Observational Studies In Epidemiology Research Articles

Differential Outcomes of Placebo Treatment Across 9 Psychiatric Disorders: A Systematic Review and Meta-Analysis.

Placebo is the only substance systematically evaluated across common psychiatric diagnoses, but comprehensive cross-diagnostic comparisons are lacking. To compare changes in placebo groups in recent high-quality randomized clinical trials (RCTs) across a broad spectrum of psychiatric disorders in adult patients. MEDLINE and the Cochrane Database of Systematic Reviews were systematically searched in March 2022 for the latest systematic reviews meeting predetermined high-quality criteria for 9 major psychiatric diagnoses. Using these reviews, the top 10 highest-quality (ie, lowest risk of bias, according to the Cochrane Risk of Bias tool) and most recent placebo-controlled RCTs per diagnosis (totaling 90 RCTs) were selected, adhering to predetermined inclusion and exclusion criteria. Following the Cochrane Handbook, 2 authors independently carried out the study search, selection, and data extraction. Cross-diagnosis comparisons were based on standardized pre-post effect sizes (mean change divided by its SD) for each placebo group. This study is reported following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. The primary outcome, pooled pre-post placebo effect sizes (dav) with 95% CIs per diagnosis, was determined using random-effects meta-analyses. A Q test assessed statistical significance of differences across diagnoses. Heterogeneity and small-study effects were evaluated as appropriate. A total of 90 RCTs with 9985 placebo-treated participants were included. Symptom severity improved with placebo in all diagnoses. Pooled pre-post placebo effect sizes differed across diagnoses (Q = 88.5; df = 8; P < .001), with major depressive disorder (dav = 1.40; 95% CI, 1.24-1.56) and generalized anxiety disorder (dav = 1.23; 95% CI, 1.06-1.41) exhibiting the largest dav. Panic disorder, attention-deficit/hyperactivity disorder, posttraumatic stress disorder, social phobia, and mania showed dav between 0.68 and 0.92, followed by OCD (dav = 0.65; 95% CI, 0.51-0.78) and schizophrenia (dav = 0.59; 95% CI, 0.41-0.76). This systematic review and meta-analysis found that symptom improvement with placebo treatment was substantial in all conditions but varied across the 9 included diagnoses. These findings may help in assessing the necessity and ethical justification of placebo controls, in evaluating treatment effects in uncontrolled studies, and in guiding patients in treatment decisions. These findings likely encompass the true placebo effect, natural disease course, and nonspecific effects.

The perception of burnout and related influencing factors in Tunisian oncology nurses.

Oncology nurses constantly provide emotional support to patients and are confronted with their suffering, which represents chronic stress leading to the development of burnout syndrome. This study aimed to evaluate the prevalence of burnout and identify associated factors in a sample of oncology nurses. We conducted a descriptive cross-sectional study with 70 oncology nurses at the Salah Azaiez Institute of Oncology in Tunisia. Burnout was assessed using the Maslach Burnout Inventory Human Service Survey. This study follows the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Guidelines. Burnout affected 60 nurses (85.7%), with a high level in 20% of cases. High scores of emotional exhaustion, depersonalisation, and low personal accomplishment were recorded in 65.7%, 50%and 25.7% respectively. Emotional exhaustion was associated with higher age, marital status, having 2 or 3 or more dependent children, number of patients under care exceeding 15, professional experience and history of psychiatric problems. Depersonalisation was correlated with age, marital status, professional grade and history of psychiatric problems. Low levels of personal accomplishment increased with the number of patients under care, history of psychiatric problems and the regret of professional choice. Burn-out is a reality in oncology hospital with an alarming rate. Interventions including rationalisation of workload, support groups, training in emotion and stress management would improve the mental health of these nurses and increase their performance. The screening for burnout should be included as a regular practice in health promotion programmes for oncology health professionals, particularly for a vulnerable subgroup that possesses the risk mentioned above factors.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression.

