring of the patients' metabolites. This practice also promotes timely and appropriate management which can lead to better patient health outcomes.

Filipino Rehabilitation Practitioners’ COVID-19 knowledge, practice and attitude: A cross-sectional study

Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).Setting: The study was conducted in the Philippines.Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p 0.000).Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.

Addressing a community need: assessing the confidence and attitude of senior medical students in responding to in-flight emergencies

Traveling physicians will likely be called for medical assistance on board. In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. This study evaluated senior medical students’ willingness, understanding, confidence, and attitudes toward IMEs and their willingness to respond to them. This cross-sectional study was conducted among senior medical students in the College of Medicine, King Saud University, Riyadh, Saudi Arabia. These medical students were sent a self-administered online questionnaire, which consisted of basic demographic data, a survey to evaluate IME experiences, and a 10-item questionnaire to assess the attitude of students. Among 302 medical students, 52.3% were males, while 66.9% were over 22 years old. The prevalence of students who attended life support training was 62.6%, which was highly significant among the 5th-year level (p = 0.001). Neutral attitudes were found in most students (87.7%); 4.6% had positive attitudes, while 7.6% had negative ones. Being at the 5th-year level and having previous participation in life support training were associated with an increased attitude toward in-flight medical emergencies. The attitude of senior medical students toward IMEs was less than desired. However, the attitude was better among 5th-year medical students who attended training courses on managing IMEs. Thus, participation in training courses influenced the willingness to manage such cases. Subsequently, longitudinal studies are needed to extract more data on the knowledge and confidence of medical students toward IMEs.

The impact of social media screen-exposure time on suicidal ideation among Pakistani adolescents.

Adolescence is a crucial life stage for the individual identity formation. The growing employment of social media and screen-exposure among teenagers and the concerning rise in suicide ideation rates in this susceptible group both suggested this study. Thus, we explored the association between adolescents' suicidal ideation and their daily social media screen-exposure. We surveyed 502 students, aged 13 to 19 years old, recruited in colleges and universities of Punjab, Pakistan. The survey was based on a 28-item self-reported questionnaire and demographic data collection. Approximately 40% of adolescents reporting suicidal ideation showed an extended social media screen-exposure, as well as significant depressive feelings and problematic personality traits. In particular, suicidal ideation increased by 0.39 for each one-unit increase in screen-exposure time and levels of depression increased by 0.21 times by unit of screen-exposure. The correlation coefficients further indicated a moderate positive association between depression and suicidal thoughts as well as personality traits played as mediators between social media screen-exposure time and suicidal ideation among adolescents. Our study found a positive association, even if modest, between the use of social media screens and suicidal ideation among adolescents. This evidence may suggest to adopt specific strategies to address the use of media among youths and prevent mental disorders related to the prolonged and inappropriate use of digital technologies in those users with a vulnerable personality.

Organizational health literacy in German hospitals: a cross-sectional survey among hospital managers

BackgroundOrganizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients’ health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers.MethodsBetween November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data.ResultsOf 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials.ConclusionsGiven their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals’ organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training.

Reading Difficulties of Grade 4 Learners in the Post-Pandemic

The post-pandemic era exacerbated the reading difficulties of learners due to disrupted learning, limited access to resources, and potential gaps in foundational skills. Along this premise, this study analyzed the level of reading difficulties of Grade 4 learners in the post-pandemic. Data needed for the descriptive study was collected from 155 respondents using a self–made 40–item questionnaire that passed the rigorous tests of validity and reliability. Across areas of concern, the level of reading difficulties of Grade 4 learners was found to be moderate. Further, a significant difference was found in respondents’ reading difficulties in word decoding, fluency, reading comprehension, and vocabulary when grouped according to parents’ educational attainment, family income, and number of siblings. However, no significant difference was found in groupings by fluency and sex. These findings call for technical assistance and workshops for teachers to equip them with techniques and strategies in teaching reading and creating a sustainable reading program that will capacitate and strengthen learners’ motivation towards reading, aiming to improve their skills in word decoding, fluency, reading comprehension, and vocabulary. Keywords: Language education, reading difficulties, word decoding and fluency, reading comprehension and vocabulary, Negros Occidental, Philippines

Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants.

Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants. A 23-item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple-choice questions were used to self-evaluate knowledge of ANS disorders. In all, 285 individuals answered the survey (60% female, mostly 25-34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum. Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula.

A Study of Chinese University Students’ English Learning Motivation, Anxiety, Use of English and English Achievement

Research has found that contact with a second language (L2), L2 motivation and foreign language anxiety are important variables affecting L2 learning. Nevertheless, not much research has explored the relationships among these variables and their interactive effects on L2 learning outcomes. The present large-scale survey study examined the relationships between English learning motivation, English classroom anxiety and use of English, as well as their predictive effects on Chinese university students’ English achievement. A total of 439 randomly sampled students from two Chinese universities in Beijing answered the background information questionnaire, the 8-item English Classroom Anxiety Scale and the 35-item English Learning Motivation Questionnaire. The major findings were as follows: (a) English learning motivation, English classroom anxiety and use of English were significantly correlated with one another, and (b) English classroom anxiety, use of English and English learning motivation generally significantly predicted the students’ English achievements. These findings confirm the importance of L2 motivation, foreign language anxiety and contact with the L2 for second language learners. Hence, specific suggestions (e.g., reading and listening to more of a second language, creating a supportive and relaxed L2 classroom environment, etc.) are discussed regarding how to enhance L2 learning motivation, reduce foreign language anxiety and increase contact with the L2 in second language learning, so as to ensure sustainable development in second language learning.

Exploring Moroccan EFL Undergraduates’ Readiness for a Newly-Implemented Blended Learning Course in English Language Proficiency

Over the last two decades, online learning has gained global attention from education stakeholders worldwide. Given the ubiquitous feature of today’s technology-driven world, the switch from face-to-face delivery to technology-delivered instruction has become a necessity. However, the implementation of innovative e-learning models such as blended learning cannot be a success without learners’ readiness and adaptability. Therefore, it is a top priority to be aware of students’ e-learning readiness to make the teaching-learning process effective and rewarding. This study seeks to gain insights into Moroccan EFL students’ readiness for a newly implemented blended language proficiency course. Data were collected using three research questions and a 29-item questionnaire adopted from Shakeel et al. (2023). The findings reveal that Moroccan university EFL students display a moderately positive attitude towards blended learning and this is a prerequisite for a smooth implementation of blended learning.

Association of macronutrient intake, physical activity, anxiety, and depression with sleep quality among Iranian male adolescents

BackgroundAdolescence is a unique stage of life accompanied by physiological and psychological modifications, along with stress, confusion, and depression.Materials and methodsThe present descriptive-analytical cross-sectional research was done on 267 male adolescents who studied at high schools in Zanjan, Iran. Demographic characteristics questionnaires, a 48-item food frequency questionnaire, a short version of the International Physical Activity Questionnaire (IPAQ), the Depression Anxiety Stress Scale (DASS-21), and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data.ResultsThe mean ± standard deviation (SD) of age, weight, height, and sitting time was 15.94 ± 0.91 years, 68.53 ± 15.28 kg, 1.75 ± 0.06 m, and 449.25 ± 322.06 min, respectively. The study results showed that students with poor sleep quality showed a higher rate of depression than those with good sleep quality in the high and low physical activity groups (p < 0.05). The stress, depression, and anxiety scores significantly correlated with sleep quality in the physical activity groups (p < 0.05). The structural equation model analysis results showed that mental health directly affected sleep quality; this association was significant in the low physical activity group.ConclusionWe found that sleep quality was independently related to mental health in young Iranian men. However, dietary intake was not a significant predictor of mental health or sleep quality. More studies are required to evaluate the association between dietary intake and sleep quality in adults.

MLA Research Training Institute (RTI) 2018 and 2019: participant research confidence and program effectiveness.

