General Population Research Articles

Minoritised ethnic groups and modifiable dementia risk: a scoping review of UK-based evidence

BackgroundPeople from minoritised ethnic groups are more likely to be impacted by dementia. In the general population, dementia may be prevented or delayed by up to 40% by reducing risk...

Are food taxes for healthy eating acceptable? A survey of public attitudes in the UK

IntroductionAppropriately designed food taxes can improve diet quality and health. Fiscal levers are used in several countries to combat the rise in obesity and diet-related diseases. This study aims to...

Epidemiology and Burden of Pediatric Atopic Dermatitis in China.

We aimed to estimate the prevalence, severity, and burden of pediatric atopic dermatitis (AD) in China. EPI-CARE China was a cross-sectional online survey that assessed AD in the general pediatric populations (aged 0.5‒17years) between 21 March 2021 and 5 April 2021 in China. Diagnosis of AD prevalence was based on both International Study of Asthma and Allergies in Childhood criteria and self-reported or parent-reported physician confirmation of ever having had AD. Severity (mild, moderate, and severe) in the preceding week was assessed by patient global assessment. Health-related quality of life (HRQoL) was assessed using established dermatology patient-reported outcomes tools (Infant Dermatitis Quality of Life and Children's Dermatology Life Quality Index). Outcomes included type 2 inflammatory comorbidities and itch, skin pain, and sleep disturbance in the previous 24h (numeric rating scale [NRS]: 0-10 [no symptoms-worst symptoms]), stratified by age group (aged ≤ 5years, 6-11years, and 12-17years). In 7148 patients, AD prevalence was 3.2% (≤ 5years, 3.8%; 6-11years, 4.1%; 12-17years, 1.7%). Of these, 59.1% (≤ 5years, 66.1%; 6-11years, 60.1%; 12-17years, 39.4%), 38.8% (≤ 5years, 33.9%; 6-11years, 38.0%; 12-17years, 53.1%), and 2.0% (≤ 5years, 0.0%; 6-11years, 1.9%; 12-17years, 7.5%) had mild, moderate, and severe AD, respectively. Patients with moderate AD reported greater impacts on HRQoL than patients with mild AD (too few patients with severe AD provided HRQoL data for comparison). Overall, 90.5% patients reported ≥ 1 atopic comorbid condition. The mean (SD) itch, skin pain, and sleep disturbance NRS values were 5.9 (2.4), 5.6 (2.6), and 5.9 (2.3), respectively. These results demonstrate that AD is associated with substantial patient burden in pediatric patients in China.

Association of scalloped tongue with blood pressure among community-dwelling Japanese: The Toon Health Study.

In traditional East Asian medicine, scalloped tongue, characterized by dental indentations, indicates fluid retention and may be associated with hypertension. Few epidemiological studies have examined the association between scalloped tongue and blood pressure. Therefore, we aimed to examine this association in the Japanese general population. This study included 1,681 individuals, aged 30-84 years, who had participated in the Toon Health Study. The scalloped tongue was assessed using tongue images and we classified them into two groups: scalloped and non-scalloped. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and hypertension was defined as SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or the use of antihypertensive medication. Multivariable-adjusted Poisson regression analyses were used to examine the association between scalloped tongue and blood pressure after adjusting for potential confounders including age, sex and body mass index. Of the participants, 326 (19.6%) had scalloped tongue and 624 (51.6%) had hypertension. The multivariable-adjusted means of SBP were 126.6 mmHg and 129.7 mmHg in the non-scalloped and scalloped tongue groups (p < 0.01), respectively. The respective means of DBP were 76.5 mmHg and 78.0 mmHg (p = 0.02). The multivariable-adjusted prevalence ratios (95% confidence intervals) for hypertension and the highest quartile of SBP and DBP for scalloped tongue were 1.21 (1.04-1.41), 1.50 (1.23-1.84), and 1.25 (1.03-1.53), respectively, compared to the non-scalloped tongue group. The present study found that participants with scalloped tongue had higher SBP and DBP, even after adjusting for potential confounding factors.

Effects of Ban-Xia-Hou-Pu-Tang and Western medicine on patients with globus sensation: A randomized controlled trial.

