Cross-sectional Study Research Articles

Predicting Intention for Food Safety Behavior among Food Handlers: A Cross-sectional Study in Indonesia’s Beach Culinary Area

Background: The food safety behavior of food handlers constitutes the main factor in foodborne disease control. According to the Theory of Planned Behavior, behavior is determined by the intention that is established from a combination of attitudes, subjective norms, and perceived behavioral control. This research aimed to predict the intention for food safety behavior using the Theory of Planned Behavior. Methods: A cross-sectional study was conducted for two months in the Bantul beach culinary area, Yogyakarta, Indonesia. The research population consisted of 80 food handlers representative of all existing seafood stalls. The respondents were interviewed face-to-face using a paper-based questionnaire related to attitudes, subjective norms, perceived behavioral control, and intention. The data collected were evaluated using structural equation model-partial least square (SEM-PLS), version 3.0, with a sig. level of 0.05. Results: This research successfully predicted 64.3% of the variance in the intention for food safety behavior of food handlers (R2 adjusted = 0.643). The variable-perceived behavioral control was the strongest and most significant predictor, with a positive effect on intention for food safety behavior (β = 0.560, p = 0.000 < 0.05), followed by the variable subjective norms (β = 0.275, p = 0.001 < 0.05). The variable attitude was the weakest predictor, with an insignificant positive effect (β = 007.0, p = 0.182 > 0.05). Conclusion: This research successfully predicted the intention for food safety behavior of food handlers in the Bantul beach culinary area, Yogyakarta, Indonesia.

Neonatal mortality during the war in Tigray: a cross-sectional community-based study

Neonatal mortality is among the key national and international indicators of health services. The global Sustainable Development Goal target for neonatal mortality is fewer than 12 deaths per 1000 livebirths, by 2030. Neonatal mortality estimates in the 2019 Ethiopian Demographic Health Survey found 25·7 deaths per 1000 livebirths. Subnational surveys specific to Tigray, Ethiopia, reported a neonatal mortality lifetime prevalence of 7·13 deaths. Another government report from the Tigray region estimated a neonatal mortality rate of ten deaths per 1000 livebirths in 2020. Despite the numerous interventions in Ethiopia's Tigray region to achieve the Sustainable Development Goals, the war has disrupted most health services, but the effect on neonatal mortality is unknown. Thus, this study aimed to investigate the magnitude and causes of neonatal mortality during the war in Tigray. A cross-sectional community-based study was conducted in Tigray to evaluate neonatal mortality that occurred from Nov 4, 2020, to May 30, 2022. Among the 31 districts, 121 tabias were selected using computer-generated random sampling, and 189 087 households were visited. We adopted a validated WHO 2022 verbal autopsy tool, and data were collected using an interviewer-administrated Open Data Kit. In the absence of the mother, other respondents to the verbal autopsy interview were household members aged 18 years and older who provided care during the final illness that led to death. 29 761 livebirths were recorded during the screening of 189 087 households. Verbal autopsy was administered for 1158 households with neonatal deaths. 317 neonates were stillborn, and 841 neonatal deaths were recorded with the WHO 2022 verbal autopsy tool from Nov 4, 2020, to May 30, 2022, in 31 districts. The neonatal mortality rate was 28·2 deaths per 1000 livebirths. 476 (57%) of the 841 neonatal deaths occurred at home and 296 (35%) in health facilities. A high rate of neonatal deaths was reported in rural districts (80% [673 of 841]) compared with urban districts (20% [168 of 841]), and 663 (79%) deaths occurred during the early neonatal period, in the first week of life (0-6 days). The leading causes of neonatal death were asphyxia (35% [291 of 834]), prematurity (30% [247 of 834]), and infection (12% [104 of 834]). Asphyxia (37% [246 of 663]) and infection (28% [50 of 178]) were the leading causes of death for early and late neonatal period deaths, respectively. Neonatal mortality in Tigray is high due to preventable causes. An urgent response is needed to prevent the high number of neonatal deaths associated with the depleted health resources and services resulting from the war, and to achieve the Sustainable Development Goal on neonatal mortality. UNICEF and United Nations Fund for Population Activities. For the Tigrigna translation of the abstract see Supplementary Materials section.

