General Health Research Articles

Anemia in Reproductive Age Group Women Attending in General Health Check-up in the Tertiary Care Centre in Kathmandu, Nepal: A Descriptive Cross-sectional Study

Background: Anemia is common, particularly among women in Southeast Asia and other Asian countries. In reproductive-age women (15-49 years), increased demand without adequate supply often leads to deficiency. This study aimed to determine the prevalence of anemia in this group. Methods: A descriptive cross-sectional study was conducted among women of reproductive age (15-49 years) visiting Tribhuvan University Teaching Hospital August 1st 2024 to October 20th 2024, following ethical approval. Exclusions included those with chronic diseases, incomplete data, heavy menstrual loss, or pregnancy complications. A convenience sampling method was used, yielding 372 participants. Data were recorded in MS Excel and analyzed in SPSS. Results: Our study of 372 participants (mean age 35.39 ± 8.73 years) found that 22.8% were women aged 40-44 years. BMI analysis showed 43% were overweight, and 34.1% had normal BMI. Blood group distribution was 27.4% A+ and 28.8% B+, with A- being the least common (0.3%). Most participants (75.3%) were from the Hill region, and 71.8% were unmarried. Anemia prevalence was 24.46%, highest in the 45-49 age groups and lowest in the 20-24 groups. Anemia was more common in the underweight (44.44%) and very obese (50%) groups and most prevalent among Terai region women (35.59%). Conclusion: The study found a significant prevalence of anemia among women of reproductive age, with higher rates observed in specific age groups, BMI categories, and geographic regions. This highlights the need for targeted interventions to address anemia in vulnerable populations.

Generic vs. Disease-Specific Patient Reported Outcome (PRO) Instruments for Assessing HRQoL Burden Among Patients Diagnosed with Alopecia Areata: Evidence from TARGET-DERM AA

Introduction Alopecia areata (AA) is a chronic, autoimmune disease characterized by patchy hair loss. Compared to other disease areas, recent work has signaled a potential shortcoming, that generic quality of life (QOL) questionnaires are not sufficiently sensitive to the impact of AA disease severity. This cross-sectional analysis investigates the Short-Form 36, the dermatology life quality index (DLQI), and the Alopecia Areata Patient Priority Outcomes (AAPPO) for similar shortcomings. Methods Patients of all ages enrolled from December 2021 to June 2024 in TARGET-DERM AA (data collection on-going) in the United States and Canada were grouped by Severity of Alopecia Tool (SALT) score (1-20, 21-49, or 50-100). At enrollment, patients completed the AAPPO and DLQI questionnaire as well as the RAND MOS Short-Form 36. The SF-36 has 8 subdomain scores (vitality, physical function, bodily pain, general health, physical role function, emotional role function, social role function, mental health) along with the physical component summaries (PCS), mental component summaries (MCS), and the SF-6D utility index score. The Kruskal-Wallis test compared differences in mean scores across SALT subgroups defined by severity. Results Of the 141 AA patients, 61.7% were female; 95.0% adults, and 67.4% Non-Hispanic White. When comparing the SALT 1-20 and the >50 subgroups, significant differences in SF-36 derived mean scores were only observed in the PCS and the physical function score (p<0.05). None of the other scores (MCS, SF-6D, or other SF-36 subdomains) showed any differences. Mean DLQI scores were similar across subgroups (p>.05) Notably, the hair loss and activity limitation domains of the AAPPO demonstrated significant differences between the patient subgroups (p<.0001 and p<.05, respectively) Discussion In this real-world cohort, generic QoL instruments, namely the SF-36 and DLQI, did not capture differences in the underlying health-related QoL burden of AA patients with different AA severity. Such differences were clear when HRQoL was measured for AA patients with mild hair loss AAPPO.