Effects of Ban-Xia-Hou-Pu-Tang and Western medicine on patients with globus sensation: A randomized controlled trial.

Quality of Life among Predominately African Americans with HIV Who Use Drugs: The Role of Patient-Provider Engagement in Mediating the Impacts of Depression and Healthcare Discrimination.

Enhancing mental health-related quality of life (MHRQOL) is an important clinical objective for people with HIV (PWH), due to their elevated risk of psychological distress and mental health challenges. Depression, pain, stigma, and discrimination are among the main contributors to poor MHRQOL in this population and can negatively impact PWH's interaction with their healthcare providers, and vice versa. We used structural equation modeling to examine whether the quality of patient-provider engagement in HIV primary care mediated the effects of depression and prior experiences of discrimination in healthcare settings on later MHRQOL, assessed using the SF- 12 Mental Component Summary (MCS- 12), among a sample of predominately African Americans with HIV and a history of drug use. A total of 331 participants, recruited from HIV clinics and community venues in Baltimore, Maryland, USA, completed three semi-annual surveys between 2014 and 2018. At baseline, the sample showed a high percentage of probable depression (35.6%) and a low MCS- 12 mean score (38.72, SD = 6.88) compared with the US general population norm of 50 (SD = 10). There were significant indirect paths from baseline depression (β= -0.04, 95% CI= -0.10, -0.01) and healthcare discrimination (β= -0.05, 95% CI= -0.12, -0.01) to lower MHRQOL at 12-months, mediated through reduced patient-centered patient-provider engagement with primary care providers at 6-months, after adjusting for baseline assessment of the mediator and the outcome, demographic covariates, substance use, pain level, and time since HIV diagnosis. Findings suggest a potential for mitigating the impacts of depression and healthcare discrimination on MHRQOL through intervening on the quality of patient-provider engagement.

Knowledge, awareness, attitudes, and practices toward Parkinson’s disease among the general population in Saudi Arabia

BackgroundParkinson’s disease is a progressive disease that causes damage to parts of the brain, especially the substantia nigra. It is the most common motor brain condition.ObjectiveTo investigate the knowledge, awareness, attitudes, and practices toward Parkinson’s disease among the general population in Saudi Arabia.MethodsThis cross-sectional study was conducted in Saudi Arabia from July 20 to November 20, 2024, targeting adults aged 18 years and older. Participants (n = 385) were randomly selected via social media platforms, using a bilingual (Arabic and English) online questionnaire. The survey included demographics, knowledge, awareness, attitudes, and practices. Data was analyzed using SPSS (version 28), with ethical approval obtained.ResultsA total of 330 participants were surveyed, mostly young (292, 88.5% aged 18–24), female (269, 81.5%), and students (281, 85.2%). Nearly half (162, 49.1%) had heard of PD, but only 81 (24.5%) showed good knowledge, with misconceptions about causes and treatment. Commonly recognized symptoms included hand tremors (292, 88.5%) and poor balance (210, 63.6%), while awareness of non-motor symptoms was low. Most participants (319, 96.7%) supported public education, and 310 (93.9%) recommended social support for PD patients.ConclusionThis study emphasizes the lack of public knowledge and awareness regarding Parkinson’s disease, its symptoms, and its causes in Saudi Arabia. The results highlight the need for educational efforts to improve understanding and address misconceptions.CategoriesNeuroscience.

All-cause and cause-specific mortality in respiratory symptom clusters: a population-based multicohort study

