Current Health Research Articles

Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer-Reviewed Literature.

Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers. We conducted a scoping review of the peer-reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation-by-scope category. The final yield included 44 peer-reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry-motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin-motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission-motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission. In our scoping review of the 340B program, the highest-quality evidence indicates nonprofit, DSHs may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy discussion regarding the 340B program.

Pharmacy practice and First Peoples health equity: a scoping review protocol.

The objective of this review is to examine and describe global pharmacy practice strategies and interventions designed to achieve health equity for First Peoples. Access to medicines and quality use of medicines is critical to achieving health equity for First Peoples. Pharmacists are uniquely placed to lead the charge in transforming current health systems, reducing health disparities, and bolstering the movement toward health equity. Global studies describing pharmacy practice strategies and interventions designed to achieve health equity for First Peoples will be considered for inclusion in the review. Studies relating to all areas of pharmacy practice, including community and clinical pharmacy, social, administrative, pharmaceutical sciences, practice, teaching, research, advocacy, or service relevant to the review's objective will also be considered for inclusion. The types of studies to be included are qualitative, quantitative, and mixed methods systematic reviews, scoping reviews, literature reviews, and gray literature. This review will be conducted in accordance with JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, CINAHL, and gray literature sources will be searched from 1998 to the present. Titles, abstracts, and full texts will be screened against the inclusion criteria. Strategies and interventions identified in the included reviews will be mapped to a published framework, outlining actionable strategies for pharmacy practice inclusion in sustainable efforts to achieve health equity. Qualitative content analysis and descriptive statistics will be utilized with data presented in tables, accompanied by a narrative. Open Science Framework osf.io/qa64b.

FCE-based health status evaluation and IGM-based failure prediction of tool magazine manipulator for CNC machine tools

The reliability of machine tool components, particularly the tool magazine manipulator, significantly affects the overall performance of the machine tool. To address the challenge of accurately evaluating the manipulator’s health status using a single performance indicator, this study proposes a method that combines Fuzzy Comprehensive Evaluation (FCE) and a Combined Weighting Method (CWM). By considering both subjective and objective factors, this method provides a comprehensive evaluation of the manipulator’s health status, enhancing the accuracy and reliability of the assessment. The method utilizes fuzzy distribution to construct membership matrices for different health levels and adopts the CWM that combines the Entropy Weight Method (EWM) and Analytic Hierarchy Process (AHP) to determine the combined weights of the health evaluation indices. This approach improves the accuracy and reliability by considering multiple indicators and objectively weighting them based on their importance. The current health status of the manipulator is evaluated using the fuzzy weighted average operator and the maximum membership principle. Moreover, a fault prediction method based on Particle Swarm Optimization (PSO) and GM(1,1) is proposed to overcome the information gap and small sample problems. The proposed model’s prediction accuracy is verified by comparing it with other models, demonstrating its effectiveness and reliability.

Pressure Injuries in Different Disciplines: A Bibliometric Analysis

Introduction: Despite developing health technologies and many preventive approaches, pressure injuries are still among the current health problems for health professionals and health costs. Aim: This study was conducted to examine the features of the studies on pressure injuries in different disciplines like authors, journals, and the number of citations and provide a perspective for further studies.Material and Methods: The study used the bibliometric analysis method, MS Excel program, and Vosviwer. The data were searched using the keywords “pressure ulcer”, “pressure wound”, pressure injuries”, bedsore”, “pressure sores”, “decubitus ulcer”, and “decubitus” Results: A total of 4224 research articles, book chapters, and review articles were analyzed for the study criteria. The results showed that the first article was published in 1949, the highest number of studies was done in 2021, 87.2% of the studies were nursing, and 13.3% were published in the Journal of Wound Care. 87.9% of the studies were published in English, and 26.7% were published in the United States of America. It was determined that there was a positive relationship between the number of publications and the gross national product of the countries (r=0.774, p<0.009). Conclusion and sugestions: It was concluded that despite the increasing number of studies on pressure injury over the years, there was a decrease in author collaboration, the studies were primarily conducted in nursing and published in relevant journals, and there was a lack of a multidisciplinary approach. With this research, new researchers will be asked research to be conducted on the subject when researching pressure injury, it provides researchers with which keywords they can use, which authors’ articles they can review, and collaborative research by the authors. Based on the research results, encouraging interdisciplinary collaboration and interdisciplinary cooperation is recommended for pressure injury prevention.