Coronary Computed Tomography Angiography in Heart Transplant Patients: Current Insights and Future Directions

Cardiac allograft vasculopathy (CAV) remains a significant challenge after heart transplantation, necessitating effective surveillance methods. This review centers around the role of coronary computed tomography angiography (CCTA) in CAV surveillance, given its unique capabilities to visualize and quantify CAV in comparison with other imaging modalities, including invasive coronary angiography and intravascular ultrasound. CCTA has shown good diagnostic performance for detecting and monitoring CAV, exemplified by a higher sensitivity and negative predictive value compared with invasive coronary angiography. Additionally, CCTA can provide valuable functional insights with fractional flow reserve integration. An additional, considerable benefit of CCTA is that it allows for the opportunity to assess other imaging markers of cardiometabolic and general health, including coronary artery calcium score, epicardial fat volume, liver fat, vertebral bone density, and lung density, which allows for a comprehensive assessment of the overall health of the patient.

Quality of life and functional outcomes after ileocystoplasty for microcystis of tuberculous etiology

BACKGROUND: The outcome of tuberculous bladder lesions is its irreversible shrinkage, persistent disorder of accumulative function and a significant decline in the quality of patient’s life. Supratrigonal augmentation ileocystoplasty and replacement ileocystoplasty are standard treatments for microcystis of tuberculous etiology. Currently, the advantages and disadvantages of these methods have not been sufficiently studied. AIM: To conduct a comparative assessment of the quality of life and functional outcomes of patients with tuberculosis etiology microcystis after supratrigonal augmentation and replacement ileocystoplasty. MATERIALS AND METHODS: The patients of the study were divided into two groups. The first group included 19 patients who underwent supratrigonal bladder resection with augmentation ileocystoplasty, the second group included 20 patients treated with replacement ileocystoplasty. In the period from one to six years after the surgery, quality of life was assessed and a complex urodynamic study was carried out. RESULTS: Analysis of the “General health” measure according to the King’s Health Questionnaire demonstrated the worst quality of life in the patient group after bladder resection (p = 0.013). In this group, the QoL scale indicated the worst measures of “Quality of Life due to Dysuria” (p = 0.019). The measures of the filling enterocystometry were consistent between the patient cohorts and varied in the satisfactory range. All key criteria reflecting the voiding function were significantly worse in group I: larger volume of residual urine (p = 0.001), lower maximum emptying rate (p = 0.034), and higher frequency of intermittent self-catheterization (p = 0.001). Calculation of the obstruction index showed a high prevalence of chronic urinary retention in the specified patient group (p = 0.015). Thus, abdominal pressure had to be increased several-fold for the patients underwent augmentation ileocystoplasty to initiate (p = 0.001) and maintain (p = 0.036) emptying of the intestinal urinary reservoir. The incidence of reservoir-ureteral reflux and incontinence is consistent in both groups (p 0.05). CONCLUSIONS: Cystectomy with replacement ileocystoplasty, as an intervention with the best quality of life and functional results, is the optimal choice in patients with microcystis of tuberculous etiology.

Combined laparoscopic nephroureterectomy with transurethral approach to the ureter in renal tuberculosis treatment

BACKGROUND: Tuberculosis of the genitourinary system is a common cause of organ removal surgeries. Despite the improvement of medical technologies, kidney and urinary tract surgeries for urogenital tuberculosis are traditionally performed using the open method. AIM: To assess the findings of laparoscopic and open combined nephroureterectomy with transurethral resection of the distal ureter in patients with renal tuberculosis. MATERIALS AND METHODS: The findings of 61 nephroureterectomies with transurethral resection of the distal ureter performed for destructive renal tuberculosis were analyzed. Open nephroureterectomy was performed in 31 patients, and laparoscopic approach was used in 30 patients. Patients in both groups were comparable by gender and age. RESULTS: The surgery duration, volume of intraoperative blood loss, rate and severity of postoperative complications were lower in patients who had laparoscopic interventions. When examined 1 month after surgery, patients in both groups showed the improvement of clinical parameters. The following changes were reported: a significant decrease in the nighttime urination rate, a decrease in IPSS scores, and an increase in the functional bladder capacity without significant differences depending on the surgical approach. After the surgery, a significant improvement in the quality of patients’ life was observed. In patients who had laparoscopic surgery, improvements were detected in all the SF-36 questionnaire domains. However, in patients after open surgery with a positive effect on most of assessed parameters no significant improvement of parameters in section “General Physical Health” was found. CONCLUSIONS: Irrespective of the selected approach, combined nephroureterectomy with transurethral resection of the distal ureter is an effective method of surgical treatment of patients with destructive renal tuberculosis. Moreover, the laparoscopic technique has shown a number of significant advantages over open surgery.