BackgroundRespiratory symptoms are common in the general adult population. Increased burden of respiratory symptoms may increase the risk of mortality. We assessed the association between respiratory symptom clusters and mortality.MethodsParticipants were derived from two population-based Swedish adult cohorts (N = 63,060). Cluster analysis was performed with Locality Sensitive Hashing (LSH)-k-prototypes in subjects with ≥ 1 self-reported respiratory symptom. Linked mortality register data (up to 21 years of follow-up, > 600,000 person-years) were used. Associations between clusters and all-cause/cause-specific mortality were assessed using asymptomatic subjects as reference.ResultsOver 60% reported ≥ 1 respiratory symptom and ~ 30% reported ≥ 5 respiratory symptoms. Five clusters were identified, partly overlapping with established respiratory disease phenotypes but many individuals were undiagnosed: (1) "low-symptomatic" (30.3%); (2) "allergic nasal symptoms" (10.7%); (3) "allergic nasal symptoms, wheezing, and dyspnea attacks" (4.7%); (4) "wheezing and dyspnea attacks" (6.6%); (5) "recurrent productive cough and wheezing" (4.1%). All but Cluster 2 were associated with all-cause mortality, highest risk for Cluster 3 (hazard ratio 1.4, 95% confidence interval 1.13–1.73) and Cluster 5 (1.4, 1.22–1.61). Comparable associations were seen for cardiovascular mortality. For respiratory mortality, Cluster 4 (2.02, 1.18–3.46) and Cluster 5 (1.89, 1.1–3.25) were most strongly associated.ConclusionsRespiratory symptoms are common in the general adult population, with identifiable clusters. These clusters have clinical relevancy as they are differentially associated with mortality and relatively weakly correlated with diagnosed respiratory disease.

Narrative Review: Continuous Glucose Monitoring (CGM) in Older Adults with Diabetes.

Continuous glucose monitoring (CGM) has revolutionised diabetes care, with proven effect on glycaemic control, adverse diabetic events (such as hypoglycaemia and diabetic ketoacidosis) and hospitalisations in the general population. However, the evidence for CGM in older people is less robust. We conducted a narrative review of trials reporting data comparing standard blood glucose monitoring (SBGM) and CGM in adults over 65 with type 1 or type 2 diabetes who were treated with insulin published between 1999 and 2024. Seventeen studies were identified, including eight retrospective cohort studies and five randomised controlled trials (RCTs). Sixteen of the 17 papers were based in Europe or North America. The studies were highly heterogeneous; however, they provided clear evidence supporting the use of CGM in reducing hypoglycemia in older adults, with potential benefits for overall wellbeing and quality of life.. Current approaches to diabetes care in older adults may over-rely on HbA1c (haemoglobin A1c) as a measurement of control given accuracy may be reduced in older adults and propensity for hypoglycaemia. Although goals should be personalised, avoidance of hypoglycaemia is a key goal for many older people with diabetes. There is good evidence that CGM can improve time-in-range and reduce hypoglycaemia and glucose variability in older adults. CGM should be considered for older adults as a means of reducing hypoglycaemia and associated potential harm.

Blood Pressure Variability in Older Patients with Chronic Kidney Disease.

An increased blood pressure variability (BPV) is associated with a high risk of cardiovascular events in the general population. This concept was scarcely tested in patients with chronic kidney disease. We investigated the behavior of BPV parameters in a large cohort of older patients with CKD. This retrospective cohort study included patients ≥ 75 years old with eGFR ≤ 60 ml/min. Three systolic and diastolic consecutive blood pressure (BP) measurements were obtained automatically per visit (short-term - 3 consecutive measurements) and across visits (long-term - across visits). We calculated: 1) standard deviation (SD); 2) coefficient of variation (SD divided by the BP average) and 3) variability independent of the mean (VIM). For each BPV parameter, patients were divided into four quartiles. We included 1,063 patients (17,363 measurements). For short-BPV: the higher systolic BPV (SD and VIM) was associated with older age, a lower proportion of males and a higher proportion of patients with pulse pressure (PP) > 40 mmHg. Higher diastolic BPV (SD and VIM) was associated with lower body mass index, lower eGFR and a higher proportion of PP > 40 mmHg (for SD). Bland-Altman plots revealed comparable results between short- and long-term BPV. A higher BPV was associated with reduced renal function in older patients with chronic kidney disease. Our study also suggests that short- and long-term BPV can be used with similar results. Further studies are needed to confirm the association between BPV and outcomes and understand the physiological mechanisms underlying this correlation.

The role of spinal and hip mobility in disability among patients with chronic low back pain.