Identification of group differences in predictive anticipatory biasing of pain during uncertainty: preparing for the worst but hoping for the best.

Pain anticipation during conditions of uncertainty can unveil intrinsic biases, and understanding these biases can guide pain treatment interventions. This study used machine learning and functional magnetic resonance imaging to predict anticipatory responses in a pain anticipation experiment. One hundred forty-seven participants that included healthy controls (n = 57) and individuals with current and/or past mental health diagnosis (n = 90) received cues indicating upcoming pain stimuli: 2 cues predicted high and low temperatures, while a third cue introduced uncertainty. Accurate differentiation of neural patterns associated with specific anticipatory conditions was observed, involving activation in the anterior short gyrus of the insula and the nucleus accumbens. Three distinct response profiles emerged: subjects with a negative bias towards high pain anticipation, those with a positive bias towards low pain anticipation, and individuals whose predictions during uncertainty were unbiased. These profiles remained stable over one year, were consistent across diagnosed psychopathologies, and correlated with cognitive coping styles and underlying insula anatomy. The findings suggest that individualized and stable pain anticipation occurs in uncertain conditions.

Public Health Law In Malaysia And The United States: Comparing Current Applications

Background: The main objective of public health law is to pursue the highest possible level of physical and mental health in the population, consistent with the values of social justice. Aims: To elaborate on Malaysia’s public health laws that share unique commonalities with those of the United States of America, due to both countries’ colonial past as part of the British Empire. Methods: Historical review and analysis of current public health law issues in both nations. Results: The United States of America gained full independence from the British Empire on 3 September 1783, while almost three years later, on 11 August 1786, the Union Jack was raised on the island of Pulau Pinang in Malaysia. When the colonies first formed the United States, there was no national public health law; the American colonies adopted the English laws on the control of diseases. This is similar to Pulau Pinang, after the implementation of the Charter of Justice in 1807. Conclusion: Current applications of the law, which include quarantine, sanitation, disease reporting, and vaccination,exhibit interesting similarities as well as differences between the United States and Malaysia.

Physical Activity and the Health of a Nation: A National Challenge and Collective Response

Historic recruitment and retention challenges confront the U.S. military. In an invited panel discussion at Lifestyle Medicine 2023, we argued that widespread physical inactivity is contributing to these challenges, and that Lifestyle Medicine approaches should be part of the solution. Our aim in this commentary is to recapture the most salient messages from that discussion. First, we summarize significant epidemiologic studies that describe the scope of the problem among future recruits, current service members, and Veterans. Then, in the optimistic spirit that characterizes both the armed forces and Lifestyle Medicine communities, we outline several potential solutions. By increasing physical activity during the school day, using wearable technology to monitor and prompt health behaviors, addressing the other pillars of Lifestyle Medicine (especially sleep, nutrition, and stress management), aligning efforts with current health frameworks in the Departments of Defense and Veterans Affairs, and recruiting Lifestyle Medicine professionals, we are convinced that we can improve the health of our nation and, in so doing, strengthen military readiness and national security.

Urban and Rural Attitudes toward School Food

AbstractIn the social sciences, it is a classic practice to contrast the development of the countryside and the city as two endpoints of a chain. However, since the beginning of the 21st century, the validity of the rural-urban dichotomy has been increasingly questioned, and we are now talking about two interconnected and complementary systems instead. In examining contemporary school meals, we ourselves observed this close and varied pattern of intertwining between the city and the countryside. Therefore, we believe it is useful to identify rural and urban features in contemporary public catering practices, and to outline mixed models that can be placed between the two endpoints in space and time. All of this can be edifying because urbanized foodways, following current food health and gastronomic trends, sustainability, climate and environmental protection requirements, as well as social considerations, return from time to time to the old village farming practices and foodways in various ways, and utilize knowledge related to traditional farming. Illustrated with specific examples, the study outlines three types of school catering models, from the oldest practice called “rural” to the “urban” (urbanized) type. A comparison of these types of public catering practices reveals the problems observed in today’s public catering.