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions. A cross-sectional study reported according to the STROBE checklist. A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro. Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability. Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability. Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability. No patient or public contribution. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Acidentes de trabalho com exposição a material biológico entre profissionais de enfermagem no Paraná

The objective was to analyze the epidemiological profile of notifications of work accidents with exposure to biological material among nursing professionals in Parana, through the historical series determined for the years 2013 to 2022. Descriptive observational epidemiological study of the survey type, based on descriptive epidemiology, based on data from the System Information on Notifiable Diseases and the National Registry of Health Establishments. 48,405 cases were identified, with a prevalence of 98.54/1,000. More occurrences among female nursing technicians aged between 31 and 40 years old, from the Metropolitan Health Regional Facilities, in year 2019, stand out. Among nurses, the age range was between 18 and 30 years old, with discharge progressing without serological conversion and negative sources of disease. The high number of abandoned treatments and underreporting stands out. Investing in professional training, continuing education, quality protective equipment and implementing protocols for prophylactic treatment are essential to prevent the disease.

Factors conditioning pain control and reduction in post-cesarean section parturients: a cross-sectional study.

Pain experienced by women in the perinatal period constitutes a complex and multifaceted phenomenon. The aim of the study was to assess conditions of pain locus of control and pain reduction in post-cesarean section parturients. A cross-sectional quantitative study with convenience sampling was performed among 175 hospitalized post-cesarean section women in hospitals in Eastern Poland in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. A self-design questionnaire regarding general information and obstetrics/gynaecology medical interview, The Pain Coping Strategies Questionnaire (CSQ) and The Beliefs about Pain Control Questionnaire (BPCQ) were used. The inclusion criteria were as follows (1) age of ⩾18 years old; (2) cesarean section (CS); (3) period from the 13th hour to the end of the 72nd hour after the procedure; and (4) informed consent. The data was analyzed with IBM SPSS Statistics. Internal locus of control (M = 14.02) was provided the highest value by the parturients and followed by chance events (M = 12.61) and doctors' power (M = 12.18). Dominant coping with pain strategies in the post-cesarean parturients were coping self-statements (M = 19.06), praying or hoping (M = 18.86). The parturients assessed their pain coping (M = 3.31) strategies along with pain reduction (M = 3.35) at the moderate level. Higher pain control was correlated with cognitive pain coping strategies (β = 0.305; t = 4.632; p < 0.001), internal pain control β = 0.191; t = 2.894; p = 0.004), cesarean section planning (β = -0.240; t = -3.496; p = 0.001) and past medical history of CS (β = 0.240; t = 3.481; p = 0.001). The skill of reduction of pain was positively associated with cognitive pain coping strategies (β = 0.266; t = 3.665; p < 0.001) and being in subsequent pregnancy (β = 0.147; t = 2.022; p = 0.045). Catastrophizing and hoping were related to lower competences of coping with pain (B = - 0.033, SE = 0.012, β = - 0.206, T = -2.861). The study allowed for identification and better comprehension of factors conditioning pain control and pain reduction in parturients after the cesarean section. Furthermore, a stronger belief that pain can be dealt with is found in the parturients characterized by cognitive pain coping strategies and internal pain locus of control. The skill of reduction of pain is related to cognitive coping strategy and procreation status.

Nurses' intention and attitude to participate in advance care planning: An extended theory of planned behaviour using structural equation modelling–A cross‐sectional study

AbstractAimsThis study aimed to investigate the factors influencing nurses' intentions to participate in advance care planning (ACP) by examining the mediating roles of attitude, subjective norm, and perceived behavioural control in the relationship between knowledge and intention, using an extended theory of planned behaviour and structural equation modelling.MethodsA descriptive cross‐sectional survey was conducted between January and April 2023, involving 515 registered nurses, selected through two‐stage sampling. Data were collected using a self‐administered online survey distributed via the internal communication system of hospital. Structural equation Modelling was employed to analyse the relationships among knowledge, attitude, subjective norm, perceived behavioural control and intention to participate in ACP.ResultsThe results supported two hypotheses regarding the relationships between knowledge, attitude, subjective norm, perceived behavioural control, and intention (p &lt; 0.05). While the direct effect of knowledge on intention was not significant (β = 0.087, p = 0.292), the total indirect effect through attitude, subjective norm and perceived behavioural control was significant (β = 0.449, p &lt; 0.001), accounting for approximately 83.77% of the total effect on intention. This underscores the critical role of these mediators in influencing nurses' intention to participate in ACP.ConclusionsThis study highlights the significant indirect influence of knowledge on nurses' intentions to participate in ACP through attitude, subjective norms and perceived behavioural control. These findings suggest that targeted educational is needed to enhance ACP participation among nurses.Implications for the Profession and/or Patient CareUnderstanding the role of attitude, subjective norm and perceived behavioural control can enhance nursing practice. Creating supportive environments and promoting interdisciplinary collaboration are crucial. Professional development through training, mentorship and role modelling can empower nurses in ACP. Comprehensive programs that increase knowledge and foster positive attitudes are essential for advancing ACP practice among nurses.ImpactEducational programs aimed at nurses should include components designed to strengthen knowledge and the identified mediators, equipping nurses with the necessary ACP skills. Organizational support through appropriate policy frameworks can facilitate these educational endeavours and ensure a sustainable impact on practice.Reporting MethodThe Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross‐sectional studies.