Chronic low back pain (cLBP) imposes substantial functional limitations and contributes significantly to healthcare costs worldwide. Identifying factors associated with disability is crucial for developing targeted strategies. Thus, this study aims to determine the relationship between mobility impairments and disability in individuals with cLBP. In this cross-sectional study, a adults aged 18-64 were enrolled from the general population, stratified by pain status: no LBP, intermediate LBP, and chronic LBP. Disability and pain intensity were evaluated using the Roland-Morris Disability Scale and the von Korff Chronic Pain Grade Questionnaire. Multivariable regression models examined the associations between the mobility parameters, disability, and pain intensity, adjusting for age, sex, body mass index (BMI), physical activity level, work status and smoking. 1,239 participants (55.8% female) were included. Disability was significantly associated with spinal and hip mobility impairments in the cLBP group but not in those with intermediate LBP or no LBP. In specific, lower lumbar sagittal (β: -0.04, 95% CI: -0.07- -0.01, p = 0.009) and coronal mobility (β: -0.06, 95%CI: -0.08 - -0.03, p < 0.001), as well as hip rotational (β: -0.06, 95%CI: -0.09 - -0.03, p < 0.001) and coronal mobility (β: -0.05, 95%CI: -0.07 - -0.02, p < 0.001), were associated with higher disability scores. In contrast, most mobility parameters showed no significant association with pain. This study demonstrates that both spinal and hip mobility impairments are independently associated with disability in individuals with cLBP. Notably, hip mobility was equally relevant as spinal mobility, underscoring the need for comprehensive mobility assessments in clinical practice.

Macular ganglion cell complex layer thickness measured with spectral-domain OCT in a large population-based cohort study

PurposeTo establish the normal GCC thickness profile in the general population using SD-OCT in different macular sectors. Determining the systemic and ophthalmic factors associated with GCC thickness and further identifying the potential risk factors were the secondary objectives.MethodsParticipants in the population-based cohort study had to be at least thirty years old. Every participant had a routine ophthalmological examination. Using SD-OCT, the GCC thickness was determined. To assess the relationship between GCC thickness and systemic and ocular characteristics, mixed linear models were used. R V.4.1.1 was the statistical analysis program utilized.ResultsTwo thousand four hundred ninety subjects, average age 56.60 ± 10.39 years, were collected in this analysis. GCC average thickness measured was 95.57 ± 7.47 μm. The GCC thickness of the superior (95.46 ± 7.87 μm) was the thinnest, and the inferior subfield (95.68 ± 7.66 μm) was thickest. In the multivariate regression analysis, a thinner GCC was majorly linked to being older (P < 0.001), current smoking (P < 0.001), no diabetes (P = 0.014), and a larger vertical cup disc ratio (VCDR) (P < 0.001). When the data was divided by age, a thinner GCC was also connected to female (P < 0.001), current smoking (P = 0.006), having high systolic blood pressure (SBP) (P = 0.002), lower low-density lipoprotein (LDL) (P = 0.002), higher triglycerides (TG) (P = 0.029), higher best corrected visual acuity (BCVA) (P < 0.001), and a larger vertical cup disc ratio (VCDR) (P = 0.002). Stratified by axial length (AL), a thinner GCC was associated with advanced age (P < 0.001), female (P = 0.005), and a larger VCDR (P = 0.001).ConclusionsOur study provides benchmarks for GCC thickness, distribution, and linked ocular and systemic factors among middle-aged individuals in rural China, emphasizing the strong correlation between GCC thickness and multiple ocular and systemic variables. Additionally, our findings underscore the importance of establishing global normative databases to address ethnic variations in GCC thickness and the distinctiveness of related ocular and systemic factors.

Coronary Artery Disease Doubles Excess Mortality in Patients With Heart Failure With Reduced Ejection Fraction.