Systemic and Cutaneous Side Effects of COVID-19 Vaccines in Iraq, A cross-sectional study

Systemic and Cutaneous Side Effects of COVID-19 Vaccines in Iraq, A cross-sectional study

Robotic Telepresence and Face-to-Face Collaborative Nursing Simulation: A Correlational, Cross-Sectional Study

BackgroundMobile robotic telepresence provides an equitable opportunity for distance learners to collaborate with face-to-face counterparts through live simulation at a campus-based point of learning. The Technology Acceptance Model serves as the theoretical framework regarding ease of use and perceived usefulness of telepresence robots as the stress and anxiety of simulation and novel technologies can impact learning. MethodsUsing peer/collaborative learning, waves of undergraduate nursing student dyads (distance/telepresence with face-to-face) provided patient care in multiroom simulations. The correlational, cross-sectional study surveyed students to assess a relationship between anxiety, use of new technology, and student satisfaction, and self-confidence in learning. ResultsState trait anxiety inventory scores were significantly higher in distance/telepresence students. The mean overall score for satisfaction/self-confidence in learning was favorable for all students. ConclusionTelepresence robots in simulation may increase learner acceptance and readiness to use such technology within their future practice.

Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study

Although the stigma associated with seeking professional psychological help has received significant attention, few studies have focused on the status and factors influencing this stigma among pregnant women, especially those with a Chinese cultural background. This study aimed to assess the status of stigma associated with seeking professional psychological help and its influencing factors. A total of 1325 pregnant women were recruited from Hunan Province, China. The Stigma for Seeking Professional Psychological Help questionnaire, Patient Health Questionnaire-9, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and questionnaires on sociodemographic characteristics and pregnancy-related information were used. Descriptive, univariate, correlation, and multivariate linear regression analyses were used to investigate the status of stigma and identify its influencing factors. Pregnant Chinese women experienced a mild to moderate level of stigma associated with seeking professional psychological help, and self-stigma was more common than social stigma associated with seeking psychological help. The results of the multivariate analysis suggested that perceived social support, positive coping styles, negative coping styles, and depressive symptoms were the factors influencing self-stigma and social stigma associated with seeking professional psychological help. Advanced age and a low educational level were the only predictors associated with self-stigma, while a history of multiple pregnancies had an effect only on social stigma associated with seeking professional psychological help. Chinese pregnant women experienced a mild to moderate level of stigma associated with seeking professional psychological help. Destigmatizing interventions focusing on self-stigma and social stigma should be designed according to maternal characteristics, social support, coping style, and depressive symptoms.

Association between a malnutrition screening tool and mealtime observation checklist items in older people receiving oral intake support: A cross-sectional study of four long-term care facilities.

Multiple nutritional screening tools are available for older people; however, few screening tools include specific eating behaviours as risk factors that could lead to poor food intake. The 24-item mealtime observation checklist (MOCL), developed by the Japanese Ministry of Health, Labour and Welfare in 2015, comprises signs, symptoms and conditions during mealtime that reflect eating and swallowing functions and oral conditions. To examine factors associated with malnutrition among the MOCL items in older people. A cross-sectional study was conducted using data from a retrospective cohort study conducted at four long-term care facilities in Japan. Among the older people residing in the facilities, 198 who received oral intake support were included in the analyses. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA®-SF), and comparisons were made between 'malnutrition' and 'at-risk or well-nourished'. The association between each MOCL item and malnutrition was assessed using multivariable logistic regression analysis. Of the 198 participants, 98 (49.5%) were classified as 'malnutrition', 98 (49.5%) as 'at-risk' and 2 (1%) as 'well-nourished' by MNA®-SF. After adjusting for participant characteristics such as age and sex, significant associations with malnutrition were observed for four items from the 24-item MOCL: 'Has fatigue due to extended mealtime (odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.36-7.53)', 'Food residues in the oral cavity are conspicuous (OR = 2.77, 95% CI: 1.38-5.52)', 'Has difficulty swallowing food and takes time to swallow (OR = 3.78, 95% CI: 1.45-9.84)' and 'Assisted feeding is required (OR = 3.70, 95% CI: 1.73-7.91)'. The four signs, symptoms and conditions during mealtime identified in this study may be associated with malnutrition in older people. These may indicate the potential eating problems that can lead to malnutrition. By incorporating them into early intervention and prevention measures, health care providers may help prevent malnutrition and improve the nutritional status of older people.

