National Cross-sectional Survey Research Articles

Factors associated with bacterial sexually transmitted infection screening uptake and diagnosis among men who have sex with men in France

BackgroundThe prevalence of syphilis, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) in men who have sex with men (MSM) is very high. As these bacterial sexually transmitted infections (bSTIs) are frequently asymptomatic, they are often undiagnosed and therefore untreated. We aimed to characterize the profile of MSM who reported bSTI screening and diagnosis in the previous 12 months, and to identify the factors associated with a diagnosis of a bSTI among MSM in France.MethodsWe used data from Enquête Rapport au Sexe (ERAS), a large French national anonymous cross-sectional online survey among MSM conducted from 26 February to 11 April 2021. After comparing MSM screened and diagnosed in the previous year with those who were not, a binary logistic regression model was used to compare MSM diagnosed with at least one bSTI with those who were not.ResultsOf the 13 300 survey respondents, 6 263 (47.1%) MSM reported screening for at least one bSTI in the previous 12 months. Of these, 1 060 (16.9%) were diagnosed for at least one bSTI during their most recent screening. Specifically, 446 (7.1%) MSM were diagnosed with NG, 427 (6.8%) with CT, and 402 (6.4%) for syphilis. The following self-reported factors were associated with a greater likelihood of bSTI diagnosis: younger age, a lower educational level, frequenting MSM meeting places, not currently using pre-exposure prophylaxis (PrEP) but willing to take preventive treatment against bSTIs (reference group: not using PrEP and not willing to take preventive treatment against bSTIs), low health literacy, more than one sexual male partner, practicing chemsex, and condomless anal intercourse with casual male partners (the latter three factors concerning the previous six months).ConclusionsA large proportion of MSM were diagnosed for at least one bSTI. This result provides an insight into bSTI screening uptake and diagnosis among MSM in France, and could inform future decisions about how to plan effective bSTI screening and diagnosis programs for this population.

Understanding the distribution of recent deliberate self-harm among young LGBTQ+ australians

ABSTRACT Deliberate self-harm (DSH) is a high prevalence experience for lesbian, gay, bisexual, trans, non-binary and queer (LGBTQ) youth. These behaviours are associated with significant morbidity and suicidality and constitute a risk factor for future impairment. Presently, there is little understanding about how DSH burden is distributed among LGBTQ youth in Australia, and how engagement is shaped by biographic factors. A national cross-sectional online survey was conducted involving 5,660 LGBTQ participants in Australia aged 14–21. Univariable logistic regression analyses were used to explore the factors associated with recent DSH. Independent variables included demographic traits as well as experiences of verbal, physical and sexual harassment and attachment to one’s school. DSH is strongly associated with suicidality and clinically significant psychological distress. Likelihood of recent (<12 months) engagement did not differ by sexual orientation but was more likely among trans and non-binary youth, with the highest odds of engagement noted among trans men. DSH engagement was significantly associated with most domains of harassment experiences (physical and sexual), but attachment to one’s school or educational appeared to exert a protective effect. DSH engagement is unevenly distributed among LGBTQ youths; interventions should focus on fostering a positive and inclusive educational environment for those most impacted.

Flourishing and job satisfaction in employees working in UK clinical trial units: a national cross-sectional survey

BackgroundTo evaluate healthcare interventions in clinical trials, it is crucial to attract and retain a skilled workforce. The job demands associated with developing and running clinical trials have been linked with difficulties in recruiting and retaining skilled Clinical Trial Unit (CTU) staff. Flourishing conceptualises positive aspects of wellbeing which may help staff to thrive within a demanding job role. This study explored the association between flourishing and job satisfaction among staff based in UK Clinical Research Collaboration (UKCRC)-registered CTUs.MethodsA national online survey of UKCRC-registered CTUs was conducted which combined psychometric measures of flourishing (eudaimonic workplace wellbeing scale) and job satisfaction (including measures of turnover intention and workplace engagement), alongside free-text questions.ResultsFour hundred and eighty-four staff from 52 UKCRC CTUs completed the survey. Overall, participants reported 'average’ levels of job satisfaction and work engagement, but there was evidence that CTU staff reported slightly lower levels of flourishing and moderate levels of turnover intention. Salary, role, and flexible working arrangements were associated with levels of flourishing. When these factors were controlled for, higher levels of flourishing were still predictive of job satisfaction and turnover, but not work engagement. Qualitative analysis of free text responses revealed that elements of the working environment, such as supportive relationships, flexible working, and development opportunities, can act as resources to help employees flourish in their jobs.ConclusionsThrough exploring flourishing in CTU staff we identified factors which may help CTU employees thrive in their role, and in turn increase job satisfaction and commitment to their place of work. CTUs should consider the importance of developing a working environment which supports staff to feel valued, experience autonomy and supportive working relationships, as well as opportunities to develop and engage in meaningful work. Efforts to understand and protect the wellbeing of CTU staff are vital to attract and retain staff to design and conduct clinical trials. The learning from this may be applicable to other healthcare workforces facing a recruitment and retention crisis.