Food Insecurity and Depressive Symptoms Among Persons With Diabetes in the United States: Findings From the 2022 National Health Interview Survey (NHIS).

The purpose of this study is to examine whether food insecurity increases risk for depressive symptoms among adults with diabetes. Food insecurity is associated with depression in the general population. However, minimal research has examined this relationship among persons with diabetes. Adults with diabetes were identified from the 2022 National Health Interview Survey. Depressive symptoms were assessed by the 8-item Patient Health Questionnaire. Food insecurity status was measured with the USDA 10-item food insecurity scale. Participants were categorized as food secure, low food security, and very low food security. The association between food insecurity and depressive symptoms was examined using weighted logistic regression, adjusting for potentially influential covariates (age, sex, ethnicity, poverty to income ratio, education, diabetes type, body mass index, region, and general health). Among 2595 persons with diabetes, nearly one third (29.8%) reported symptoms of depression. Over one tenth (11.7%) had low or very low food security. Persons who had low or very low food security were more than twice as likely to report depressive symptoms (adjusted odds ratio [AOR] = 2.15, 95% CI, 1.39-3.32; AOR = 3.84, 95% CI, 2.28-6.45, respectively). Persons who were older, had higher income, and better general health were less likely to report depressive symptoms. Among adults with diabetes, low or very low food security was associated with increased risk for depressive symptoms. Further research is needed to evaluate the relationship between food insecurity and depressive symptoms among persons with diabetes.

Comparing self-rated health among exclusive e-cigarette users and traditional cigarette smokers: an analysis of the Health Survey for England 2019.

The health implications of e-cigarette use compared to traditional cigarette smoking continue to attract significant public health interest. This study examines self-rated health (SRH) outcomes among exclusive e-cigarette users versus exclusive traditional cigarette smokers, using data from the Health Survey for England 2019. From an initial sample of 10,299 participants, the study focused on 8204 adults, excluding those aged 0-15. Further refinement to exclusive nicotine product users led to 274 e-cigarette users and 1017 cigarette smokers, after excluding dual users, never users, ex-users, non-responders, and users of other tobacco products such as pipes and cigars. SRH was derived from participants' responses to a question asking how they rated their general health, with five possible options: "very good", "good", "fair", "bad", and "very bad". For the purposes of this study, these responses were collapsed into two categories: "Good Health" (combining "very good" and "good") and "Poor Health" (combining "fair", "bad", and "very bad"). Consequently, 834 participants were classified as reporting good health, while 457 reported poor health. Binary logistic regression, adjusted for factors such as age, sex, ethnicity, residence, education, body mass index, alcohol use, age started smoking, physical or mental health conditions, and frequency of GP visits, revealed that exclusive e-cigarette users were significantly more likely to report good health compared to exclusive cigarette smokers, with an odds ratio(OR) of 1.59 (95% CI: 1.10 - 2.32, p = 0.014). As a sensitivity analysis, a generalized ordered logistic regression model was performed using the original five SRH categories. The adjusted model confirmed consistent results, with exclusive e-cigarette users showing higher odds of reporting better health across the full range of SRH outcomes (OR = 1.40, 95% CI: 1.08-1.82, p = 0.011). These findings suggest that exclusive e-cigarette users perceive their health more positively than traditional cigarette smokers, contributing useful insights to the discussions around harm reduction strategies.