Adverse Effects Post COVID-19 Vaccination and its Association with Age, Gender and Comorbid Disease in Basrah City Southern of Iraq.

Vaccination against COVID-19 virus is the most valuable tool available for protection during the pandemic of coronavirus. The clinical manifestation post-vaccination is a barrier to vaccination for many people in Iraq and worldwide. The objective of this study is identifying various clinical manifestations occurring after receiving vaccines among individuals in Basrah Governorate. Moreover, we examine its association with respondents' demographics and the type of vaccine they received. A cross-section study was conducted in Basrah, southern Iraq. Research data were collected through an online questionnaire. The data were analyzed using both descriptive and analytic statistical tools using the SPSS program. Most of the participants (86.68%) received the vaccine. The side effects were reported in 71.61% of vaccinated individuals. Fever and muscle pain were the two most experienced clinical manifestations, while lymph node enlargement and disturbances in taste and/or smell sensations were reported infrequently. Adverse effects were mostly reported with the Pfizer BioNTech vaccine receiver. Females and those in the younger age group also reported a significantly higher incidence of side effects. Most adverse effects related to the COVID-19 vaccine were minor and could be tolerated without the need for hospital admission.

Mediating effects of sleep quality between clinical characteristics and quality of life in children with epilepsy: A cross-sectional study from Southwest China

BackgroundAlthough sleep quality (SQ) reportedly affects the health-related quality of life (QOL) of patients with epilepsy, little is known about the potential association between SQ and QOL, particularly in children with epilepsy (CWE). Our study aimed to investigate the mediating effect of SQ on the QOL of CWE to obtain more information for the prevention and treatment of epilepsy in children. MethodsWe collected general demographic and clinical data of 212 CWE and 79 controls (children who visited the Health Examination Department), and their guardians were instructed to answer the Children’s Sleep Habits Questionnaire (CSHQ) and the optimized Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). The t-test, analysis of variance, chi-square test, and Fisher’s exact test were used for between group comparisons. The Pearson correlation was used to analyze the correlation between variables. The direct, indirect, and total effects of predictors on the QOL of CWE were estimated based on an adjusted mediation model. ResultsCWE had significantly smaller long-term urban residence rates, less educated guardians, higher total CSHQ score, higher incidence of poor SQ, higher bedtime resistance, more sleep anxiety, worse sleep-disordered breathing, increased parasomnia, more daytime sleepiness, more frequent night waking, and greater sleep onset delay than controls (P < 0.05 for all). The univariable analysis showed significant differences in total CSHQ scores between CWE with different seizure frequency in the last month, whether or not drug-resistant epilepsy (DRE), and with different video electroencephalogram (VEEG) findings (P < 0.05 for all). Differences in QOLCE-16 scores between CWE with different guardian’s employment status, age at diagnosis, number of anti-seizure medication (ASM) types, seizure frequency in the last month, DRE status, seizure type, VEEG findings, neuropsychological evaluation findings, magnetic resonance imaging (MRI) findings, and etiology were statistically significant (P < 0.05 for all). The correlation study indicated that the total CSHQ score was negatively correlated with the QOLCE-16 score (P < 0.05). The mediation analysis showed that DRE and VEEG abnormalities had a standardized direct effect on the QOL. Seizure frequency in the last month, DRE, and VEEG abnormalities had an indirect effect on the QOL through SQ, and their mediating effect values of SQ were 31.61 %, 13.45 %, and 14.35 %, respectively. ConclusionOur findings uncovered the relationship of some clinical characteristics with SQ and QOL and characterized the nature of factors affecting the QOL of CWE. SQ could be a key factor in the prognosis of CWE experiencing epileptic seizures, and more attention should be paid on the management of SQ in interventions for epilepsy.