The article reports on an assessment of the effectiveness of the MLA Research Training Institute (RTI) for the years 2018 and 2019. The RTI is a year-long continuing education research methods training and support program for health sciences librarians. The study focuses on assessing RTI participants' research confidence after program completion and compares these results with their perceptions of workshop/program performance and learning outcomes. In addition, the authors discuss how the findings were applied to inform and improve the program. The study used a 26-item questionnaire, RTI Research Confidence Questionnaire, to gather information on participants' self-reported research confidence before the workshop, immediately after the workshop, and one year after the workshop to determine statistically significant differences. Differences in research confidence were identified by using three nonparametric statistical tests. Additional workshop and program surveys were used to corroborate the research confidence findings. Post-workshop and one-year-after-workshop research confidence ratings were significantly higher than pre-workshop levels for years 1 and 2. A comparison of median ratings between years 1 and 2 showed significant increases in research confidence for nine items in year 2. Participants' positive perceptions of workshop/program effectiveness and learning outcomes corroborated these findings. Overall assessment findings indicated that RTI training helped participants understand, use, and apply research skills to conduct research. Findings also revealed that participants' heightened research confidence persisted at least 12 months postintervention. The RTI Research Confidence Questionnaire proved effective for rigorously assessing and improving the RTI program. This study enhances the currently limited evidence on evidence-based approaches for assessing and improving research instruction for librarians.

Translation and validation of the CLEO tool in Vietnamese to assess the significance of pharmacist interventions.

There is currently no validated tool available for assessing the potential significance of pharmacist interventions in Vietnam. This study aimed to translate the CLEO tool from French into Vietnamese, validate the Vietnamese version, and demonstrate its feasibility in daily practice. The CLEO tool was translated into Vietnamese (CLEOVN) using a 5-step process by bilingual experts. A total of 100 scenarios were compiled from clinical cases from nine hospitals evaluated by seven clinical pharmacists to determine inter-rater reliability and 30 out of 100 scenarios were re-evaluated one month later to determine test-retest reliability. Reliability was quantified using the intra-class correlation coefficient (ICC). A 20-item questionnaire on a 7-point Likert scale assessed the tool's appropriateness, acceptability, precision, and feasibility. Inter-rater reliability was good for clinical dimension (ICCA,1 = 0.71), excellent for economic dimension (ICCA,1 = 0.86), and fair for organizational/operational dimension (ICCA,1 = 0.56). Test-retest reliability scores were excellent for clinical (I̅C̅C̅A,1 = 0.79), excellent for economic (I̅C̅C̅A,1 = 0.84), and fair for organizational/operational (I̅C̅C̅A,1 = 0.56). The tool was rated as appropriate (mean = 5.86; SD = 1.03), acceptable (mean = 5.19; SD = 1.12), precise (mean = 5.71; SD = 1.17), and feasible (mean = 5.05; SD = 1.24). The maximum time required to evaluate an intervention was three minutes. The CLEOVN tool was successfully translated and validated for reliability, appropriateness, acceptability, precision, and feasibility. It will be suitable toevaluate the value of clinical pharmacy interventions.

Effectiveness of jigsaw puzzle assisted visual reinforcement technique on toothbrushing knowledge, practices and clinical parameters of hearing and speech-impaired adolescents: A single-blind randomized controlled trial.

Oral health education (OHE) for hearing and speech-impaired (HSI) adolescents relies heavily on sign language. However, it is not effective in conveying oral health concepts due to communication barriers, resulting in suboptimal oral health outcomes. This study aims to evaluate the impact of the jigsaw puzzle assisted visual reinforcement (JPVR) technique on toothbrushing knowledge, practices, and clinical parameters among HSI adolescents. The study was carried out as a single-blind randomized controlled trial in a public school in Belagavi, India for a period of three months. The study included 95 participants who were randomly allocated into two groups. One group received sign language with JPVR technique, and the other group received only sign language. A self-designed 15-item closed-ended questionnaire (Cronbach's alpha value of 0.88; content validity ratio=0.85) was developed to assess the knowledge, and practices at baseline and 3 months. Plaque and gingival indices were also recorded. At the end of 3 months, the knowledge gained and practices improved in JPVR group were significantly higher compared to sign language group (p=.001). The mean plaque score was significantly lower in JPVR group than that in the sign language group (p=.001); however, gingival index did not show any statistically significant difference at 3 months. The current study demonstrated that OHE utilizing JPVR technique led to significant improvements in toothbrushing knowledge, practices, and plaque scores compared to that of conventional sign language. This promising strategy has the potential to be cost-effective and does not incorporate specialized sign language training for health professionals.