The effects of vitamin D levels on physical, mental health, and sleep quality in adults: a comprehensive investigation

BackgroundVitamin D, essential hormone for endocrine, autocrine, and paracrine functions. A billion people are deficient globally which contributing to numerous health issues. This study explores the link between vitamin D levels and sleep quality, impacting mental and physical health in adults.MethodsThis prospective cross-sectional study was conducted at Nims Hospital, Jaipur, involving 484 adults’ participants. Blood samples were collected for serum 25(OH) D measurements. Data were gathered using the SF-36 and ISI questionnaires to assess health and sleep quality.ResultsHigher vitamin D levels were strongly linked to better physical health, including physical function (r = 0.642, p < 0.001), general health (r = 0.560, p < 0.001), and PCS score (r = 0.441, p < 0.001). Vitamin D also positively impacted social functioning (r = 0.096, p = 0.035) and was negatively related to ISI scores (r = −0.112, p = 0.014).ConclusionThe study highlights a strong link between higher vitamin D levels and improved physical and mental health, with significant negative correlation to ISI scores. This underscores the importance of adequate vitamin D for overall well-being. The findings call for urgent measures to address vitamin D deficiency and further research into its health impacts.

Clinicians' experiences of obtaining informed consent for research and treatment: a nested qualitative study from Pakistan.

Informed consent is considered to be the standard method for respecting the autonomy of individual participants in research and practices and is thought to be based on several conditions: (1) providing information on the purpose of the research or a specific treatment, what it will entail, (2) the participants being mentally competent to understand the information and weigh it in the balance, and (3) the participants to be free from coercion. While there are studies of informed consent in other countries, especially Low and Middle Income Countries (LMICs), this study explored the experiences of clinicians regarding the process of obtaining informed consent to participate in a Randomised Controlled Trial (RCT) in particular and treatment in general in healthcare settings, both general and mental health, specifically focusing on the tension between individualistic concept of autonomy and collectivist values in cultures such as Pakistan. Qualitative interviews with 20 clinicians from healthcare settings in Pakistan who also served as recruiters in a suicide prevention RCT in Pakistan. The interviews were guided by semi-structured topic guide. All interviews were audio-recorded and transcribed verbatim. The interviews revealed that shared decision making was more morally important than individual autonomy, the role of the family played a dominant part in the consent-taking procedure, the decision of the elder and/or family patriarch took prominence, and that clinician-researchers encountered significant challenges in consent process in Pakistan, while recruiting patients into the trial as well as during routine treatment processes in healthcare settings. Four distinct themes emerged which were (1) Family deciding for patients, (2) Benefits of involving family in consent process, (3) Gender disparity in consent process, (4) Challenges experienced by clinician-researchers during consent process in Pakistan. The concept of consent is generally considered important in many cultures, however, there are two strands of understanding. There seems to be consensus that participant agreement is necessary to protect the participant but with regards to autonomy there are significant cultural differences whether it is the right for autonomy of the individual (individualistic concept) or family, community, or expert authority in other cultures. In Pakistan clinician-researchers sometimes preferred one approach and sometimes the other as they appreciated the interests of the patient to be.

Oral health knowledge and attitude among nursing students and staff in Mahasamund City, India

Oral health is a human right, an integral part of general health and essential for overall wellbeing and quality of life. Proper oral health care reduces premature mortality Nurses act as a link between admitted patients and doctors in the hospital. Public health nurses can educate people about health subjects. The study was conducted to assess oral health knowledge and attitude among nursing students and staff in Mahasamund city, India.To assess the level of knowledge and attitude regarding oral health among nursing students and staff in Mahasamund City, India and to identify gaps that can be addressed through targeted educational interventions.The study was conducted at five nursing colleges in Mahasamund city, India. A total of 281 nursing students and staff from nursing colleges were included and requested to complete 25 closely ended questionnaires. A written informed consent was taken. The data collected was analysed using Statistical Package for the Social Sciences 16.0 and frequencies were calculated for each item in the questionnaire. 53% were of the view that toothpaste and brush is an ideal material for brushing. More than (73%) participants responded that gum infections were responsible for bleeding from gums. Almost 6.4% reported that brushing should be done twice daily. The majority of those (65%) had sufficient knowledge for detection of Dental Caries. Almost 66% had sufficient knowledge about Public Health Dentistry. Most of the (70%) were interested in doing work at the Public Health Dentistry.The overall oral health knowledge and attitude of nursing students and staff was insufficient. Only half of the study participants were aware of various aspects of oral health. Nurses should have basic knowledge about oral health and disease. It is recommended that a dental curriculum should be introduced in the nurses undergraduate training program which can be housed in Public Health Dentistry department as a part of community nursing.