Assessment of coronary artery disease (CAD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) varies between countries and there are only limited data on the long-term impact of CAD in these patients. We examined the association between CAD and mortality in patients with HFrEF undergoing coronary angiography. Using Danish registries, we identified patients with HFrEF (EF ≤40%) undergoing coronary angiography from 2003 to 2016. We estimated 10-year cumulative incidence proportions and adjusted hazard ratios (aHR) for all-cause death, comparing patients with HFrEF with CAD with patients with HFrEF without CAD. Both groups were further compared with an age- and sex-matched general population cohort in a 1:5 ratio. We included 3294 patients with HFrEF, of whom 1436 (44%) had CAD, as well as 16 365 matched general population individuals. Median follow-up was 5.3 years. Patients with HFrEF with CAD had higher 10-year mortality than patients with HFrEF without CAD (55% versus 33%; aHR, 1.38 [95% CI, 1.19-1.59]). These estimates were consistent across ages, whereas greater extent of CAD was associated with higher mortality (Ptrend<0.01). Compared with the matched general population, the 10-year excess mortality was 29% for patients with HFrEF with CAD (55% versus 26%; aHR, 2.18 [95% CI, 1.92-2.48]), and 15% for patients with HFrEF without CAD (33% versus 17%; aHR, 1.87 [95% CI, 1.63-2.14]). Presence and extent of CAD are strongly associated with all-cause mortality in patients with HFrEF and, when compared with a matched general population, presence of CAD doubles excess mortality. This highlights the importance of CAD assessment for prognostication in patients with HFrEF.

COVID- 19 in patients affected by red blood cell disorders, results from the European registry ERN-EuroBloodNet

BackgroundDespite several publications covering patients from multiple centers, no international registry covered all patients with red blood cell diseases (RBCD) affected by COVID- 19. The ERN-EuroBloodNet's registry provided real-time registration of SARS-CoV- 2 patients with RBCD, promoting timely disease-specific knowledge sharing during the pandemic's early stages.ProceduresThe study evaluated patient distribution, the infection across different RBCDs, and severity risk factors across similar healthcare systems, using data collected from the ERN-EuroBloodNet's REDCap platform.ResultsFrom April 2020 to April 2023, 681 infections were recorded among 663 patients, of which 373 had transfusion-dependent thalassemia or non-transfusion-dependent thalassemia (TDT/NTDT), and 269 had sickle cell disease (SCD). SCD patients had a higher incidence of COVID- 19 than those with TDT/NTDT (10.5 vs. 4.8 COVID/100 patients). Notably, 92% of the cases were mild, with neither age nor the specific RBCD affecting severity. The number of comorbidities, notably obesity and hypertension, that patients had prior to infection was associated with more severe COVID- 19. During the infection, the presence of vaso-occlusive crises, acute chest syndrome, kidney failure, and ground-glass opacities on chest tomography scans were associated with a more severe clinical picture. The vaccination rate (32%) mirrored that of the general population and showed a protective effect against severe COVID- 19. The observed mortality rate was 0.7%, aligning with Europe's general population.ConclusionSARS-CoV- 2 infection in SCD and TDT/NTDT patients is mild and without higher mortality than the general population. The ERN-Eurobloodnet’s registry collaborative structure exemplifies the power of international cooperation in tackling rare diseases, especially during health emergencies.

Understanding the onset and remission of suicidal thoughts in Australian men: Findings from the Ten to Men study.

While Australian studies explore suicidal thoughts' prevalence and correlates, little is known about their first onset in unaffected individuals or the predictors and rates of remission in the general population. The objective of the study is to determine the rates of first-onset suicidal thought and remission of suicidal thoughts among Australian males over a 9-year period and to identify predictors of these rates. This retrospective cohort study analysed 6035 participants from the Ten to Men study over four waves spanning 9 years. Outcomes included the first onset and remission of suicidal thoughts, with predictors encompassing sociodemographic, lifestyle, substance use, mental health and social factors. Modified Poisson regression with robust errors was used to identify predictors. The rate of first-onset suicidal thoughts over the 9-year study period was 19.2% (95% confidence interval = [18.1%, 20.4%]). The remission rate for suicidal thoughts over the same period was 65.5% (95% confidence interval = [62.5%, 68.4%]). The onset of suicidal thoughts was linked to lower education, depressive symptoms, disability, financial stress, homosexual orientation and history of partner violence. Depressive symptoms and disability were also associated with reduced remission rates. One-fifth of males reported a first onset of suicidal thoughts, while nearly two-thirds with a history of such thoughts experienced remission over the 9-year period. Suicide prevention interventions need to prioritize males with a disability and mental health problems, as these factors both predict the first onset of suicidal ideation and reduce the rate of remission.

Hyperandrogenaemia, PCOS, and Physical Fitness in Women - A Northern Finland Birth Cohort Study.