Prevalence and predictors of misperceptions of 'better-for-you' alcohol products among Australian adult drinkers.

This study investigated the prevalence and predictors of misperceptions about the healthiness of alcohol products carrying common health-oriented marketing cues and the relative importance of the type (versus amount) of alcohol consumed in contributing to health risks. Data were from a 2022 cross-sectional national population survey. Australian adults (18-65 years) who consumed alcohol in the past year (n = 1960) reported their agreement with statements that a selection of health-oriented marketing cues meant an alcohol product was 'better for you' and rated the importance of the type and amount of alcohol consumed in causing health risks. The majority of participants misperceived the type of alcohol to be at least as important as the amount in causing health risks (61%) and misperceived at least one health-oriented marketing cue as meaning a product was 'better for you' (75%). Misperceptions about low sugar, calorie and carbohydrate; and preservative-free claims (46-56%) were most common. Misperceptions about natural, organic, vegan, low sugar, low calorie, gluten-free and seltzer cues were less prevalent among older (45-65 years) than young adults (18-24 years, PR = 0.27-0.86). A lower proportion of women (compared to men) held misperceptions about vegan (PR = 0.66) and gluten-free claims (PR = 0.78), but a higher proportion held misperceptions about low sugar claims (PR = 1.13). There were also variations by socioeconomic status, alcohol consumption, education and regional/metropolitan location. Misperceptions about health-oriented marketing of alcohol are widespread. Further regulation of permissible alcohol marketing content is needed, but until then, differences in misperceptions between population segments may inform targeted health promotion efforts.

Spatiotemporal variations in body mass index among Han adolescents aged 18 years across 27 provinces of China, 1985–2019: Results from eight successive national cross-sectional surveys

ObjectivesTo investigate the spatiotemporal variations in body mass index among Han adolescents aged 18 years across 27 provinces of China from 1985 to 2019. Study designCross-sectional epidemiological study. MethodsA total of 141,406 adolescents aged 18 years were included from eight Chinese National Surveillance on Students’ Constitution and Health from 1985 to 2019. Body mass index data were extracted from 27 provinces in each CNSSCH. All provinces were categorized into seven regions. Linear regression was used to assess the trends. ResultsThe population-based national body mass index of boys and girls aged 18 years from 27 provinces increased by 2.35 kg/m2 and 1.40 kg/m2, respectively (all p < 0.001). Body mass index has been greater and the increase was larger in North China and East China during the 34-year period. Body mass index has been smaller and the increase was smaller in South China and Southwest China. The Northeast China had the largest increase in body mass index, becoming the region with the largest body mass index through 2019. ConclusionThe body mass index among Chinese adolescents aged 18 years across provinces increased from 1985 to 2019. Further national and local efforts are needed to address spatiotemporal variations in body mass index.

Uptake and experience of professional interpreting services in primary care in a South Asian population: a national cross-sectional study

BackgroundInterpreting services bridge language barriers that may prevent patients and clinicians from understanding each other, impacting quality of care and health outcomes. Despite this, there is limited up-to-date evidence regarding the barriers to and facilitators of uptake in primary care. The aim of this study was to ascertain current national uptake and experience of interpreting services in primary care (general practice) by South Asian communities in England.MethodsWe conducted a national cross-sectional survey in 2023 with people with limited or no English language proficiency (n = 609). Multilingual researchers interviewed people from Bangladeshi (n = 213), Indian (n = 200), and Pakistani (n = 196) backgrounds from four regions in England (Greater London, Midlands, Yorkshire and the Humber, North West).ResultsSixty-three percent of participants reported using professional interpreting services in primary care. The most common modality was face-to-face interpreting (55%), followed by telephone (17%) and video (8%). Multivariable analysis identified several correlates of lower uptake: participants from Indian backgrounds, those living in the Midlands, and those whose family member/friend interpreted for them within the past year were less likely to have used a professional interpreter provided by their general/family practice. Participants who had visited primary care within the last 12 months, had requested an interpreter but were told they could not have one, were informed about professional interpreting services, and were given choice in their language support were more likely to have used a professional interpreter.ConclusionsOur approach provides novel data on professional interpreting service use and evidence about the factors that may play a role in patient uptake and experience.

