Health Assessment Research Articles

Prioritizing Health Literacy Educational Objectives for Pediatric Residents – A Delphi Study

ObjectiveChildren of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. MethodsOur Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. ResultsThirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. ConclusionsA panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.

Chemometrics, health and environmental risk assessments of commonly consumed biscuits in Lagos and Ibadan metropolises, Southwestern Nigeria

The United Nations' Agenda 2030 for sustainable development calls, amongst others, for universal action toward ending malnutrition and ensuring healthy living and well-being for all. So, efforts have intensified to attain the sustainable development goal-2 targets on stunting and wasting in children. Reported herein, therefore, is the quantification of metals in biscuits. Biscuits are commonly consumed snacks world-over and have become sources of nourishment for children and adults due to growing sedentary lifestyles and hectic school/work schedules. Nine metals (Pb, Ni, Cu, Co, Zn, Fe, Na, Mg and Ca) were assayed in six biscuit types (crackers, cookies, shortcakes, digestives, cabins and wafers) via wet digestion and flame atomic absorption spectrophotometry, and the ensuing data subjected to multivariate analyses (analysis of variance, Tukey's test, Pearson correlation, and principal component and hierarchical cluster analyses). The highest concentrations of macrominerals were found in the wafers (Ca), crackers (Na) and cabins (Mg) whereas the micronutrients peaked in the cookies (Fe, Zn), crackers (Cu), shortcake (Co) and wafers (Ni), respectively. The metal levels in the sampled biscuits were all safe for consumption, except for Pb at 0.83 ± 0.76–2.3 ± 1.3 mg/kg. Similarly, the health risk assessments of ingesting metals from the biscuits exposed Pb as potentially liable to cause adverse non-carcinogenic and carcinogenic health effects in children (aged 4–20 years) but Co and Ni exhibited borderline non-carcinogenic and carcinogenic health risks, respectively, in children. Gratifyingly, the ecological risk assessments to evaluate the likelihood of wastes, from expired and/or egested potentially toxic metals-contaminated biscuits, to cause damage to ecology were categorized as low. Nonetheless, constant evaluation and monitoring remain germane.

Development of a tool for rapid assessment of the evidence of human observational epidemiological studies with focus on risk of bias in the context of public health and risk assessment

Development of a tool for rapid assessment of the evidence of human observational epidemiological studies with focus on risk of bias in the context of public health and risk assessment

Microaggression and discrimination exposure on young adult anxiety, depression, and sleep

BackgroundIncreasing research examines social determinants of health, including structural oppression and discrimination. Microaggression – subtle/ambiguous slights against one's marginalized identity – is distinct from discrimination, which typically presents as overt and hostile. The current study investigated the comparative effects of each exposure on young adult anxiety, depression, and sleep. Race-stratified analyses investigated patterns across groups. MethodsYoung adults (N = 48,606) completed the Spring 2022 American College Health Association-National College Health Assessment III. Logistic regressions tested odds of anxiety symptoms, depressive symptoms, and sleep disturbance in association with microaggression and discrimination exposure. ResultsMicroaggression and discrimination equally predicted increased likelihood of anxiety symptoms (ORDiscrim = 1.46, ORMicro = 1.42). Discrimination more strongly predicted depressive symptoms (OR = 1.59) and sleep disturbance (OR = 1.54) than microaggression (ORDepress = 1.24, ORSleep = 1.27). Race-stratified analyses indicated stronger associations between the exposures and poor mental health in Whites than Asian American, Black/African American, and Hispanic or Latino/a/x respondents. LimitationsMicroaggression and discrimination exposure were each assessed using a single item. The outcome measures were not assessed using validated measures of anxiety, depression, and sleep (e.g., GAD-7, MOS-SS), thus results should be interpreted with caution. Analyses were cross-sectional hindering our ability to make causal inferences. ConclusionsThe findings provide preliminary evidence that microaggression and discrimination exposure operate on health in distinct ways. Racially marginalized individuals may demonstrate a blunted stress response relative to Whites. Treatment approaches must be tailored to the particular exposures facing affected individuals to maximize benefits.

Suicidal ideation, suicide attempt, and self-injury among American Indian, Alaskan Native, and Native Hawaiian college students in the United States from 2015 to 2019.