Comparison of tau spread in people with Down syndrome versus autosomal-dominant Alzheimer's disease: a cross-sectional study

Comparison of tau spread in people with Down syndrome versus autosomal-dominant Alzheimer's disease: a cross-sectional study

Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran

ObjectivesCancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL). MethodsWe analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs. ResultsA total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study. ConclusionsThe results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.

Child immunization status according to number of siblings and birth order in 85 low- and middle-income countries: a cross-sectional study

Identification of unvaccinated children is important for preventing deaths due to infections. Number of siblings and birth order have been postulated as risk factors for zero-dose prevalence. We analysed nationally representative cross-sectional surveys from 85 low and middle-income countries (2010-2020) with information on immunisation status of children aged 12-35 months. Zero-dose prevalence was defined as the failure to receive any doses of DPT (diphtheria-pertussis-tetanus) vaccine. We examined associations with birth order and the number of siblings, adjusting for child's sex, maternal age and education, household wealth quintiles and place of residence. Poisson regression was used to calculate zero-dose prevalence ratios. We studied 375,548 children, of whom 13.7% (n=51,450) were classified as zero-dose. Prevalence increased monotonically with birth order and with the number of siblings, with prevalence increasing from 11.0% for firstborn children to 17.1% for birth order 5 or higher, and from 10.5% for children with no siblings to 17.2% for those with four or more siblings. Adjustment for confounders attenuated but did not eliminate these associations. The number of siblings remained as a strong risk factor when adjusted for confounders and birth order, but the reverse was not observed. Among children with the same number of siblings, there was no clear pattern in zero-dose prevalence by birth order; for instance, among children with two siblings, the prevalence was 13.0%, 14.7%, and 13.3% for firstborn, second, and third-born, respectively. Similar results were observed for girls and boys. 9513 families had two children aged 12-35 months. When the younger sibling was unvaccinated, 61.9% of the older siblings were also unvaccinated. On the other hand, when the younger sibling was vaccinated, only 5.9% of the older siblings were unvaccinated. The number of siblings is a better predictor than birth order in identifying children to be targeted by immunization campaigns. Zero-dose children tend to be clustered within families. Gavi, the Vaccine Alliance.

Mental Health Disorders in Healthcare Workers Exposed to COVID-19, Mashhad, Iran: A Cross-sectional Study

Background: Healthcare workers (HCWs) who are directly involved in the management of patients with SARS-CoV-2 infection are at higher risk of psychological disorders. Objective: In this study, we evaluated the risk factors related to mental health disorders in HCWs active in the management of the COVID-19 pandemic in Mashhad, Iran. Methods: This was a cross-sectional investigation performed between April 2020 and May 2020 at five referral centers in Mashhad, Iran. Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder scale (GAD-7), Insomnia Severity Index (ISI), Impact of Event Scale–Revised (IESR), and VAS (for fear from COVID-19) to assess depression, anxiety, insomnia, distress and fear related to COVID-19 were filled. Risk factors were evaluated by the regression model. Results: Mean ± SD age of participants was 33.84 ± 7.03 years. Most were females (64.2%). Of 360 participants, 252 had some degree of an anxiety disorder (70%), 63.8% had depression, 55.8% had insomnia, and 72.8% had distress. Work experiences (OR: 0.94, 95% CI = 0.901- 0.983, p = 0.007), exposure to COVID-19 patients (OR: 2.54, 95% CI = 1.37-4.69, p &lt; 0.001), and job status (OR: 1.40, 95% CI = 1.19 -1.54, p &lt; 0.001) were significant predictors of anxiety. Age (OR: 1.15, 95% CI = 1.05-1.27, p = 0.002), exposure to COVID-19 patients (OR: 1.95, 95% CI = 1.04-3.64, p = 0.037), work experience (OR: 0.86, 95% CI = 0.78-0.93, p &lt; 0.001), having children (OR: 0.58, 95% CI = 0.39- 0.87, p = 0.008), and being infected with COVID-19 (OR: 9.95, 95% CI = 1.92-51.64, p &lt; 0.001) were the significant independent factors for depression in participants. Conclusion: COVID-19 could significantly affect HCWs mental health status, specifically depression. By targeting these predictors, health policymakers can reduce the burden of psychological disorders in HCWs.