Network based evidence of suicidal ideation among teachers.

This study investigates the relationship between risk and protective factors and suicidal ideation among teachers, a group often overlooked in suicide prevention efforts. Using the diathesis-stress model as a partial framework, the research explores how depression and anxiety, as risk factors, and emotional intelligence, resilience, and positive thoughts, as protective factors, influence suicidal ideation. A cross-sectional design was employed, involving 1,270 Spanish teachers (median age: 46, 70.2% female). Key measures included the Positive and Negative Suicidal Ideation scale (PANSI), the Brief Emotional Intelligence Scale (BEIS-10), the Brief Resilient Coping Scale (BRCS) for resilience, and the General Health Questionnaire (GHQ-12) for depression and anxiety. A network approach was used to examine the relationships between these variables. Results showed that depression had a stronger relationship with negative ideation than anxiety, while emotional intelligence and positive thoughts acted as protective factors. Positive ideation was negatively associated with depression and anxiety, and positively linked to emotional intelligence and resilience. Emotional intelligence emerged as the most critical protective factor. These findings provide valuable evidence to inform the development of emotional management and resilience-building programs aimed at enhancing teachers' mental health and performance, which could also indirectly benefit students.

Comparative Effects of Spinal Anesthesia and Combined Spinal with Peripheral Nerve Blocks on Postoperative Outcomes in Anterior Cruciate Ligament Repair

Objectives: This study aimed to compare the effectiveness of spinal anesthesia (SA) alone versus combined spinal anesthesia with adductor canal block (ACB) and sciatic nerve block (SNB) (SA + ACB + SNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. We hypothesized that SA + ACB + SNB would provide better analgesia, greater patient satisfaction, and shorter postanesthesia recovery times than SA alone. Methods: A prospective randomized controlled trial was conducted with 60 patients aged 15–49 years scheduled for elective arthroscopic ACL reconstruction. Participants were randomly assigned to receive either SA or SA + ACB + SNB. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4, 12, and 24 h post-operation. General health was evaluated using the 12-item Short Form Survey (SF-12) at 1 month postoperatively. Range of motion and analgesic consumption were also recorded. Results: The median VAS score at 4 h post-operation was significantly lower in the SA + ACB + SNB group compared to the SA group (0 [IQR: 0–1] vs. 2 [IQR: 1–3], p = 0.0137). No significant differences in VAS scores were found at 12 h (p = 0.9282) and 24 h (p = 0.5809). PCS-12 and MCS-12 scores did not differ significantly between groups. The SA group had a lower postoperative range of motion (ROM) compared to the SA + ACB + SNB group, with a mean active ROM of 40.67 degrees (±23.52) versus 72.17 degrees (±24.69), respectively (p < 0.0001). Analgesic consumption was similar, with 53.33% of participants in each group using postoperative analgesics (p = 1.0). The mean surgery duration was 74.6 min. The gender distribution was 83% male and 17% female, with an average age of 27.7 years. Conclusions: Adding ACB and SNB to spinal anesthesia improved immediate postoperative pain relief and preserved range of motion in patients undergoing ACL reconstruction, suggesting potential clinical benefits in pain management and functional recovery.