Frontline clinic perspectives on climate change, human health, and resilience: a national cross-sectional survey

BackgroundFrontline clinics - primary care clinics that predominantly serve low-income and socially disadvantaged communities - are facing increasing impacts from climate-related extreme events. This study evaluated staff perspectives at frontline clinics on the health risks of climate change, the impacts of extreme events on their clinics and patients, and their motivators to improve climate resiliency.MethodsA national, cross-sectional survey was conducted of staff working at frontline clinics including administrators, case workers, and providers across the United States. Survey questions assessed clinic and respondent attributes, knowledge of health risks of climate change, preferences for climate change educational and operational resources, and clinic and patient climate impacts and resilience. The survey was distributed electronically to a convenience sample of primary care clinics and to the National Association of Community Health Centers (NACHC) and National Association of Free and Charitable Clinics (NAFC) listservs. Data was collected from September to November of 2021. Respondents were current staff who consented to the survey. Responses were collected via Qualtrics, and the statistical analysis was completed using Stata.ResultsA total of 430 surveys were completed representing clinics in 43 states. Most (82.0%) respondents reported human activities were causing climate change. Over half (52.8%) of respondents reported an operational disruption to their clinic from extreme events in the past 3 years, and another 54.4% had plans in place to address risks from extreme events. The most useful resources identified to improve operational resilience were checklists and planning guidance. Over half (52.0%) of respondents reported they were motivated to use these resources to improve clinic preparedness. Most (84.4%) providers and case workers reported that climate change impacted patient health, however only 36.2% discussed health risks with patients, with barriers including more pressing topics and time available. Another 55.7% of respondents reported they were motivated to learn ways to help patients prepare for extreme events.ConclusionsClimate-related extreme events were reported to impact patient health and disrupt frontline clinic operations. Overcoming gaps in knowledge about climate change impacts on health and providing climate educational resources can engender motivation to improve clinic and patient resilience to climate change.

Factors Contributing to Successful Information System Implementation and Employee Well-Being in Health Care and Social Welfare Professionals: Comparative Cross-Sectional Study.

The integration of information systems in health care and social welfare organizations has brought significant changes in patient and client care. This integration is expected to offer numerous benefits, but simultaneously the implementation of health information systems and client information systems can also introduce added stress due to the increased time and effort required by professionals. This study aimed to examine whether professional groups and the factors that contribute to successful implementation (participation in information systems development and satisfaction with software providers' development work) are associated with the well-being of health care and social welfare professionals. Data were obtained from 3 national cross-sectional surveys (n=9240), which were carried out among Finnish health care and social welfare professionals (registered nurses, physicians, and social welfare professionals) in 2020-2021. Self-rated stress and stress related to information systems were used as indicators of well-being. Analyses were conducted using linear and logistic regression analysis. Registered nurses were more likely to experience self-rated stress than physicians (odds ratio [OR] -0.47; P>.001) and social welfare professionals (OR -0.68; P<.001). They also had a higher likelihood of stress related to information systems than physicians (b=-.11; P<.001). Stress related to information systems was less prevalent among professionals who did not participate in information systems development work (b=-.14; P<.001). Higher satisfaction with software providers' development work was associated with a lower likelihood of self-rated stress (OR -0.23; P<.001) and stress related to information systems (b=-.36 P<.001). When comparing the professional groups, we found that physicians who were satisfied with software providers' development work had a significantly lower likelihood of stress related to information systems (b=-.12; P<.001) compared with registered nurses and social welfare professionals. Organizations can enhance the well-being of professionals and improve the successful implementation of information systems by actively soliciting and incorporating professional feedback, dedicating time for information systems development, fostering collaboration with software providers, and addressing the unique needs of different professional groups.

Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study.

Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear. This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study. A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators. Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men. There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.

Trends in the practice environment of Chinese healthcare professionals from 2008 to 2023: an age period cohort analysis

BackgroundHealthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals’ perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis.MethodsFour national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor–patient relationships were also analyzed.ResultsBetween 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28–38 during 2013–2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor–patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment.ConclusionsThe APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.