Disease-Modifying Treatments for Multiple Sclerosis Affect Measures of Cellular Immune Responses to EBNA-1 Peptides.

Epstein-Barr virus (EBV) has been strongly implicated in the pathogenesis of multiple sclerosis (MS). Despite this, there are no routinely used tests to measure cellular response to EBV. In this study, we analyzed the cellular response to EBV nuclear antigen-1 (EBNA-1) in people with MS (pwMS) using a whole blood assay. This cross-sectional study took place in a dedicated MS clinic in a university hospital. We recruited healthy controls, people with epilepsy (PWE), and pwMS taking a range of disease-modifying treatments (DMTs) including natalizumab, anti-CD20 monoclonal antibodies (mAbs), dimethyl fumarate (DMF), and also treatment naïve. Whole blood samples were stimulated with commercially available PepTivator EBNA1 peptides and a control virus-cytomegalovirus (CMV) peptide. We recorded the cellular response to stimulation with both interferon gamma (IFN-γ) and interleukin-2 (IL-2). We also compared the cellular responses to EBNA1 with IgG responses to EBNA1, viral capsid antigen (VCA), and EBV viral load. We recruited 86 pwMS, with relapsing remitting MS, in this group, and we observed a higher level of cellular response recorded with IFN-γ (0.79 IU/mL ± 1.36) vs healthy controls (0.29 IU/mL ± 0.90, p = 0.0048) and PWE (0.17 IU/mL ± 0.33, p = 0.0088). Treatment with either anti-CD20 mAbs (0.28 IU/mL ± 0.57) or DMF (0.07 IU/mL ± 0.15) resulted in a cellular response equivalent to control levels or in PWE (p = 0.26). The results of recording IL-2 response were concordant with IFN-γ: with suppression also seen with anti-CD20 mAbs and DMF. By contrast, we did not record any differential effect of DMTs on the levels of IgG to either EBNA-1 or VCA. Nor did we observe differences in cellular response to cytomegalovirus between groups. This study demonstrates how testing and recording the cellular response to EBNA-1 in pwMS may be beneficial. EBNA-1 stimulation of whole blood samples produced higher levels of IFN-γ and IL-2 in pwMS compared with controls and PWE. In addition, we show a differential effect of currently available DMTs on this response. The functional assay deployed uses whole blood samples with minimal preprocessing suggesting that employment as a treatment response measure in clinical trials targeting EBV may be possible.

Assessment of the general health status of children in Turkey: A community-based cross-sectional study.

This study aims to assess the general health status and factors affecting the general health status in the 0-14 age group in Turkey. This cross-sectional study was conducted using the Turkish Statistical Institute Turkey Health Survey 2022 micro data set. This study included 7019 participants. Household heads described the general health status of 91.3% of children and the dental and gum status of 82.4% of children as very good or good, and 9.2% of children had any chronic disease. Although the median breastfeeding duration was 15 months, there is statistical significant association between sex and general health status (p = 0.014) and sex and duration of breastfeeding (p = 0.006). A statistical difference was found between duration of breastfeeding and general health status (p = 0.009) and dental and gum status (p = 0.001). In 2022, the majority of children in Turkey had very good or good general health and dental and gum status. More than a third of children were breastfed for less than 12 months. Considering the possibility of neglecting oral and dental health problems, it is recommended to prioritize oral and dental health literacy trainings and to continue breastfeeding promotion programmes.