Effects of Exercise on Pain and Disability after Lumbar Disc Herniation Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Objective To evaluate the effects of postoperative exercise on pain, disability, and quality of life (QoL) after lumbar disc herniation (LDH) surgery. Design We systematically searched the PubMed, EMBASE, Cochrane Library, and PEDro databases up to May 2024. Two reviewers independently selected and assessed relevant randomized controlled trials investigating the effectiveness of postoperative exercise after the surgical treatment of patients diagnosed with LDH on low back pain, disability, and QoL assessed using visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-item short-form health survey (SF-36). Results Compared with the control group, the exercise intervention group had significantly lower VAS scores both in the short-term (effect: 95% confidence interval [CI] = −1.14 [−1.69, −0.58], I2 = 91.4%, n = 9 studies) and long-term follow-up (effect: 95% CI = −0.99 [−1.89, −0.08], I2 = 58.9%, n = 4 studies). The exercise intervention group also showed a significant reduction in ODI in the short-term follow-up (effect: 95% CI = −5.00 [−7.72, −2.29], I2 = 79.3, n = 7 studies), but not in the long-term follow-up (effect: 95% CI = −0.80 [−3.97, 2.38], I2 = 0.0%, n = 4 studies). Among the SF-36 factors, physical function, pain, general health, energy and vitality, and social function significantly improved in the exercise intervention group compared with the control group. Conclusions Exercise after LDH surgery was effective in reducing pain and disability and improving QoL.

The effects of psychological flexibility and night shifts on mental health and well-being in nurses.

Examining mental health among nurses in the later stages of the COVID-19 pandemic could offer valuable information for addressing these symptoms in the long term. Therefore, the current study aimed to assess the mental health and well-being of Chinese nurses, as well as investigate the impact of psychological flexibility and night shifts on this relationship. In cross-sectional, hospital-based, multicenter study, 422 Chinese nurses were selected by multistage stratified cluster random sampling. The mental health status, psychological flexibility, and wellbeing were assessed via 12-item General Health Questionnaire (GHQ-12), Chinese version of Personalized Psychological Flexibility Index, and Chinese version of the 5-item WHO Well-Being Index, respectively. To examine the proposed theoretical model, we conducted structural equation modeling using SPSS Amos 26 version. The age, gender, night shift, psychological flexibility, mental health, and well-being data were entered into the model. Pearson correlation and chi-square were used to explore the correlation between variables. The high night shifts, being young and low psychological flexibility significantly had a direct effect on worse mental health (night shifts: ES, 95% CI: 0.619, 0.328-0.725; age: ES, 95% CI: 0.542, 0.226-0.993; psychological flexibility: ES, 95% CI: 0.675, 0.369-1.466). The low psychological flexibility and worse mental health were able to directly effect on worse wellbeing (psychological flexibility: ES, 95% CI: 0.419, 0.757-1.519; mental health: ES, 95% CI: 0.719, 1.109-2.607). In addition, psychological flexibility through the mediation of mental health also had an indirect effect on wellbeing (ES, 95% CI: 0.269, 0.957-2.165). Being young, having more night shifts and having less psychological flexibility can be related to the deterioration of mental health and well-being in nurses. Therefore, it is recommended that nurses use the shift routine program with the least focus on the night shifts. Also, interventions to teach younger nurses how to face work stress and interventions to improve the psychological flexibility of all nurses are needed.

Within-person, longitudinal associations between neighborhood cohesion and adult mental health: A test of bidirectional relations.

There is theory and evidence supporting a relationship between neighborhood cohesion and mental health among adult people. However, most studies have used a cross-sectional design, and longitudinal studies have provided mixed support for this hypothesis. Moreover, while neighborhood cohesion is assumed to be a consistent predictor of mental health, the possibility of a reciprocal relation has been overlooked. The aim of the current study was to investigate the within-person reciprocal associations between neighborhood cohesion and adult mental health. This study used data from Understanding Society: the UK Household Longitudinal Study including waves 1, 3, 6, 9, and 12 (n = 81,895). A short version of Buckner's Neighborhood Cohesion Instrument was used, along with two well-established measures of mental health: the 12-item General Health Questionnaire and the mental component summary score of the 12-item Short-Form Health Survey. Hierarchical Bayesian continuous time dynamic modeling revealed significant reciprocal within-person cross-effects (i.e. deterministic effects) between neighborhood cohesion and adult mental health, a larger standardized effect of mental health on neighborhood cohesion than than vice versa. Moreover, peak standardized cross-lagged effects were found for a time interval of approximately 1 year. Finally, the combined stochastic and deterministic interpretation revealed effects of neighborhood cohesion on mental health that were opposite to what was expected, suggesting a faster dissipation of some initially correlated change. Although neighborhood cohesion has traditionally been conceptualized in terms of its contribution to mental health, there is greater support for the view that mental health precedes neighborhood cohesion rather than the reverse.