État des lieux de la prise en charge de l’orbitopathie dysthyroidïenne modérée à sévère active en France à partir de 28 centres experts métropolitains

Introduction: This study investigates the management of Graves’orbitopathy (GO) in France, at 26 university medical centers (CHU) as well as the Rothschild Foundation and the Quinze-Vingts national eye hospital in Paris.Methods: The 28 metropolitan university medical centers were contacted by telephone or e-mail. The authors devised a 5-item questionnaire that explored the scheduling of multidisciplinary meetings, the existence or lack of a dedicated Graves’ consultation service, the place of hospitalization, and first- and second-line treatments.Results: 89% of hospital departments had a dedicated service for patients with GO, with 36% organizing multidisciplinary meetings. Intravenous corticosteroid therapy is still used as first-line treatment, while mycophenolate is used much less (14.3%), despite the new EUGOGO (European Group on Graves' orbitopathy) 2021 recommendations. For second-line treatment, tocilizumab is most commonly used (64%). Teprotumumab is available in France only on a compassionate basis, and its use is limited (18%).Conclusion: This study highlights the variability in practices and the importance of a multidisciplinary approach, while calling for national standardization of practices. Despite disparities in the application of recommendations, the emergence of second-line treatments such as tocilizumab and teprotumumab indicates a steady evolution in therapeutic options, although obstacles in terms of accessibility and cost remain.

Self-Stigma vs. Perceived Public Stigma Toward Mental Illness in Rural Adults

Introduction: Mental illness is a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior. Stigma toward mental health comes in two primary forms: Self-stigma and perceived public stigma. Purpose: The objective of this study is to quantify the amount of stigma toward mental illness in rural adults and analyze differences in stigma across demographic groups. Methods: Adults were offered a 14-item questionnaire at five different sites from January 2023 to April 2023. Rural distinctions were made based on participants' reported county of residence following the Indiana Office of Community and Rural Affairs (OCRA) definition of rurality. Demographic information such as age, gender, marital status, total household income, and highest level of education were also obtained. Results: Rural adults experience mild amounts of self-stigma (14.52 +/- 5.0) and moderate amounts of perceived public stigma (18.4 +/- 4.3). Adults aged 46-65 experience more significant levels of perceived public stigma when compared to those of younger participants. An inverse relationship exists between the highest level of education and self-stigma towards mental illness. Seventy two percent of respondents agreed or strongly agreed with the statement, “In general, others believe that having a mental illness is a sign of personal weakness or inadequacy.” Conclusions: This study demonstrates that perceived public stigma toward mental illness presents a significant barrier to care for mental illness. Adults aged 46-65 are especially vulnerable to the perceived public stigma toward mental illness. To provide the largest benefit to rural populations, anti-stigma campaigns should focus on perceived public stigma among adults aged 46-65.

The current attitudes and practices of dentists in Australia towards composite repair: A cross-sectional survey study.

Whether to replace or repair a composite restoration is controversial and varies among clinicians. This study was designed to collect information on the attitudes and practices of Australian dentists towards composite repair. An electronic 16-item questionnaire was distributed online on Australian clinicians' dental forum with a URL address and instructions on completing the survey. The questionnaire remained accessible for 2 months. The data collected were analysed statistically using descriptive, average rank, Pearson chi-square and Kruskal-Wallis tests at α = 0.05. Repair of composite restorations was a widely accepted treatment modality among surveyed dentists. Despite this, approximately half of clinicians reported the prognosis of repaired restorations to be worse when compared to replacement. The most cited indications for repair were partial loss or fracture of the restoration, while the most common reason for repair was because this treatment modality was more conservative in terms of tooth structure removal. Most important patient factor influencing decision to repair composite restoration was caries risk of the patient (n = 50). Most significant situational factor to consider in decision whether to repair was previous (failed) attempts to repair (n = 74). The most important tooth level factor was the proximity of restoration to pulp (mean statistic rank 2.22). The most common composite surface treatment employed by participants bonding to old composite was acid etching (n = 87), and the main reason participants employed their chosen surface treatment was based on personal experience (n = 72). The repair of composite restorations was a commonly performed procedure that is well accepted but may still be viewed as an inferior treatment to replacement by many Australian dentists. Most dentists agreed on indications for repair restorations and surface conditioning techniques, but there was wide variation in opinions overall. Due to the lack of high-quality evidence regarding composite repair techniques, dentists tend to rely on personal experience to guide their clinical decisions.