Relationship between fear of falling and quality of life in nursing home residents: The role of activity restriction

This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents’ excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents’ quality of life and mental health.

Knowledge, Attitude, and Dispensing Practice of Emergency Contraceptive Pills among Community Pharmacists: A Cross-sectional Survey

Background: The improper or incorrect usage of birth control results in unintended pregnancy. In India, 78% of pregnancies are accidental, with unwanted pregnancies accounting for about 25% of all pregnancies. The family, society, and country may all be financially impacted by such pregnancies. Community pharmacists must have a good attitude and sufficient knowledge of emergency contraception pills (ECPs) in order for women to receive them in a timely manner and as a result, have fewer unintended pregnancies. The purpose of this study is to investigate the knowledge, attitude, and, practices of community pharmacy practitioners towards ECPs. Methods: A cross-sectional study was carried out on retail pharmacies located in Madhya Pradesh, Mumbai. A standardized questionnaire was used in 164 community pharmacies to interview about CPPs using a convenience sampling technique. The survey evaluated the CPP's dispensing procedures, knowledge, attitude, and demographic profile. Data analysis was carried out by using the statistical package for the social sciences (SPSS) version 18 (SPSS Inc., Chicago, IL, USA). Results: A total of 164 registered pharmacists participated in the study, which included 76.1 % (n=124) males and 23.9% (n=39) females. Among all the participants, 73.0% of them had a diploma in pharmacy (D Pharm) education, and half of the study participants had a working experience between 1-5 years. In this study, 56.64 %, 27.6%, and 16% of participants had average knowledge, sound knowledge, and poor knowledge, respectively. Results showed that 90.2% (147) of pharmacists came under the positive attitude category, 5.5% of pharmacists had a negative attitude, and 4.3% had a neutral attitude. A moderate positive linear relationship (0.401) existed between the knowledge and attitude of the pharmacist in this study. Attitude and dispensing of emergency OC as OTC to people older than 18 years old and less than 18 years old showed a moderate negative linear relationship. After adjusting the possible confounder variables, age and years of experience significantly affected the knowledge, attitude, and practice of EC. Conclusion: In conclusion, the present study has shown that there is generally a lack of knowledge and poor attitude toward emergency contraceptive medicines among community pharmacists. Therefore, it is recommended that improving pharmacist's knowledge, attitude, and practice (KAP) through proper training and counseling about EC can enhance the appropriate use of drugs.

Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition.

The aim of this study was to examine the practices and knowledge levels of nurses regarding enteral nutrition interventions in intensive care unit patients in terms of evidence. This cross-sectional study was conducted in 2 hospitals between May and August 2021. A total of 136 nurses working in the intensive care units of the hospitals completed online questionnaires including demographic characteristics and questions about enteral nutrition. According to the nurses' knowledge level about the indication of enteral nutrition formulas, the following were incorrect or incomplete: their knowledge about transition to parenteral nutrition in case of nutritional contraindications, what to do when the amount of gastric residual volume in tolerance is >500 mL every 6 hours, the conditions for starting enteral nutrition, and which formulas are appropriate to use. Regarding their knowledge about enteral feeding tubes/sets, their knowledge about radiologic imaging after tube placement, measurement of gastric pH level, and marking the tube location was insufficient. Differently, the correct answer percentages of the nurses in 11 of the 13 questions regarding the principles of enteral nutrition practice were above 70%. Nurses had adequate knowledge of the principles of enteral nutrition practice, but their knowledge of the indication of enteral nutrition formulas and the evidence for enteral feeding tubes/sets varied. The results showed that nurses need to gain information about the indication of enteral nutrition formulas and evidence related to enteral feeding tubes/sets.