Suicide is a major driver of mortality among college students and is the leading cause of death among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) young adults. Data on suicidal ideation, suicide attempt, and self-injury among AI/AN/NH college students (n = 8103) were analyzed via multivariable logistic regressions employing the American College Health Association National College Health Assessment survey from 2015 to 2019. Adjusted odds ratios (aORs) were used to assess how opioid misuse may act as a risk or protective factor for suicidality and self-injury. Between 2015 and 2019, suicidal ideation was the most prevalent dimension of suicidality affecting AI/AN/NH college students (ranges from 12.69% to 18.35%), followed by self-injury (7.83%-11.41%) and suicide attempt (2.40%-4.10%). AI/AN/NH college students who reported opioid misuse were significantly more likely to experience suicidal ideation (aOR: 1.417; 95% confidence interval [CI]: 1.154-1.740) and self-injury (aOR: 1.684; 95% CI: 1.341-2.116) than those who did not engage in such behavior. We identified opioid misuse as a potential risk factor for suicidal ideation and intentional self-injury among populations of AI/AN/NH college students. Programs seeking to reduce suicide prevalence among Indigenous college students may benefit from the inclusion of evidence-based interventions that prevent and treat issues related to opioid use.

Nature-Engagement and Wellbeing in Brazil: Understanding the Dose-effect Relationship for Designing Urban Green Spaces

Statement of ProblemIn the face of increasing urbanization, the pursuit of healthy and sustainable cities promoting a high quality of life intertwined with nature is paramount. PurposeThis research endeavors to assess the impact of variations in nature interaction styles on health, with the objective of generating evidence to inform the design of urban green spaces. MethodEthically approved by the Human Research Ethics Committee (CAAE 58149622.3.0000.0077), a survey involving 2,136 respondents was conducted. Participants reported their nature engagement frequency, duration, and intensity, alongside mental health assessments using the Depression, Anxiety, and Stress Scale (DASS-21). Welch's ANOVA and Cohen’s d were employed to derive meaningful effect size. ConclusionsThis research provided empirical insights into the relationship between nature interaction and public health, thus offering evidence to inform urban green space design. Practical ImplicationsThe findings are expected to empower urban planners and policymakers with evidence-based strategies for creating urban green spaces conducive to physical activities, leisure events, and nature-based recreation, promoting public health through appropriately timed and frequented activities. Future DirectionsFurther research avenues may include longitudinal studies to assess the long-term impact of nature interaction on mental health and the implementation of evidence-based design strategies in urban green space development.

Reproductive Health Assessment and Reports of Fertility Counseling in Pediatric and Adolescent Patients with Sickle Cell Disease After Hematopoietic Cell Transplantation

Conditioning regimens for hematopoietic cell transplant (HCT) in patients with sickle cell disease (SCD) place patients at risk for reproductive health issues. The purpose of this study was to assess reproductive health and reports of fertility counseling in patients with SCD who received a transplant. This was a secondary analysis of gonadal hormone production, future infertility risk assessment, and parent-proxy/patient reports of fertility counseling in SCD transplant recipients who are currently pubertal and were enrolled in the Atlanta sites of the Sickle Cell Transplant Evaluation of Long-term and Late Effects Registry (STELLAR) between May 2017 and October 2023. Clinical information was abstracted from medical records and reproductive health survey data from the STELLAR database. Descriptive statistics were reported as median (interquartile range [IQR]) or percentages. There were 20 females and 12 males in the study population. Females were median (IQR) 19.6 (9.4) years old and males 20.8 (11.4) years old at the time of the study. Transplants most commonly occurred in the decade 2010 to 2019 at 10.7 (4.8) years old for females and 11.1 (4.1) years old for males. Most participants received bone marrow stem cells (95.0% females, 100.0% males) from matched sibling donors (90.0% females, 100.0% males). Participants received one of seven HCT conditioning regimens with cyclophosphamide equivalent doses ranging from 3388 to 9706 mg/m2. The majority of females (90.0%) had diminished ovarian reserve with low anti-Mullerian hormone levels, and 61.1% had premature ovarian insufficiency with two follicle-stimulating hormone levels (FSH) ≥40 mIU/mL post-HCT. All males had normal testosterone levels, but 63.6% had elevated FSH levels suggestive of impaired spermatogenesis post-HCT. Parent proxies (for patients <18 years old) and patients ≥18 years old completed surveys 9.0 years (5.2) and 7.9 years (9.3) since HCT in females and males respectively. Twenty-five percent of parent proxies and 45% of patients reported that they had not been informed by a healthcare provider of the risk of infertility post-transplant. There are high rates of gonadal dysfunction post-HCT, but many parent proxies and patients do not recall being told of the risk for future infertility. More effective methods of education are warranted to ensure SCD patients and their families clearly understand the risk for reproductive health issues post-HCT.