Prevalence of malocclusions requiring treatment according to the KIG classification : Amultipart cross-sectional study over a20-year period in the district of Viersen/North Rhine.

In Germany, the reimbursement of orthodontic treatment costs within the framework of the statutory health insurance (GKV) was restricted on 01January2002 by the introduction of the orthodontic indication groups (KIG). The aim of this study was to evaluate the prevalence of findings requiring treatment in aspecialist practice over a20-year period. The results were then compared with data from existing older studies. The distribution of treatment-eligible KIG (KIG classifications grades 3-5) among patients with statutory health insurance in an orthodontic practice in North Rhine was determined over a20-year period (2002-2021) after the introduction of the KIG system. This period was additionally scrutinized in four 5‑year periods according to the operating cycles of the practice. Findings were classified into the highest of 19 possible KIG treatment needs levels. Multiple classifications were not made. Orthodontic treatment was indicated in a total of4537 (2393 female, 2144 male) patients according to current statutory health insurance guidelines. The KIG classification "D" (increased overjet) was the most frequent within the observed 20years with 24.3%. Among 11 KIG classifications, 86.1% of the 6 most frequent and 13.9% of the 5 rarest findings were observed constantly over all periods. Of 19 possible indications, "D4" was the most frequent with 19.6%. Of 4537 patients, 20.7% had KIG grade3, 63.6% KIG grade4 and 15.7% KIG grade5. The prevalence of sagittal deviations "D" and "M" was 35.0%, transverse "B" and "K" 17.9% and vertical "O" and "T" 3.7%. Tooth position anomalies "E" and "P" had ashare of 24.6%. The present study confirms existing findings as well as the nationwide data of the National Association of Statutory Health Insurance Dentists (KZBV) from 2020: The sagittal deviations "D" (increased overjet) and "M" (negative overjet) represented the most frequent findings with KIG D4 as the most common classification. The prevalence and age distribution of KIG grades 3-5 requiring treatment corresponded to nationwide comparative data.

Immunomodulatory Effects of Vitamin D and Zinc on Viral Infection.

Several nutrients are crucial in enhancing the immune system and preserving the structural integrity of bodily tissue barriers. Vitamin D (VD) and zinc (Zn) have received considerable interest due to their immunomodulatory properties and ability to enhance the body's immune defenses. Due to their antiviral, anti-inflammatory, antioxidative, and immunomodulatory properties, the two nutritional powerhouses VD and Zn are crucial for innate and adaptive immunity. As observed with COVID-19, deficiencies in these micronutrients impair immune responses, increasing susceptibility to viral infections and severe disease. Ensuring an adequate intake of VD and Zn emerges as a promising strategy for fortifying the immune system. Ongoing clinical trials are actively investigating their potential therapeutic advantages. Beyond the immediate context of the pandemic, these micronutrients offer valuable tools for enhancing immunity and overall well-being, especially in the face of future viral threats. This analysis emphasizes the enduring significance of VD and Zn as both treatment and preventive measures against potential viral challenges beyond the current health crisis. The overview delves into the immunomodulatory potential of VD and Zn in combating viral infections, with particular attention to their effects on animals. It provides a comprehensive summary of current research findings regarding their individual and synergistic impacts on immune function, underlining their potential in treating and preventing viral infections. Overall, this overview underscores the need for further research to understand how VD and Zn can modulate the immune response in combatting viral diseases in animals.

The Impact of Health Expenses on Economic Growth: Empirical Evidence from SAARC Countries

This study seeks to empirically explore the influence of health expenditure on economic growth in SAARC countries. Gross domestic product (GDP) the proxy variable of economic growth has been used as a dependent variable and current health expenses (CHE) as the independent variable. The panel dynamic OLS (DOLS), panel fully modified OLS (FMOLS), panel OLS, panel co inte gration test, along with Granger causality test have been used to determine the link between health expenses and economic growth. The result presented that health expenses and economic growth have a bidirectional causa l relationship in the short run. The f indings of the panel fully modified OLS (FMOLS) also showed that long run economic growth is increasingly and significantly affected by health expenses, HDI, infant mortality, and life expectancy. Therefore, this st udy presents empirical evidence to the po licymakers of SAARC nations that increasing health expenditures contribute to a country's economic growth.