Differences in Post-Traumatic Stress Disorder (PTSD) Between U.S. Civilians and Military Veterans in the Gulf War and Post-9/11 War Eligibility Cohorts: A Research Note

Post-traumatic stress disorder (PTSD) is common among military veterans who experienced combat compared with those who did not. However, it is unknown how PTSD rates differ between veterans and nonveterans when accounting for combat status. We used a sample of 10,880 participants from the 2021 and 2022 National Wellbeing Survey—national annual cross-sectional surveys of U.S. adults aged 18 to 64—to assess relationships between military veteran-combat status and PTSD diagnosis among two war eligibility cohorts: the Gulf War and post-9/11 conflicts. We found that among both war eligibility cohorts, combat veterans were more likely than nonveterans to report a PTSD diagnosis: 3.42 times greater probability in the Gulf War eligibility cohort and 4.87 times greater probability in the post 9/11 cohort. Noncombat veterans had greater probability of PTSD (odds ratio [ OR] = 1.63) than nonveterans only in the post 9/11 cohort. These results underscore the importance of ensuring proper mental health care for combat veterans.

A cross-sectional study of anesthesia medical staff's occupational and health status in nongovernment medical institutions in China.

Nongovernment medical institutions have gradually become a significant part of China's healthcare system, with a growing numbers of staff. However, the current status of anesthesiology staff in these institutions is unclear. To gain insight into this situation and to compare it with public hospitals, the national anesthesia professional committee of the Chinese Nongovernment Medical Institutions Association (CNMIA) designed and conducted the national cross-sectional survey. We conducted a national cross-sectional study to investigate the occupational and health status of anesthesiology staff in Nongovernment medical institutions. Additional questions were included for the directors of the anesthesiology department to understand their work stress and the reasons for employee turnover. The electronic questionnaire was created using Questionnaire Star and distributed by Anesthesia Professional Committee of the CNMIA through the QR code links and WeChat. A total of 1111 questionnaires were collected, including 989 from anesthesiologists and 122 from nurse anesthetists. The overall job satisfaction score (MSQ) was 75.57 ± 12.32 and the average fatigue score (MFI-20) was 49.10 ± 10.90. High-risk factors for severe fatigue included being aged 31-40, holding a middle title, frequently working night shifts, having long working hours, and participating surgeries classified as ASA III or higher. The most common disease reported was difficulty falling asleep/insomnia. Multivariate logistic regression analysis showed that men (OR = 0.662, 95% CI: 0.482-0.909, p < 0.05), those with a bachelor's degree (OR = 2.152, 95% CI: 1.186-3.903, p < 0.05), individuals with heavy workloads (OR = 2.999, 95% CI: 1.493-6.024, p < 0.01), poor health (OR = 4.280, 95% CI: 1.216-15.057, p < 0.05), and high MFI-20 scores (OR = 1.085, 95% CI: 1.067-1.103, p < 0.001) were more likely to suffer from insomnia. Directors identified medical quality and safety management as their main source of stress and low income as the primary reason for employee resignation. Nongovernment medical institutions have fewer employees, similar workloads, relatively low job stress and higher job satisfaction compared to public hospitals. Low income and difficulty falling asleep/insomnia are significant issues that require attention.

Sequential multiple mediating effect of loneliness and family health on physical frailty and willingness to age at home in older adults: a national survey in China

BackgroundWith the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults.MethodsThis study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann–Whitney U test and Kruskal–Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis.ResultsA total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = − 0.044, P < 0.01) and loneliness (β = − 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = − 0.018, Boot SE = 0.002, 95% CI = [–0.022, − 0.014]) between physical frailty and willingness to age at home.ConclusionsReducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home.

Weight control efforts and practices and health professional advice: a cross-sectional national survey in England

ObjectivesThere is evidence that general practitioners (GPs) can increase the uptake of weight management programmes that enhance weight loss compared with self-directed efforts, but the rate at which they do...