Chikungunya Arthritis Treatment with Methotrexate and Dexamethasone: A Randomized, Double-blind, Placebo-controlled Trial.

Chikungunya fever is a reemerging epidemic disease caused by a single-stranded RNA alphavirus transmitted throughout by Aedes mosquitoes. Chikungunya virus infection is a biphasic disease in which 72% to 95% of affected individuals manifest acute chikungunya fever. Following the acute phase, more than 40% of affected individuals develop arthritis, often lasting more than 3 months, referred to as chronic chikungunya arthritis, which frequently mimics rheumatoid arthritis. This study aimed to evaluate the efficacy and safety of treatment of chronic chikungunya arthritis with methotrexate and dexamethasone in a randomized, double-blind, placebo-controlled clinical trial. The patients were reassessed for treatment response by the DAS28-ESR, tender joint count and swollen joint count, Patient Global Assessment, and for secondary measures, including the Health Assessment Questionnaire Disability Index and Pain Visual Analog Scale. Thirty-one subjects were randomized (placebo, n = 16; methotrexate, n = 15); 27 completed treatment and 4 discontinued during the 8-week blinded period. Among the participants, 96.8% were female, with mean ± SD age was 52.9 ± 13. The mean ± SD disease duration prior to treatment was 220.9 ± 51.2 days. At 8 weeks, methotrexate-treated subjects showed a greater numerical trend towards improvement, but there were no significant differences between methotrexate- dexamethasone group and dexamethasone (placebo) group. In this relatively small cohort, all of whom received background dexamethasone, there was a greater numerical improvement trend in prespecified outcome measures, but methotrexate in combination with dexamethasone was not superior to dexamethasone in chronic chikungunya arthritis.

Nanoarchitectonics of Fe single-atom catalyst modified with flexible wearable patch for sweat biomarker analysis

In personalized medical diagnostics and health monitoring, the analysis of biomarkers in sweat, such as uric acid (UA) and dopamine (DA), offers valuable insights into metabolic states. This study introduces a flexible wearable patch based on Fe single-atom catalysts (FeSAs) to simultaneously detect UA and DA in sweat for comprehensive health assessment. Our wearable patch demonstrated linear response ranges of 1–800 μM for UA and 1–500 μM for DA, with detection limits of 2.68 μM and 3.76 μM, and sensitivities of 0.015 μA μM−1 cm−2 and 0.0176 μA μM−1 cm−2, respectively. Additionally, we integrated agarose hydrogel into the wearable patches, optimizing sweat collection efficiency at agarose concentrations ranging from 2 % to 3.8 %. This innovation enables effective biomarker enrichment directly from the skin surface. In conclusion, our study presents an innovative FeSAs-based electrocatalyst capable of simultaneous detection of low-concentration UA and DA biomarkers.

Noninvasive microvascular imaging in newborn rats using high-frequency ultrafast ultrasound

Ultrasound imaging stands as the predominant modality for neonatal health assessment, with recent advancements in ultrafast Doppler (μDoppler) technology offering significant promise in fields such as neonatal brain imaging. Combining μDoppler with high-frequency ultrasound (HF-μDoppler) presents a potential efficient avenue to enhance in vivo microvascular imaging in small animals, notably newborn rats, a crucial preclinical animal model for neonatal disease and development research. It is necessary to verify the imaging performance of HF-μDoppler in preclinical trials. This study investigates the microvascular imaging capabilities of HF-μDoppler using a 30 MHz high-frequency linear array probe in newborn rats. Results demonstrate the clarity of cerebral microvascular imaging in rats aged 1 to 7 postnatal days, extending to whole-body microvascular imaging, encompassing the central nervous system, including the brain and spinal cord. In conclusion, HF-μDoppler technology emerges as a reliable imaging tool, offering a new perspective for preclinical investigations into neonatal diseases and development.