Assisted reproductive technology, pregnancy and recurrent disease in melanoma patients: a 30-year single institution experience.

Objectives The aim of this study is to assess differences in melanoma recurrence between patients conceiving spontaneously versus those undergoing assisted reproductive technology (ART), to determine use of ART in post-melanoma patients and to examine the impact of counseling of this specific patient group. Design This study is a 30-year analysis including data from a single center questionnaire and a retrospective cohort study. Participants/Materials Women of childbearing age with a history of melanoma were requested to participate in our study. We selected patients who underwent either primary melanoma treatment or treatment of local / distant recurrence at our institute between 1994 and 2021. Each participant received a questionnaire and informed consent form. The questions concerned general health, primary tumor characteristics, utilization of ART, subsequent pregnancies and development of recurrent melanoma. Additional information was collected from the medical files. Setting The research was conducted in a dedicated oncology center and tertiary referral center for melanoma in The Netherlands. Methods Participants received the questionnaires by mail. Six weeks later a reminder was sent to non-responders. Analysis was performed using descriptive statistics. For comparisons between groups Chi-square tests were used. P-value was considered significant when below 0.05. A clinically relevant difference in recurrence rate was defined as a 10% difference. Results A total of 498 questionnaires were available for analyses, 449 from living patients and 49 from relatives of diseased patients. One hundred and seventy-nine patients (36%) with a history of melanoma became pregnant following their diagnosis. In this group, 28 patients (16%) attempted to conceive using ART, and eight of them experienced disease recurrence. There was no difference in the recurrence rate between patients who became pregnant after the diagnosis of melanoma and those who never subsequently conceived (37% vs 35%, p=0.609). Limitations The main limitations of the study are its size, observational design and questionnaire methodology. Conclusions Pregnancy did not increase the risk of recurrent melanoma. The group of patients conceiving after ART was small and therefore it is difficult to confidently conclude that the recurrence risk is comparable to the other groups. Prospective international registration of these patients, their oncologic follow-up and possible use of assisted reproduction, will provide valuable information to determine any potential association between ART and risk of recurrent melanoma. This would enable health professionals to develop surveillance strategies and pre-conception counselling of patients wishing to conceive.

Understanding the Relationship between Sleep Quality and Physical Activity: Implications for Healthy Aging

Background: Understanding the general health and well-being of the aged population requires an understanding of several factors, among which the interplay between physical activity and sleep quality are the most efficient determinants. There is still much to learn about the precise ways that different components of sleep quality affect different kinds of physical activity in older persons, accordingly, the study aims to provide a comprehensive understanding of the interaction between these variables. Methods: An online questionnaire-based investigation was conducted between August and September 2023. This cross-sectional study analyzed data from 1,437 participants aged 50 to 89 years. The questionnaire evaluated levels of physical activity, sleep satisfaction, and demographic data. We used cluster analysis, regression analysis, and factor analysis to investigate the connections between these variables. Results: Factor analysis revealed a single factor that accounted for 51.95% of the variance in all variables linked to sleep, and this factor represented overall quality of sleep. Regression analysis revealed that gender significantly predicted sleep quality, with females reporting lower sleep satisfaction. While strenuous exercise did not significantly affect sleep quality, moderate exercise was a positive predictor of sleep quality that neared statistical significance. Furthermore, cluster analysis revealed that those who engaged in more physical activity had higher-quality sleep. Conclusion: These results highlight the significance of encouraging physical activity to improve older adults' sleep quality. Specific programs that promote moderate exercise may enhance this population's general health and sleep quality. Future research should focus on longitudinal studies to create causality and modify intervention strategies aimed at promoting healthy aging.

The impact of Benson's relaxation technique on the quality of life of operating room nurses in hospitals southwest Iran: a randomized controlled trial.