Understanding Psychological Symptoms Among Chinese College Students During the COVID-19 Omicron Pandemic: Findings from a National Cross-Sectional Survey in 2023

During the Omicron pandemic in late 2022, this study surveyed Chinese students via an online questionnaire to assess their mental health status, prevalence of psychological symptoms, and associated factors. A nationwide cross-sectional survey of 4254 participants was conducted in seven regions of China from January 5 to February 9, 2023. Scales were utilized respectively to measure depressive symptoms, anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms, and perceived social support. Descriptive, univariate, and multivariable analyses were performed to identify associated factors. Protective factors against depressive symptoms include regular exercise and robust social support networks, while risk factors involve excessive alcohol consumption, comorbidities, Omicron infection, and irregular sleep patterns. Risk factors for anxiety symptoms include comorbidities, Omicron infection, living alone, and irregular sleep patterns, while social support emerges as a protective factor. For PTSD symptoms, regular exercise and strong social support systems are identified as protective measures, with risks associated with comorbidities, Omicron infection, and poor sleep quality. Students are particularly vulnerable during the pandemic due to their lifestyle and academic pressures. It's essential to bolster their social support and promote healthier habits

Public perceptions of climate change and health in Wales: a national cross-sectional survey

BackgroundClimate change significantly threatens global health. In Wales, rising temperatures are projected to exacerbate extreme weather, disproportionately impacting vulnerable populations. Despite efforts to mitigate climate change, understanding of public perceptions and behaviours remains limited. To address this, a national survey was conducted to assess population views on climate change, policy solutions, health implications and climate-friendly behaviours. MethodsA cross-sectional survey targeted a stratified random sample of Welsh residents aged ≥16, using lower super output area as the sampling unit, stratified by health board and deprivation quintile. Ethical approval and informed consent were obtained. Self-reported data were collected via interviews and an online panel survey, and weighted to reflect national population demographics. Analyses included descriptive statistics and multivariate analyses to examine the impact of gender, age, deprivation, location and education on population views and behaviours. FindingsData from 2296 participants showed 82% were concerned about climate change, with females (adjusted odds ratio 1·824, 95% CIs 1·446–2·301, p<0·001) and those with higher education (3·073, 2·023–4·669, p<0·001) more likely to express concern. Heating costs (18%) and access to health services (14%) were the top health-related concerns across all demographics. Popular mitigation policies, each strongly supported by 63%, included expanding renewable energy, improving public transport, and reducing plastic packaging. Challenges include confusion due to conflicting information (54%) and reluctance to adopt certain climate-friendly behaviours like reducing meat and dairy intake (41%). InterpretationResults indicate public concern about climate change and support for mitigation policies. Key areas for future action include provision of trusted information, promoting personal responsibility for action, providing guidance on engaging in climate-friendly actions, and capitalising on opportunities to shift attitudes. While the study's cross-sectional design offers only a snapshot of public views, future research could track opinion changes over time. Findings can inform targeted strategies to mitigate climate change and protect public health. FundingPublic Health Wales NHS Trust.

Health information system support for collaboration between physicians and registered nurses: National cross-sectional user experience surveys from 2010 to 2023

BackgroundIn addition to storing patient data, health information systems (HISs) should advance continuity and quality of care by supporting collaboration between physicians and registered nurses (RNs). Our aim was to study how physicians and RNs experience this support and how the situation has evolved from 2010 to 2023. MethodsNationwide usability-focused cross-sectional surveys were conducted among Finnish physicians in 2010, 2014, 2017, and 2021 and RNs in 2017, 2020, and 2023. For this study, we selected respondents (1807–2555 physicians and 1126–1950 RNs) working in public sector wards and outpatient clinics and using the six largest electronic health record (EHR) system brands. Eight statements related to collaboration were analyzed by professional group and study year. ResultsAlthough both professional groups rated HIS support for collaboration and information exchange between physicians and RNs relatively positively (42–69% agreed), their experiences had not improved much over the years. Continuity of care was considered good by 34–54% of physicians and 51–58% of RNs. Half of respondents were dissatisfied with the readability of nursing documentation (52–56% of physicians and 30–37% of RNs) and support for noticing new orders (40–46% of physicians and 26–36% of RNs). Only 7–30% of all respondents felt that patient summary views provided by EHR systems helped to form an overall picture of the patient’s situation; however, the proportion did improve over the years. ConclusionsHISs were considered to better support collaboration among their own professional group than between physicians and RNs. As reviewing patient information forms a basis for decision making and high-quality care, EHR development should not only focus on ordering and documentation tools but also on securing multiprofessional utilization of data. Indeed, the varied needs of professional groups should be recognized in the early stages of the development process.

Cross-Sectional National Survey of Practice Patterns in Radiotherapy for Rectal Cancer: A Snapshot of India.