Respiratory health assessment of outdoor workers exposed to urban air pollution based on satellite observations

Human health impact assessment due to air pollution is critical for evaluating environmental hazards. In this research, levels of three air pollutants (CO, NO2, and SO2) were estimated based on satellite data (sentinel-5p) to assess the air quality over three areas (Al-Mahaad Al-Dinni, Bus Stop, and Oil Company areas) at Banha city, Qalyobia in addition to evaluating the human health risks resulting from exposure to these air pollutants. Unlike the conventional approaches for human health risk assessment, which depend on in-situ air pollution measurements, in this study, the spatial distribution of the pollutants was acquired from satellite remote sensing for the period 2021–2022. The respiratory health assessment of 151 outdoor workers, exposed to air pollution in Banha City was conducted. Results showed that the highest concentration of the pollutants was found in areas of Bus Stop and Oil Company. Consequently, the percentage of predicted pulmonary function tests was significantly lower among those working in the Oil company area than those working in the Bus Stop and Al-Mahaad Al-Dinni areas. Additionally, 47.6 % of the studied group complained of nasal congestion and 67.5 % of them complained of wheezing, 30.5% of them had obstructive airway diseases. In conclusion, remotely sensed air quality data proved its efficiency in health impact studies which could be carried out in different regions globally with less cost than traditional measurement techniques. Urban pollution can influence outdoor workers with varied percentages according to their exposure rate to pollutants and work-related factors.

Infant and early childhood physical health assessments in the HEALthy Brain and Child Development (HBCD) Study

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child’s routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.

Results of a 12-Week Open-Label, Non-Interventional Study of the Efficacy and Safety of Olokizumab Therapy in Patients with Rheumatoid Arthritis after Switching from Anti-B-Cell Therapy during the SARS-CoV-2 Pandemic.

The purpose of the study was to evaluate the efficacy and safety of the drug Artlegia® (olokizumab), solution for subcutaneous injection, 160 mg/ml-0.4 ml, manufactured by R-Pharm JSC, Russia) for the treatment of patients with rheumatoid arthritis in real clinical practice after switching with rituximab during the COVID-19 pandemic. The study included 14 patients with a confirmed diagnosis of rheumatoid arthritis (RA), who were previously on rituximab therapy at a dose of 1000-500 mg twice with an interval of 2 weeks, who received at least one course of therapy with this drug. As RA worsened, patients were switched to olokizumab against the background of standard DMARDs. On weeks 0, 4, 8, and 12 after the switch, the severity of pain was assessed on the VAS scale, the number of tender and swollen joints (TJC28 and SJC28), the level of acute-phase inflammation markers, the DAS28 (disease activity score), ESR, CRP, CDAI (clinical activity index), and the functional state index HAQ (Health Assessment Questionnaire) were determined, as well as the safety profile of therapy was assessed. Data analysis was performed using median values (Me) were used for data analysis. A significant decrease in TJC28 was detected after 8 and 12 weeks of treatment with olokizumab (Artlegia®) (Me baseline = 10, Me 8 weeks = 4, Me 12 weeks = 4, p < 0.05) and a decrease in TSC28 was detected after 4, 8, and 12 weeks of treatment (Me baseline = 9, Me 4 weeks = 3.5, Me 8 weeks = 2.5, Me 12 weeks = 2.0, p < 0.05). Laboratory markers of inflammation showed a decrease in CRP and ESR levels after 4 weeks of treatment (CRP: Me4 weeks = 21, Me4 weeks = 1, p < 0.05, ESR: Mesno = 31, Me4 weeks = 7, p < 0.05). Positive dynamics persisted on 8 and 12 weeks (CRP: Me 8 weeks = 1, Me 12 weeks = 0; ESR: Me 8 weeks = 4, Me 12 weeks = 5). The level of CRP by week 4 became within the normal range, regardless of the initial values. All activity indices improved from week 4 in each evaluation period compared to baseline: DAS28-ESR: Me baseline = 5.52, Me 4 weeks = 3.59, Me 8 weeks = 3.33, Me 12 weeks = 3.22, p < 0.05; DAS28CRP: Me baseline = 5.39, Me 4 weeks = 3.71, Me 8 weeks = 3.35, Me 12 weeks = 3.45, p < 0.05; CDAI: Me baseline = 28.5, Me 4 weeks = 18.0, Me 8 weeks = 16.5, Me 12 weeks = 16.0, p < 0.05. All patients showed a reduction in pain (VAS scale) by week 8. The functional status of patients, according to the HAQ index, showed a significant decrease only by week 12 of the study: Me baseline = 1.62, Me 12 weeks = 1.31, p < 0.05. The study found that switching from rituximab to olokizumab was effective and safe during the COVID-19 pandemic.