Health and social care managers' self-assessed competence in knowledge management: A descriptive cross-sectional study.

To describe health and social care managers' self-assessed competence in knowledge management and the factors associated with management competence. It has been shown that the performance of an organization is as good as the competence of its managers, so health and social care managers' competence in knowledge management should be assessed to improve organizational performance. A descriptive cross-sectional design. A total of 116 managers participated from six Finnish public health and social care organizations. The data were collected in February and August 2022 using the managers' competence in knowledge management (MCKM) instrument and analysed using descriptive statistical methods. Health and social care managers rated their self-reported total competence in knowledge management as good. Among the dimensions of knowledge management competence, managing a culture of competence received the highest rating, while planning competence development and cooperation was perceived as the weakest dimension. The results indicate that background factors such as the healthcare setting, the number of units managed and the number of direct staff had a statistically significant association with the health and social care managers' self-assessed competence in planning competence development and cooperation. Even though the health and social care managers' total self-assessed competence level in knowledge management was rated as good, the results underscore the significance of continuous competence development among these managers in all dimensions of knowledge management. By enhancing and clarifying managers' tasks and competence in knowledge management, managers can increase staff retention, attractiveness and work well-being. The results can be utilized to identify managers' strengths and weaknesses in knowledge management and, thus, effectively target their limited competence development resources. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. There is no patient or public contribution.

Associated Demographic Factors for the Recurrence and Prognosis of Stroke Patients within a Multi-Ethnic Asian Population.

There is a paucity of studies investigating the outcomes amongst Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality. This cohort study adhered to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. We obtained data from the Singapore Stroke Registry (SSR) from 2005 to 2016 and cross referenced to the Death Registry, Myocardial Infarction Registry. Outcome measures included recurrent stroke, acute myocardial infarction (AMI), all-cause and stroke-related deaths. Multivariable Cox proportional hazards regression models were performed to determine risk factors for recurrent stroke, AMI, all-cause and stroke-related deaths. A total of 64,915 patients (6,705 young, and 58,210 older) were included in our analysis. Older stroke patients were found to have an increased risk of recurrent stroke (HR = 1.21, 95%CI: 1.12-1.30), AMI (HR = 1.73, 95%CI: 1.54-1.95), all-cause death (HR = 2.49, 95%CI: 2.34-2.64) and stroke-related death (HR = 176, 95%CI: 1.61-1.92). Amongst young stroke patients, males were at increased risk for recurrent stroke (HR = 1.18, 95%CI: 1.01-1.39) and AMI (HR = 1.41, 95%CI: 1.08-1.83), but at reduced risk for all-cause (HR = 0.78, 95%CI: 0.69-0.89) and stroke-related death (HR = 0.79, 95%CI: 0.67-0.94). Ethnicity appeared to influence outcomes, with Malay patients at increased risk of recurrent stroke (HR = 1.37, 95%CI: 1.14-1.65), AMI (HR = 2.45, 95%CI: 1.87-3.22), all-cause (HR = 1.43, 95%CI: 1.24-1.66) and stroke-related deaths (HR = 1.34, 95%CI: 1.09-1.64). Indian patients were also at increased risk of AMI (HR = 1.96, 95%CI: 1.41-2.72). Similar findings were seen amongst the older stroke patients. This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. Additionally, Malay and Indian patients experience poorer outcomes after first stroke. Further optimisation of risk factors targeting these high-priority populations are needed to achieve high quality care.