The information on the practice of radiotherapy, including intensity-modulated radiotherapy (IMRT) use for rectal cancer in India, is lacking. This national survey was planned to understand the current status of knowledge, attitudes, and practice among radiation oncologists, specifically concerning the practice of IMRT for rectal cancers. A national survey was sent to radiation oncologists through e-mail or a WhatsApp message, where feasible, with a request letter containing the link to the survey questionnaire. The survey questionnaire was adapted from the UK IMRT survey with permission from the authors. It explored rectal cancer management, IMRT use, reasons for nonadoption, total neoadjuvant therapy (TNT), dose fractionation schedules and radiotherapy processes like radiotherapy simulation, target volume/organ at risk definition, and treatment planning, evaluation, and verification. Descriptive statistics is used to present the results. Over 300 radiation oncologists were approached, and 182 (60.6%) of the 153 institutes responded. Around 88% (160 of 182) indicated using IMRT or volumetric modulated arc therapy (VMAT) to treat rectal cancer, of whom 32% used exclusively IMRT/VMAT in all their patients. The reasons for not adopting IMRT were affordability/lack of insurance, resource constraints, and lack of guidelines. Long-course chemoradiation (capecitabine-based) followed by surgery was the most common neoadjuvant approach, with short course and TNT in less than a third of patients. Daily verification feasibility was reported by 60%. Seventy-three percent emphasized the need for a national IMRT guidance document. This national survey from India indicates a scope of routine implementation of IMRT in rectal cancer, highlighting the urgent need for a national IMRT guidance document, which could significantly enhance the quality of care for patients with rectal cancer in India.

Importance of medical home domains on emergency visits using a cross-sectional national survey of US children.

Receiving care at patient-centred medical homes (PCMH) is associated with reduced emergency department (ED) visits among children. Adverse social determinants of health (SDoH), such as lower socioeconomic status and household poverty, are associated with increased ED visits in children. The objective of this study is to use machine learning techniques to understand the relative importance of each PCMH component among different populations with adverse SDoH on the outcome of ED visits. This study used the 2018-2019 pooled data from the National Survey of Children's Health (NSCH), an annual survey of parents and caregivers of US children from birth to 17 years. PCMH components were operationalised by classifying parent/caregiver responses into five domains: care coordination (CC), having a personal doctor or nurse, having a usual source of care, family-centred care and ease of getting referrals. SDoH included five categories: (1) social and community context, (2) economic stability, (3) education access and quality, (4) healthcare access and quality and (5) neighbourhood and built environment. We used a split-improvement variable importance measure based on random forests to determine the importance of PCMH domains on ED visits overall and stratified by SDoH. Overall, between 3% and 28% experienced one or more gaps in PCMH domains. Models show that problems with referrals (rank, 2; Gini, 83.5) and gaps in CC (rank, 3; Gini, 81.0) were the two most important domains of PCMH associated with ED visits in children. This result was consistent among black and Hispanic children and among children with lower socioeconomic status. Our study findings underscore the importance of poor CC and referrals on ED visits for all children and those from disadvantaged populations. Initiatives for expanding the reach of PCMH should consider prioritising these two domains, especially in areas with significant minority populations.

Rural-urban differences in common mental disorders among Indonesian youth: a cross-sectional national survey.

The onset of common mental disorders (CMDs) is most prevalent among youth; thus, mental health management is crucial. We examined differences in risk and risk factor determinants regarding CMDs prevalence among youth in rural and urban Indonesia. This cross-sectional study utilized data from the 2018 Indonesia National Health Survey. The population comprised 122,114 respondents, aged 15 to 24 years, who had completed the 20-item Self-Report Questionnaire along with providing demographic and health behavior data. Chi-square testing and logistic regression were employed for analysis. The CMDs risk was higher among urban than rural youth. Risk factors impacting both populations included being female, having a lower education level, consuming fewer than 7 portions of vegetables weekly, smoking, and drinking alcohol (p<0.05). Consuming under 7 portions of fruit weekly and being in the highest or lowest wealth quintile were significant risk factors only in urban youth, while unemployment and divorce were significant only among rural respondents (p<0.05). Marriage was protective against CMDs among rural participants. Being male, possessing a college degree, consuming at least 7 portions of vegetables weekly, not smoking, and not consuming alcohol were associated with reduced CMDs risk in urban and rural youth. Among rural youth, marriage and employment were linked to decreased risk, whereas divorce displayed the opposite relationship. In urban populations, consuming at least 7 portions of fruit weekly and belonging to neither the highest nor the lowest economic quintile were protective factors. Management strategies for CMDs in young people must address these considerations.