End-tidal-to-arterial PCO2 ratio as a prognostic value in mechanically ventilated patients at respiratory intensive care unit

Background Dead space refers to the part of each tidal volume that does not contribute to gas exchange. It serves as an indicator of lung function efficiency. Aim To evaluate the end-tidal-to-arterial PCO2 ratio and Acute Physiological and Chronic Health Assessment (APACHE IV) scoring system as prognostic values in mechanically ventilated patients at the respiratory intensive care unit (ICU). Patients and methods This prospective cohort research was done on 40 mechanically ventilated patients due to different respiratory causes who were admitted at the respiratory ICU at Ain Shams University hospitals. Results This study found that decreasing end tidal PCO2 (PETCO2)/arterial carbon dioxide (PaCO2) is associated with higher mortality amongst mechanically ventilated cases in respiratory ICU. A significant negative association between APACHE IV score and end-tidal to arterial PCO2 ratio following 1 h and after 24 h of mechanical ventilation. APACHE IV score showed a significant relation with mortality, being higher in survivors than nonsurvivors. Conclusion PETCO2/PaCO2 is a relevant prognostic value that reflects dead space ventilation among mechanically ventilated patients in respiratory ICU. APACHE IV score is a good mortality predictor in respiratory ICU.

A Comparison of Food Insecurity Prevalence among Students Attending Minority Serving Compared with Predominantly White Institutions in Prephase, Earlier, and Later Phases of the COVID-19 Pandemic

BackgroundCollege students have a high prevalence of food insecurity, and descriptive reports suggest even higher rates at minority-serving institutions than those at predominantly White institutions. These institutional inequities in food insecurity among college students based on minority designation may have shifted owing to the COVID-19 pandemic. ObjectivesWe aimed to compare the prevalence of food insecurity between students at minority serving and predominantly White institutions during 3 phases: prepandemic [Fall 2019–Spring 2020 (February 2020)], earlier pandemic (Fall 2020–Spring 2021), and later pandemic (Fall 2021–Spring 2022). MethodsOur study included repeated cross-sectional samples from the American College Health Association–National College Health Assessment III (N = 287,221 students, 354 institutions). We performed multivariable Poisson regression with cluster-robust SEs to estimate associations between institutional minority designation and food insecurity, with 1 model for each pandemic phase. ResultsStudents attending minority serving compared with predominantly White institutions had a higher prevalence of food insecurity overall (42% compared with 37%) and within each pandemic phase. After adjusting for sociodemographic and institutional characteristics, students at minority serving institutions had 23% higher food insecurity prevalence during the prepandemic phase than students at predominantly White institutions (95% confidence interval: 1.14, 1.32). Associations were null for earlier and later pandemic phases. ConclusionsLower institutional inequities in food insecurity after the onset of the pandemic may reflect more students returning home as well as an increase in social safety net programs. Regardless of cause, the high prevalence of food insecurity among students, especially at minority serving institutions, underscores the importance of addressing food insecurity at postsecondary campuses.