Impact of Early Personal Resources on Long-Term Psychosocial Outcomes After Moderate-to-Severe Traumatic Brain Injury: A Systematic Review.

To investigate the relationship between preinjury or early personal resources and long-term psychosocial outcomes following moderate-to-severe traumatic brain injury (TBI) and examine evidence for the stability of personal resources over time. The review protocol was registered with the International Register of Systematic Reviews (PROSPERO, Registration No. CRD4202341056). A search of PsycINFO, Cumulative Index to Allied Health Literature (CINAHL), MEDLINE, Scopus, and Web of Science was conducted from inception to February 23, 2023, for longitudinal studies involving adults with moderate-to-severe TBI that examined: (1) the relationship between preinjury or early personal resources (measured ≤6months postinjury) and later psychosocial outcomes or (2) stability of personal resources over time with a minimum reassessment interval of 3months. Two reviewers independently assessed eligibility and rated methodological quality of studies using a checklist informed by Strengthening the Reporting of Observational Studies in Epidemiology. A narrative synthesis was conducted on 14 eligible articles summarizing 12 studies (N=826). Nine studies examined the impact of preinjury or early personal resources on long-term psychosocial outcomes, most typically at 12months postdischarge. Out of 9 studies 7 indicated that self-reported preinjury or early personal resources, including productive coping, higher self-esteem and resilience, and lower neuroticism, were associated with better psychosocial outcomes. Evidence from 7 studies examining the stability of personal resources over time was generally mixed, with personality changes (eg, neuroticism, conscientiousness, and extraversion) more evident from informant ratings than self-ratings. Preinjury or early personal resources may influence later psychosocial outcomes after TBI. Further research is needed to investigate the stability of personal resources and factors mediating or moderating change across the adjustment trajectory.

Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis.

The use of extracorporeal life support (ECLS) in patients after surgical repair for acute type A aortic dissection (ATAAD) has not been well documented. We performed a systematic review and meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with data published by October 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The protocol was registered in PROSPERO (CRD42023479955). Twelve observational studies met our eligibility criteria, including 280 patients. Mean age was 55.0 years and women represented 25.3% of the overall population. Although the mean preoperative left ventricle ejection fraction was 59.8%, 60.8% of patients developed left ventricle failure and 34.0% developed biventricular failure. Coronary involvement and malperfusion were found in 37.1% and 25.6%, respectively. Concomitant coronary bypass surgery was performed in 38.5% of patients. Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central cannulation was present in 35.4%. In-hospital mortality was 62.8% and pooled estimate of successful weaning was 50.8%. Neurological complications, bleeding and renal failure were found in 25.9%, 38.7%, and 65.5%, respectively. ECLS after surgical repair for ATAAD remains associated with high rates of in-hospital death and complications, but it still represents a chance of survival in critical situations. ECLS remains a salvage attempt and surgeons should not try to avoid ECLS at all costs after repairing an ATAAD case.

Feasibility and acceptability of measuring positivity resonance in nurse-patient telehealth videoconferencing visits: A mixed-methods observational study.

To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. Although the measurement of positivity resonance is promising, and non-participant observation is considered effective, their approaches to studying nurse-patient relationships have not been fully explored. A mixed-methods observational study. Video recordings of 30 nurse-patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post-visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from .575 to .752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse-patient relationships. Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health-related behaviours, well-being, resilience and satisfaction. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures.

Implementation of the Recovery Model and Its Outcomes in Patients with Severe Mental Disorder.

The recovery model assumes that the patient can experience personal growth even while maintaining symptoms of a mental disorder. In order to achieve this recovery, the practices of professionals must also change. However, in our setting, there are limited data on the implementation of practices based on the recovery model and their effect on personal recovery. To describe the association between professionals' practices and patients' personal recovery. An observational and cross-sectional study in which the Recovery Self-Assessment (RSA) was used to assess the degree of implementation of the different practices and the Recovery Assessment Scale (RAS) was used to assess the personal recovery of 307 patients with severe mental disorders. Patients attended by professionals who followed the recovery model obtained a greater personal recovery (p < 0.001, d = 1.10). The dimension associated with greater recovery was that of working toward life goals. The least implemented dimensions had to do with offering treatment options and patient participation in decision-making. This study was conducted in accordance with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology). Although this is a cross-sectional study that does not allow us to establish causal relationships, it shows that the model with which mental health professionals work is associated with patients' chances of recovery. We therefore consider that it is important to foster the implementation of practices based on the recovery model within mental health care.