Generation time-out grows up: young adults' reports about childhood time-out use and their mental health, attachment, and emotion regulation.

Time-out (TO) is a widely utilised parental discipline technique with a strong evidence-base that nonetheless has attracted controversy regarding potential adverse effects on mental health in developing children. Associations between TO implementation and mental health outcomes have rarely been investigated, especially through the eyes of children who grew up experiencing TO. This study recruited 407 university students (Study 1) and a community sample of 535 young adults (Study 2); both samples aged 18-30 years. Young adults were surveyed on their retrospective reports of childhood TO experience, childhood experiences of adversity, perceived parenting style and parental attachment, and their current mental health outcomes (attachment style, emotion regulation and mental health). In Study 1, 334 (82.1%) young adults reported experiencing TO in childhood, but with widely varied implementation that differed considerably from its evidence-based ideal. Reports of more TO appropriate implementation were associated with less avoidant attachment, better mental health, and emotion regulation, over and above the effects associated with authoritative parenting and secure attachment in childhood. While exposure to childhood adversity was associated with poorer adulthood outcomes, TO implementation did not moderate the association. Study 2 replicated most findings from Study 1, except that appropriate TO implementation displayed a positive association with mental health and no associations with anxious and avoidant attachment and emotion regulation. These findings suggest the safety of TO use with young children, including those who experienced childhood adversity, and highlight the importance of disseminating sufficient parenting information on TO in the community.

Environmental sustainability: the attitudes and experiences of UK students in the oral health care profession.

Objective This study aims to provide insight into the attitudes and perspectives of undergraduate dental students from UK dental schools regarding environmental sustainability in dentistry (ESD) and the manner and extent in which ESD is included in the current undergraduate oral health care curricula.Methods This study is a multi-centre, nationally representive study involving a cross-sectional online survey of undergraduate Bachelor of Dental Surgery and dental hygiene and therapy students in UK-based dental schools. Data analysis was conducted through descriptive statistics and thematic analysis.Results In total, 263 students from 13 UK schools completed the survey, resulting in a national school response rate of 68.4%. Key findings are: 97.3% of students believe that the dental profession should be more actively engaged in environmental sustainability but students currently have very little exposure to ESD at an undergraduate level; and 76.8% of students expressed that they are concerned about the impact that oral health care provision has on the environment, but only 23% of students have independently researched ESD.Conclusions Students identify that oral health care professionals should become more engaged in efforts to mitigate the negative impacts from our activities on the environment, principally via education at all levels. The data from this study provide insight into the current level of awareness and concerns for the environmental impacts of oral health care provision, and are a powerful driver for the inclusion of ESD into the undergraduate curriculum in UK based dental schools.

2024 Watch List: Top 10 Technologies and Issues Related to Caring for Children and Youth With Medical Complexity

What Is the 2024 Watch List?
 
 The Watch List annual Horizon Scan report presents emerging technologies and issues that have the potential to shape the future of health care in Canada.
 CADTH’s 2024 Watch List focuses on care for children and youth with medical complexity. This top 10 has been divided in 2 parts — the top 5 technologies and top 5 issues related to children and youth with medical complexity that have the potential to make a significant and meaningful impact in transforming health systems in Canada over the next 5 years. These technologies and issues could shape the future of health care for not only children and youth with medical complexity, but also for others with chronic health conditions.
 
 Why Is This an Issue?
 
 Children and youth (people aged 24 years and younger) with medical complexity are a diverse group with a range of needs (e.g., single or multiple conditions, rare diseases). Although there is no single definition, common characteristics include significant functional limitations often causing the child or youth to be reliant on technology; high health care utilization, often requiring specialized care and services from different providers in multiple settings; and high health care service needs, such as care provision in the home and care coordination, which can have significant social and financial impacts on caregivers and the family.
 Children and youth with medical complexity account for less than 1% of all children and youth in Canada, but they account for 37% of hospital stays and 17% of emergency department visits. Due in part to the high number of health care interactions, this group experiences the effects of challenges within the health care system more acutely than their less medically complex peers.
 
 What Is the Potential Impact?
 