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments. Level of Clinical Evidence4

Health status and characterisation of Gibraltar’s Maerl beds

Maerl beds form heterogeneous, three-dimensional habitats for numerous species, housing high levels of biodiversity and species richness across the globe. Despite the importance of maerl’s ecological and carbon-regulating role; there is still a lack of information on methods to characterise its health. Therefore, this research set out to develop a standardised health assessment framework to assess the overall health of maerl a) structural function and b) habitat function. The framework was tested in an area of Gibraltar that has historically been severely impacted from various pressures including water quality. The maerl health is in a critical status, as over 92% of it is deemed dead, with high levels of surface erosion and unusual colourations observed, and rhodoliths were generally small in size (mean: 1.35cm ± 0.19cm). The habitat health was labelled as intermediate, based on the species richness values, signs of nursery function, high number of Terebellidae (n = 233), distribution and coverage, and type of sediment composition. The maerl-forming species morphologically identified as Lithophyllum cf. racemus and Lithothamnion cf. corallioides were found to be present in the study site, which are first records within Gibraltar’s waters.

Effects of video-based cervical stabilization home exercises in patients with rheumatoid arthritis: arandomized controlled pilot study.

This study aimed to examine the effects of aremote video-based cervical stabilization exercise program on cervical proprioception, functional status, and disease-related quality of life in patients with rheumatoid arthritis (RA). Patients with RA were evaluated regarding cervical joint positioning error, cervical region functional status (Neck Disability Index), general functional status (Health Assessment Questionnaire), and disease-related quality of life (Rheumatoid Arthritis Quality of Life Scale). Patients were randomized to exercise (n = 14, 10female) and control (n = 12, 9female) groups. Patients in the exercise group performed avideo-based home exercise program consisting of progressive cervical stabilization exercises three times aweek for sixweeks in addition to their routine medication. The patients in the control group continued their routine medication only. Evaluations were repeated in both groups in the seventh week following the baseline evaluation. Groups were similar at baseline (p > 0.05). Patients in both groups had low disease activity (DAS-28 CRP ≤ 3.2). The remote video-based exercise program led to significant improvements in cervical proprioception, functional status, and disease-related quality of life (p < 0.05). No significant changes were detected in any parameters in the control group (p > 0.05). Obtained changes were superior in the exercise group compared to the control group (d > 1.00, p < 0.05). Cervical stabilization exercises may increase cervical proprioception, improve functional status, and enhance disease-related quality of life in patients with RA when administered as aremote program. https://clinicaltrials.gov/study/NCT04948775 , NCT04948775.

Heavy metal toxicity and its human health assessment: A preliminary study from the Perumal Lake sediments, Tamil Nadu, India

The current investigation manifests the heavy metal toxicity and its human health assessment to appraise the environmental deterioration of the sediments within the Perumal Lake, Tamil Nadu, India. Five surface samples were collected from the Perumal Lake in 2023, which undergoes the selective perception of the granulometric analysis, implying supremacy of the clay content and limited sand and silt contents. The organic matter indicates the higher input of waste disposal, and the CaCO3 illustrates the existence of shell fragments in the lake environments. Noteworthy results of the heavy metal concentration as arranged in the devaluation order as Zn &gt; Cu &gt; Fe &gt; Cr &gt; Ni &gt; Mn &gt; Pb &gt; Co &gt; Cd. Followed by the heavy metal concentration, the environmental contamination indices such as Igeo denote that except for Cd metal, other heavy metals indicate moderate to extreme pollution status. The Enrichment Factor (Ef) illustrates Fe, Co, Cd, Zn, Cu, Ni, and Pb, highlighting no metal enrichment. In contrast, Mn and Cr reveal low metal enrichments, and the Cf reveals all the heavy metals, which argues for low to high contamination ranges. The Cd and the mCd are categorized as very high, and PERI underscores the low-risk category. The Hazard Index (HI) of the non-carcinogenic category and carcinogenic demonstrates that children and adults are primarily at risk of ingestion. At the same time, the dermal pathway indicates low jeopardy to children and adults and no risk to humans. The Heavy Metal Toxicity Load (HMTL) poses the sample location three registers a significant accumulation of toxic contagion proposed to remove from the sediments. Realm of heavy metal toxicity and its human health assessment underscores for researchers in environmental quality determination, and the strategies discussed such as phytoremediation, in-situ capping, and biotechnological techniques, may be helpful in evaluation and implement remediation methods of pollution in aquatic environments.

Measurement properties of the Portuguese version of the rheumatoid arthritis patient-reported experience measure (CQRA-PREM): a cross-sectional single center study

Measurement properties of the Portuguese version of the rheumatoid arthritis patient-reported experience measure (CQRA-PREM): a cross-sectional single center study