Subclinical hypocalcaemia in dairy cows: definition and implications

Understanding the dynamics of postpartum blood calcium concentration and its association with cows' health and performance is key to making prophylactic and treatment decisions for subclinical hypocalcaemia. The objective of this article is to summarise results from observational epidemiological studies looking at the associations between postpartum blood calcium concentration and production, reproduction or health in dairy cows, in order to provide readers with a better understanding of subclinical hypocalcaemia and its potential implications.

Genetically predicted blood metabolites mediate the association between circulating immune cells and pancreatic cancer: A Mendelian randomization study.

Pancreatic cancer is characterized by metabolic dysregulation and unique immunological profiles. Nevertheless, the comprehensive understanding of immune and metabolic dysregulation of pancreatic cancer remains unclear. In the present study, we aimed to investigate the causal relationship of circulating immune cells and pancreatic cancer and identify the blood metabolites as potential mediators. The exposure and outcome genome-wide association studies (GWAS) data used in the present study were obtained from the GWAS open-access database (https://gwas.mrcieu.ac.uk). The study used 731 circulating immune cell features, 1400 types of blood metabolites and pancreatic cancer from GWAS. We then performed bidirectional Mendelian randomization (MR) analyses to explore the causal relationships between the circulating immune cells and pancreatic cancer, and two-step MR to discover potential mediating blood metabolites in this process. All statistical analyses were performed in R software. The STROBE-MR (i.e. Strengthening the Reporting of Observational Studies in Epidemiology using Mendelian Randomization) checklist for the reporting of MR studies was also used. MR analysis identified seven types of circulating immune cells causally associated with pancreatic cancer. Furthermore, there was no strong evidence that genetically predicted pancreatic cancer had an effect on these seven types of circulating immune cells. Further two-step MR analysis found 10 types of blood metabolites were causally associated with pancreatic cancer and the associations between circulating CD39+CD8+ T cells and pancreatic cancer were mediated by blood orotates with proportions of 5.18% (p = 0.016). The present study provides evidence supporting the causal relationships between various circulating immune cells, especially CD39+CD8+ T cells, and pancreatic cancer, with a potential effect mediated by blood orotates. Further research is needed on additional risk factors as potential mediators and establish a comprehensive immunity-metabolism network in pancreatic cancer.

Self-disclosure, perceived social support, and reproductive concerns among young male cancer patients in China: A mediating model analysis

ObjectiveMany young male cancer patients experience reproductive concerns. Self-disclosure might be able to improve patients’ perceived social support and reproductive concerns. Nevertheless, these relationships have not yet been confirmed among young male cancer patients. This study aims to investigate the level of reproductive concerns and to identify the mediating role of perceived social support between self-disclosure and reproductive concerns among young male cancer patients in China by developing a structural model. MethodsThis study was a quantitative, cross-sectional design. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines to report this study. A total of 369 young male cancer survivors were recruited by convenience sampling from two tertiary hospitals in Taiyuan, Shanxi, China. Data were collected using a “General data questionnaire”, “Distress disclosure index” (DDI), “Perceived social support scale” (PSSS), and “Reproductive concerns after cancer-male” (RCAC-M) via the WeChat mini program “Questionnaire Star” and paper questionnaire. Descriptive statistics, Pearson correlation analyses, and Structural equation models were adopted to analyze the data. ResultsReproductive concerns were at moderate levels and negatively associated with self-disclosure (r=-0.619, P<0.01) and perceived social support (r=-0.599, P<0.01). Self-disclosure indirectly influenced reproductive concerns (-0.328∼-0.159, P<0.001) through perceived social support. ConclusionsSelf-disclosure and perceived social support are closely associated with reproductive concerns in young male cancer patients, and perceived social support is a mediator between self-disclosure and reproductive concerns. Healthcare providers could reduce reproductive concerns by enhancing self-disclosure and improving perceived social support. Trial registrationThis study was registered on ClinicalTrials.gov on June 13, 2023 (NCT05914181).