 The Watch List highlights areas for innovation, systems change, and investment.
 Advances in medical care have resulted in more children living with conditions that previously would not have been survivable in infancy and childhood. Now there are more children and youth with medical complexity, and they are living longer. Our current health systems were not designed to meet the complex needs of this group of people and their caregivers, including that many of them face challenges in accessing needed care. This year’s Watch List spotlights new and emerging technologies and key issues that could have a major impact on how patient care is provided to children and youth with medical complexity.
 
 What Else Do We Need to Know?
 
 In the 2024 Watch List, we identify and describe the top 5 new and emerging technologies that could shape the future of health care for children and youth with medical complexity in Canada, including new models of care and technologies and systems to improve communication. We also explore some considerations for health care decision-makers about the potential impact of these technologies on care pathways, health care human resources, health care infrastructure, and health equity.
 The 2024 Watch List also identifies the top 5 issues that limit health systems from providing optimal quality of care for children and youth with medical complexity. Key issues such as the need for increased interoperability between health systems and the need for strategies to improve sustainability warrant more attention and will influence the wider adoption, diffusion, and implementation of new and emerging technologies for children and youth with medical complexity.
 Monitoring ongoing developments and evidence related to the top technologies and issues highlighted in the 2024 Watch List can help guide health system planning in Canada and improve access to high-quality care.

Mixed-Grade Urothelial Carcinoma: Insights Into Clinical Behavior and Prognostic Implications Compared to Pure Low-Grade and High-Grade Urothelial Carcinomas.

Low-grade urothelial carcinoma (LGUC) and high-grade urothelial carcinoma (HGUC) are distinguished based on architectural and cytological features, with the anticipation that HGUC exhibits more aggressive behavior and a worse prognosis compared to LGUC. The current World Health Organization classification recognizes mixed-grade urothelial carcinoma (MGUC, for the purposes of this study) as a separate category that behaves like LGUC if the high-grade component is <5% and states that any tumor with ≥5% high-grade component should be graded as HGUC. To evaluate the risk of tumor recurrence, grade, and stage progression of MGUC compared to LGUC and HGUC. A total of 150 de novo noninvasive polypoid urothelial carcinomas (41 cases of MGUC, 59 of LGUC, and 50 of HGUC) were included. Tumor recurrence, grade, and stage progression were compared among the MGUC, LGUC, and HGUC cases. Tumor recurrence was observed in 14 of 41 (34.2%) of MGUC, 33 of 59 (55.9%) of LGUC, and 28 of 50 (56%) of HGUC. Grade progression occurred in 5 of 41 (12.2%) of MGUC cases and 5 of 59 (8.5%) of LGUC cases. No stage progression was observed in LGUC or MGUC cases, while 7 of 50 (14%) of HGUC cases showed stage progression. MGUC was associated with lower odds and hazard of recurrence compared to LGUC. The rate of grade progression was higher in MGUC and occurred after a shorter interval compared to LGUC. MGUC showed a prognosis closer to LGUC. Our study supports the current recommendation to classify tumors with <5% high-grade component as MGUC, as these tumors display clinical characteristics and outcomes close to that of pure LGUC.

Children and adolescents' quality of life in repeated cross-sectional studies during the COVID-19.

During the COVID-19 pandemic, internalizing and externalizing symptoms have impacted the quality of life of children and adolescents. This cross-sectional study evaluated children's quality of life using parental reports, observing associations with mental health problems and sociodemographic variables. Some behavioral measures were linked to lower quality of life, particularly depression symptoms, relationship problems, and inattention. Multiple regression models indicated that reduced children's quality of life (R2 = 36%) was associated with higher levels of internalizing (r = -0.46) and externalizing (r = -0.23) behavioral problems and younger parents (r = -0.08). Children with previous mental disorder diagnoses had lower quality of life than those without (p < 0.001). In summary, children's quality of life during the COVID-19 pandemic was linked to current mental health, parental age, and previous history of mental disorders.