To investigate the independent associations of hyperandrogenaemia (HA) and polycystic ovary syndrome (PCOS) with physical fitness in women among the general population. A population-based birth cohort study including 5889 women. Longitudinal associations of serum testosterone (T), free androgen index (FAI), and PCOS with cardiorespiratory fitness (measured by heart rate after a submaximal exercise test) and grip strength over the 31 to 46 years of age timespan were examined using multivariable linear mixed models adjusted for time, body mass index, homeostatic model assessment of insulin resistance, physical activity and smoking. The results are reported as regression coefficients (β) with corresponding 95% confidence intervals [95%CI]. The third and fourth T and FAI quartiles associated positively with higher heart rate after the submaximal exercise test in multivariable models indicating poorer cardiorespiratory fitness compared to women in Q1 of T and FAI (Q3: β of T=1.58 [95% CI: 0.21-2.96], β of FAI=1.97 [0.54-3.39]; Q4: β of T=1.88 [0.46-3.30], β of FAI=2.70 [1.15-4.25]). The second, third and fourth quartiles of FAI associated with higher grip strength in multivariable models compared to women in Q1 (Q2:β=0.59 [0.04-1.14], Q3:β=0.74 [0.16-1.30], Q4:β=0.68 [0.06-1.27]). Excluding women with PCOS did not alter these results, while PCOS itself was not associated with cardiorespiratory fitness or grip strength. Hyperandrogenaemia in premenopausal women was associated with poorer cardiorespiratory fitness but better grip strength, independently of PCOS, which suggests that hyperandrogenaemia, rather than PCOS, has an independent and complex association with physical fitness in premenopausal women.

Influence of chronic pain on regional brain volume reduction in a general older Japanese population: a longitudinal imaging analysis from the Hisayama Study

Influence of chronic pain on regional brain volume reduction in a general older Japanese population: a longitudinal imaging analysis from the Hisayama Study

A shortened 10-item Spine Functional Index: clinimetric properties indicate a reliable, responsive and practical measure

BackgroundTo assess the 10-item Spine Functional Index (SFI-10) clinimetric properties in a general musculoskeletal disorder (MSD) spine population. Ascertain the psychometric characteristics’ consistency with the developmental study findings for structural and criterion validity, internal consistency, and floor/ceiling effect; establish the longitudinal characteristics for test–retest reliability, responsiveness, construct validity, and error scores; and clarify practical characteristics of readability, missing responses, and time/errors for completion/scoring related to administrative burden.MethodsA longitudinal study of deidentified spine MSD patients (n = 1317, 53.4% female, age = 18-91yrs, av = 49.5 ± 16.4yrs; neck = 36.5%, mid-back = 8.4%, low back = 56.0%, multi-site = 0.3%) who completed the SFI-10, the Patient Specific Functional Scale (PSFS), and Numerical Rating Scales for Global-function (G-NRS) and Pain (P-NRS). Structural validity used factor analysis, exploratory (EFA) and confirmatory (CFA), plus Rasch analysis. Criterion validity used Spearman's correlation coefficient (r) between the SFI-10 and criteria (PSFS, G-NRS and P-PRS) scores, and construct validity (n = 91, known-groups independent t-test). Internal consistency used Cronbach's alpha (α) and floor/ceiling effects were determined. Subgroups determined reliability (n = 104, intraclass correlation coefficient, ICC2.1); error (n = 171) through the standard error of measurement (SEM) and minimum detectable change (MDC90). Responsiveness (n = 171) was calculated using effect-size (ES), standard response mean (SRM), and area under the curve (AUC); and interpretability through the minimal clinically important difference (MCID). Practicality (n = 16) clarified missing responses, readability, and time/errors for completion/scoring.ResultsThe SFI-10’s structural validity was unequivocally one-dimensional from EFA and verified by CFA with acceptable fit-indices (chi-square/df = 2.88, CFI = 0.981, TLI = 0.975, RMSEA = 0.061), and supported by Rasch analysis (PSR = 0.79, Infit = 0.678–1.216, Outfit = 0.604–1.279, Item-difficulties = -1,215–2.488). Criterion validity varied from high (G-NRS, r = 0.60) and moderate (PSFS, r = 0.43) to low-inverse (P-NRS, r = -0.24). Internal consistency was strong (α = 0.84) and no floor/ceiling effects were present. Reliability was excellent (ICC2.1 = 0.97), responsiveness substantial (ES = 1.54; SRM = 1.64; AUC = 0.89), and measurement error robust (SEM = 3.84; MDC90 = 8.98%, MDIC = 10.4%), with construct validity confirmed (p < 0.001). Practicality showed no missing responses, completion/scoring errors < 1%, excellent readability (Grade = 5.1, Ease = 74.1%), short completion (39.2 ± 10.3 s) and scoring times (8.5 ± 1.8 s).ConclusionsThe SFI-10 demonstrates sound measurement properties in a general physiotherapy outpatient MSD spine population for both psychometric and practical characteristics. Further investigation in culturally diverse settings that include both inpatients and community settings with whole-spine and regional-spine criteria is required.