Causal Links Between Systemic Disorders and Keratoconus in European Population

PurposeThe objective of this study was to establish the presence of a causal linkage between prevalent systemic diseases and keratoconus (KC). DesignMendelian randomization (MR) analysis. MethodsAfter an exhaustive screening process, genetic variants linked to various systemic diseases were identified as instrumental variables at the genome-wide significance level. Subsequently, MR analyses were conducted to elucidate their potential causal connection with KC (N = 26,742). The encompassed systemic ailments comprise diabetes, hay fever/allergic rhinitis/eczema, obstructive sleep apnea, thyroid dysfunction, aortic aneurysm, major depressive disorder, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), and mitral valve prolapse. Our study adheres to the principles of Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines. ResultsUsing inverse variance weighting as the primary MR analysis method, our findings revealed that hay fever/allergic rhinitis/eczema (odds ratio, 10.144; 95% CI, 2.441 - 42.149; P = 0.001) and ulcerative colitis (odds ratio, 1.147; 95% CI, 1.054 - 1.248; P = 0.002) were associated with an increased risk of KC within the largest population under scrutiny. Conversely, the prolonged hyperglycemic state did not exhibit a potentially protective effect in delaying the pathogenesis of KC, and no correlation was observed between the two (odds ratio, 0.320; 95% CI, 0.029 - 3.549; P = 0.353). Also, obstructive sleep apnea, thyroid function, aortic aneurysm, major depressive disorder, Crohn's disease, and mitral valve prolapse did not exhibit a causal association with KC (P > 0.05 for all comparisons). ConclusionsThis study indicates an increased risk of KC related to hay fever/allergic rhinitis/eczema and ulcerative colitis, with diabetes not providing a protective effect. These findings may potentially contribute some insights to inform clinical interventions.

PREVALENCE OF DEPRESSION AND ANXIETY IN POLYCYSTIC OVARIAN SYNDROME WOMEN

Objective: The objective of the study was to determine the prevalence of depression and anxiety ranges in women having Polycystic Ovarian Syndrome (PCOS). Methods: An epidemiological observational study on 80 PCOS patients confirmed through ultrasound scanning over a study period of 6 mo at Government General Hospital, RIMS, KADAPA. HAM-D and HAM-A assessment scales were used to analyze the severity of depression and anxiety in PCOS women. Results: Among 80 patients, the prevalence of depression is 86.25% (n=69) and anxiety is 93.75% (n=75). Among 69 depressed patients 38 mild, 28 moderate, and 3 severe ranges were noted. Among 75 patients with anxiety, 52 mild, 18 moderate, and 5 severe ranges were noted. The age of the patient does not show a major difference in the development of depression and anxiety. PCOS women who married and have children (n=45) were mostly affected with depression (n=39) and anxiety (n=43). Menstrual irregularity in PCOS patients with depression and anxiety is majorly seen among those who have last menstrual between 30–60 d. Middle-income patients were affected by depression and anxiety greatly, according to this study. Conclusion: We conclude that the prevalence rate of depression and anxiety is greater in PCOS patients.

Knowledge and Practice Regarding Breast Self-Examination (BSE) among Nursing Students Working in A Tertiary Care Hospital Lahore, Pakistan: An Observational Descriptive Cross Sectional Study

Background: Breast self-examination (BSE) is a simple, quick, and cost-free method crucial for the early detection of breast cancer, which significantly reduces morbidity and mortality. Health Sciences students, particularly those in nursing, are ideally positioned to serve as role models and educators on this practice. Objective: The objective of this study was to assess the knowledge and practice of BSE among nursing students at a tertiary care hospital in Lahore, with a view to identifying gaps that could be addressed through targeted educational programs. Methods: This observational descriptive cross-sectional study engaged nursing students from various academic levels at a tertiary care hospital in Lahore. Participants were selected through convenience sampling. Adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was ensured. Data were collected via a self-administered structured questionnaire and analyzed using SPSS software version 26, focusing on frequencies and percentages of categorical variables. Results: Of the participants, 63.76% demonstrated a high level of knowledge about BSE, scoring ≥75%. In contrast, 36.23% scored below 75%, indicating a low level of knowledge. Practice of BSE was limited, with only 47% (n=65) of the participants engaging in the practice, and the majority, 53% (n=73), not practicing at all. Conclusion: Although nursing students show a good understanding of BSE, a significant gap exists between their knowledge and actual practice. This discrepancy highlights the need for enhanced educational interventions to encourage regular BSE practice, which is essential for the effectiveness of breast cancer screening and early detection efforts.