Association of Trauma History with Current Psychosocial Health Outcomes of Young African American Women

African American women have a higher likelihood of experiencing lifetime trauma compared to other racial/ethnic groups. Trauma exposure may be associated with higher substance misuse and greater adverse sexual and mental health outcomes. This study expands upon previous empirical findings to characterize the effect of trauma history on substance use, sexual health, and mental health among young African American women. This study included 560 African American women aged 18–24 years in Atlanta, Georgia. Trauma history was defined as having ever experienced a traumatic event based on the Traumatic Events Screening Inventory (TESI). Relative to women not reporting a trauma history and controlling for age, education, and employment, women who experienced trauma were over 2.5 and 2.3 times, respectively, more likely to report alcohol misuse and marijuana misuse. They were 3.0 times more likely to experience peer normative pressure for substance use. Women who experienced trauma were 2.1 times more likely to have multiple sex partners, 2.9 times more likely to have peer norms for risky sex, 1.8 times more likely to perceive barriers to using condoms with sex partners, 2.1 times more likely to report lower communication frequency about sex, 2.0 times more likely to report lower self-efficacy for refusing sex, and 1.9 times more likely to report less relationship control. Women with a trauma history were also 5.0 times more likely to have experienced intimate partner violence, 2.1 times more likely to report high depression symptomatology, 4.0 times more likely to report high overall stress, 3.2 times more likely to have worse coping skills, and 1.8 times more likely to have poor emotional regulation. Findings suggest that trauma history may increase myriad adverse psychosocial health outcomes. Screening for trauma history may help inform the provision of services. Intensified TESI screenings may help identify a history of trauma and assist in identifying adverse health outcomes.

Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study.

Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL). The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling. The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals. The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.

Temperament and sex as moderating factors of the effects of exposure to maternal depression on telomere length in early childhood.

Individual differences in sensitivity to context are posited to emerge early in development and to influence the effects of environmental exposures on a range of developmental outcomes. The goal of the current study was to examine the hypothesis that temperament characteristics and biological sex confer differential vulnerability to the effects of exposure to maternal depression on telomere length in early childhood. Telomere length has emerged as a potentially important biomarker of current and future health, with possible mechanistic involvement in the onset of various disease states. Participants comprised a community sample of children followed from infancy to age 3 years. Relative telomere length was assessed from DNA in saliva samples collected at infancy, 2 years, and 3 years. Maternal depressive symptoms and the child temperament traits of negative affectivity, surgency/extraversion, and regulation/effortful control were assessed via maternal report at each timepoint. Analyses revealed a 3-way interaction among surgency/extraversion, sex, and maternal depressive symptoms, such that higher surgency/extraversion was associated with shorter telomere length specifically among males exposed to elevated maternal depressive symptoms. These findings suggest that temperament and sex influence children's susceptibility to the effects of maternal depression on telomere dynamics in early life.

Imposter phenomenon in physical therapists: A cross-sectional observational study.

Imposter phenomenon (IP), or perceived fraudulence, describes an ongoing fear of exposure as a fraud or imposter, despite objective successes and accomplishments. Although there is a growing interest of IP in medicine, IP in the physical therapy profession has been minimally examined. We aimed to determine the prevalence and predictors of IP among licensed physical therapists in the United States. This cross-sectional observational study utilized an online survey to assess levels of IP using the Clance Imposter Phenomenon Scale. We assessed degrees of emotional exhaustion and job satisfaction and collected professional and demographic information. A multivariable logistic regression model examined factors associated with IP presence. The mean IP score was 60.3 (SD: 15.1, range: 19-95). Fifty-five respondents (10.7%) had low IP, 196 (38.1%) moderate, 215 (41.8%) frequent, and 48 (9.3%) intense IP. The prevalence of IP, defined as frequent or intense IP, was 51.2%. Having manager/supervisor experience (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.34-0.90) was associated with a reduced odds of IP presence. Holding a bachelor's or master's degree (vs. Doctor of Physical Therapy (DPT); OR = 2.31, 95% CI = 1.07-5.00), a history of or current mental health diagnosis (OR = 2.77, 95% CI = 1.69-4.54), and emotional exhaustion (moderate vs. low: OR = 5.37, 95% CI = 2.11-13.69; high vs. low: OR = 14.13, 95% CI = 5.56-35.89) were each associated with an increased odds of IP presence. IP is highly prevalent among licensed physical therapists. Seasoned clinicians with managerial roles seemed to be less susceptible to IP, whereas those with mental health diagnoses, emotional exhaustion, and those without a DPT degree may be more susceptible. Given its high prevalence and potential negative impact on burnout and career advancement, it is crucial to increase IP awareness and provide education on management strategies.