In clinical settings, continuous changes lead to increased professional stress, affecting the quality of life of nurses. Some complementary interventions may influence the improvement of the quality of life. This study aimed to determine the effect of Benson's relaxation technique on the operating room nurses' quality of life. In this clinical trial, 180 operating room nurses were randomly allocated to two groups: intervention (Benson's relaxation technique) and control (routine activity). The study was conducted from December 2021 to March 2022 in hospitals affiliated with Shiraz University of Medical Sciences. Benson's relaxation technique was performed twice daily by the intervention group for 8 weeks. Quality of life was measured before and after the intervention using the SF-36 questionnaire. Data were analyzed using SPSS version 21 software, with a significance level set at a P < 0.05. After the intervention, the results showed that Benson's relaxation technique led to an increase in the quality of life in the intervention group (P < 0.0001). In terms of quality-of-life dimensions, significant improvements were observed in the intervention group in the domains of physical problems (P < 0.05), emotional problems (P < 0.05), general health (P < 0.05), pain (P < 0.0001), and social functioning (P < 0.05). However, no significant differences were found in the dimensions of physical functioning, energy, and emotional well-being. Benson's relaxation technique can serve as a complementary method to improve various dimensions of the operating room nurses' quality of life. IRCT20211002052650N1 with the Clinical Trial Registry (26.10.2022).

Integrating electronic health records with other data sources for postmarket drug safety signal identification: a review

Electronic health records (EHRs) have emerged as resources for both the identification of adverse drug events (ADEs) and general population health surveillance, however questions remain around how best to utilize EHR data for drug safety signal identification. While the majority of signal identification research has utilized spontaneous reports and health insurance claims, these data also have limitations. Pharmacovigilance approaches combining EHR data with other data sources have the potential to address many of the shortcomings of individual sources. This mini-review seeks to provide an overview of some of the recent research leveraging EHR data in combination with spontaneous reports, claims data, and other pharmacovigilance data sources for drug safety signal identification. Studies have shown that combining EHR data with these and other sources is often beneficial compared to the use of a single source alone, however the synergism or friction introduced is insufficiently explored in current literature. Our review explores how EHR data benefits signal identification when used in combination with other sources, what methods have been applied, and what considerations have previously been noted. Finally, we identify gaps in current research and highlight important considerations for future work using multiple real world data sources for drug safety surveillance.

Thyroid antibodies in Hashimoto's thyroiditis patients are positively associated with inflammation and multiple symptoms.

Hashimoto's thyroiditis (HT) is an autoimmune disease, characterized by abnormal elevation in thyroid peroxidase antibody (TPO-Ab) and/or thyroglobulin antibody (TG-Ab). Patients have multiple symptoms despite adequate hormone substitution. In the present study, we aimed to quantify the relationship between thyroid antibodies and multiple symptoms, inflammation and health-related life quality. A total of 108 HT patients with clinical euthyroid status and 57 heathy controls were recruited. Clinical parameters were determined by laboratory examination, and the symptoms burden and life quality were obtained by a Hashimoto's Thyroiditis Symptom Questionnaire and a SF-36 Questionnaire, respectively. Compared with healthy controls, multiple extrathyroidal symptoms were significantly more serious in HT patients despite euthyroid status, mainly including that related to digestive system (abdominal distension, constipation and diarrhea), endocrine system (chilliness, gain weight and facial edema), neuropsychiatric system (forgetfulness, anxiety, depressed, fatigue, insomnia, irritability, and indifferent) and mucocutaneous system (dry skin, pruritus, and hair loss). Furthermore, serum TPO-Ab and TG-Ab were both inversely correlated with health-related life quality of general health and vitality parameters, and positively correlated with pro-inflammatory factors of TNF-α and IFN-γ, as well as severity of abdominal distension, diarrhea, chilliness, forgetfulness and fatigue. Moreover, TG-Ab level was positively associated with depressed, insomnia and indifferent. HT patients suffered from a variety of symptoms, and the elevated thyroid antibodies were inversely associated with health-related life quality and positively associated with inflammation and multiple extrathyroidal symptoms.