Factors affecting environmental sustainability attitudes among nurses - Focusing on climate change cognition and behaviours: A cross-sectional study.

To investigate the relationship between climate change cognition and behaviours (awareness, concern, motivation, behaviours at home and behaviours at work), positive and negative future cognition, and environmental sustainability attitudes in nurses and to identify the factors affecting environmental sustainability attitudes. A cross-sectional study. In total, 358 nurses currently working in tertiary hospitals in Korea were recruited. Data were collected using an online questionnaire link from 1 August to 7 August 2022. Climate change cognition and behaviours were measured using the Korean version of the Climate, Health, and Nursing Tool. Positive and negative future cognition were measured using the Korean version of the Future Event Questionnaire. Environmental sustainability attitude was measured using the Korean version of the Sustainability Attitudes in Nursing Survey-2. Multiple regression analysis was used to identify the factors affecting environmental sustainability attitudes. Motivation, concern and behaviours at work were factors affecting environmental sustainability attitudes. Motivation was a pivotal influencing factor. Better scores for environmental sustainability attitudes were specifically correlated with higher scores for motivation, concern and behaviours at work. Nurses' motivation, climate change concern and pro-environmental workplace practices should all be considered to improve their attitudes towards environmental sustainability. To enhance nurses' environmental sustainability attitudes and behaviours, nurse educators must educate them to increase their motivation for climate action. Nurses are increasingly expected to contribute to environmental sustainability. Hence, awareness of climate change and environmental sustainability among nurses must be improved, and nursing engagement and action encouraged. Nurse educators and managers should explore barriers to pro-environmental behaviour engagement among nurses, examine workplace cultures that encourage pro-environmental behaviours and develop policies/regulations to develop more environmentally sustainable workplaces. We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Neither patients nor the public were involved in our research's design, conduct, reporting or dissemination plans. The nurses partook in this study exclusively as research participants and were not involved in any research process.

Investigation on the relationship between hemoglobin concentration and stroke risk: a bidirectional Mendelian randomization study.

The relationship between hemoglobin concentration and stroke has garnered significant interest in the research community. However, findings from published observational epidemiological studies on this relationship have been inconclusive. By using publicly available genome-wide association study (GWAS) aggregated statistics, a two-sample Mendelian randomization analysis is conducted to explore the causal relationship between hemoglobin concentration and stroke. Summary statistics data from UK Biobank for hemoglobin concentration and from the FinnGen R9 and MEGASTROKE consortium for stroke are used. A series of quality control steps are taken to select eligible instrumental SNPs closely related to exposure. In order to make the conclusion more robust and reliable, several robust analysis methods are employed including inverse variance weighted, weighted median, MR-Egger regression, which are based on different assumptions of two-sample MR Analysis. Meanwhile, sensitivity analyses such as pleiotropy test and MR-Egg regression, are performed to mitigate horizontal pleiotropy and heterogeneity. The two-sample Mendelian randomized study indicates a negative association between hemoglobin concentration and stroke, suggesting that hemoglobin concentration acts as a protective factor against stroke. From the FinnGen database, there is a negative association between hemoglobin concentration and stroke, with an odds ratio (OR) of 0.82 and a 95% confidence interval (CI) of 0.73-0.92, p = 0.0006. Similarly, the MEGASTROKE database findings reinforce this observation. The negative association between hemoglobin concentration and stroke (OR: 0.91, 95%CI: 0.83-1.00, p = 0.040), ischemic stroke (OR: 0.87, 95%CI: 0.79-0.96, p = 0.004), and cardiogenic stroke (OR: 0.82, 95% CI: 0.69-0.99, p = 0.039) further suggests that higher hemoglobin levels might confer a protective effect against these conditions. Hemoglobin concentration serves as a protective factor against stroke, and managing abnormal hemoglobin levels can effectively reduce the incidence of stroke.