Child, maternal, and adult mortality in rural Ethiopia in 2019: a cross-sectional mortality survey using electronic verbal autopsies

Ethiopia, with about 10% of Africa's population, has little direct information on causes of death, particularly in rural areas where 80% of Ethiopians live. In 2019-2020, we conducted electronic verbal autopsies (e-VA) to examine causes of death and quantify cause-specific mortality rates in rural Ethiopia. We examined deaths under 70 years in the three years prior to the survey dates (November 25, 2019-February 29, 2020) among 2% of East Gojjam Zone (Amhara Region) using registered deaths and adding random sampling in this cross-sectional study. Trained surveyors interviewed relatives of the deceased with central dual-physician assignment of causes as the main outcome. We documented details on age, sex and location of death, and derived overall rural death rates using 2007 Census data and the United Nations national estimates for 2019. To these, we applied our sample-weighted causes to derive cause-specific mortality rates. We calculated death risks for the leading causes for major age groups. We studied 3516 deaths: 55% male, 97% rural, and 68% occurring at home. At ages 5 and older, injuries were notable, accounting for over a third of deaths at 5-14 years, half of the deaths at ages 15-29 years, and a quarter of deaths at ages 30-69 years. Neonatal mortality was high, mostly from prematurity/low birthweight and infections. Among children under 5 (excluding neonates), infections caused nearly two-thirds of deaths. Most maternal deaths (84%) arose from direct causes. After injuries, especially suicide, assaults, and road traffic accidents, vascular disease (15%) and cancer (13%) were the leading causes among adults at 30-69 years. HIV/AIDS and tuberculosis deaths were also important causes among adults. Rural Ethiopia has a high burden of avoidable mortality, particularly injury, including suicide, assaults, and road traffic accidents. International Development Research Centre, and the Canadian Institutes of Health Research.

Systemic Inflammation Indices as Hematological Biomarkers of Inflammatory Response in Non-silicotic Workers Exposed to Respirable Silica Dust

This cross-sectional study was performed to assess whether systemic inflammatory indices, including systemic inflammation response index (SIRI), systemic immune‑inflammation index (SII), and aggregate index of systemic inflammation (AISI), can be considered as possible inflammatory markers in silica-exposed workers with no diagnosis of silicosis. We studied 371 non-silicotic workers exposed to respirable silica dust (RSD) and 1422 reference workers. The workers’ exposure to RSD were assessed and the inflammatory indices were compared between subgroups of the exposed workers based on the severity and duration of exposure. Correlations between inflammatory indices and the pulmonary function parameters were investigated. Also, the receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off values of the SII, SIRI, and AISI. Significant dose–response relationships were observed between duration of exposure and all indices except monocytes and LMR. No significant interaction was observed between duration of exposure to RSD and smoking. Borderline significant correlations were observed between AISI and SIRI with forced expiratory volume (FEV1) and FEV1 to forced vital capacity (FVC) ratio. Higher AUCs were obtained for SII and AISI, respectively. The cut-off values for these biomarkers to be considered abnormal were > 348.48 for SII, > 183.78 for AISI, and > 0.768 for SIRI. Overall, the present study showed for the first time, that SII, AISI, and SIRI might be considered as available, easy-to-obtain, and non-expensive markers of inflammation in non-silicotic workers with a long duration of exposure to RSD who are at risk of developing silicosis in subsequent years.

The relationship between managerial coaching and role ambiguity among nurses in the military health system

Managerial coaching may be an effective strategy to reduce role ambiguity among nurses. Although the benefits of coaching relationships have been demonstrated outside of nursing, there is a lack of evidence about this career development relationship in nursing. A cross-sectional design was used to determine the relationship between managerial coaching and role ambiguity among military and civilian nurses who work in the Military Health System (MHS). Nurses who worked at a large academic medical center in San Antonio, Texas were asked to participate by completing a survey to examine the variables of interest. Among the 382 nurses that responded, perceived role ambiguity was low and managerial coaching was seldom perceived from first-line supervisors. However, there was a significant negative relationship between managerial coaching and role ambiguity. This study provides foundational knowledge about the relationship between managerial coaching and role ambiguity for nurses working in the MHS.