Adult Congenital Heart Disease patients understanding of their condition in Central and South-Eastern Europe: Current status and opportunity for addressing shortfalls and for better care.

Adults with congenital heart disease (ACHD) knowledge regarding their heart condition is crucial for optimal long-term outcome. Previous studies from North-Western Europe showed that important gaps in ACHD knowledge still exist. This study evaluates ACHD patients' knowledge in Central and South-eastern Europe (CESEE) and aims to identify opportunities for improving life-long ACHD care and outcomes in this region. A structured survey regarding the baseline heart condition knowledge was prospectively distributed to stable ACHD patients over a one-year period (2021-2022). Patients' responses were verified by their ACHD physicians to ensure accurate background information. Among 1650 patients (age 34.5 ±14) across 14 CESEE countries the majority 1023(62.0%) had simple congenital heart disease with at least one previous heart procedure performed 1201(72.8%); 1060(64.2%) were asymptomatic and 875(53.8%) had secondary school education. Overall, 576(34.9%) did not have basic knowledge regarding their congenital heart disease and 146(12.2%) did not have basic understanding regarding their previous heart procedure/s. Patients considered their life expectancy similar to the general population (p=0.039). Encouragingly, 962(59.5%) expressed a desire to learn more, and 929(58.1%) favoured technological integration in their care. Significant knowledge gaps exist amongst CESEE ACHD patients regarding their heart condition. Better ACHD patient education on current health and prospects is urgently needed. The results of this study should serve for developing congenital heart disease structured transitional and educational programmes in CESEE incorporating technology for their ACHD care and education to enhance patients' health knowledge and healthy life-behaviours to positively influence their life-long prospects.

Assessing the Quality and Reliability of ChatGPT's Responses to Radiotherapy-Related Patient Queries: Comparative Study With GPT-3.5 and GPT-4.

Patients frequently resort to the internet to access information about cancer. However, these websites often lack content accuracy and readability. Recently, ChatGPT, an artificial intelligence-powered chatbot, has signified a potential paradigm shift in how patients with cancer can access vast amounts of medical information, including insights into radiotherapy. However, the quality of the information provided by ChatGPT remains unclear. This is particularly significant given the general public's limited knowledge of this treatment and concerns about its possible side effects. Furthermore, evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and result in delays in receiving appropriate treatment. This study aims to evaluate the quality and reliability of ChatGPT's responses to common patient queries about radiotherapy, comparing the performance of ChatGPT's two versions: GPT-3.5 and GPT-4. We selected 40 commonly asked radiotherapy questions and entered the queries in both versions of ChatGPT. Response quality and reliability were evaluated by 16 radiotherapy experts using the General Quality Score (GQS), a 5-point Likert scale, with the median GQS determined based on the experts' ratings. Consistency and similarity of responses were assessed using the cosine similarity score, which ranges from 0 (complete dissimilarity) to 1 (complete similarity). Readability was analyzed using the Flesch Reading Ease Score, ranging from 0 to 100, and the Flesch-Kincaid Grade Level, reflecting the average number of years of education required for comprehension. Statistical analyses were performed using the Mann-Whitney test and effect size, with results deemed significant at a 5% level (P=.05). To assess agreement between experts, Krippendorff α and Fleiss κ were used. GPT-4 demonstrated superior performance, with a higher GQS and a lower number of scores of 1 and 2, compared to GPT-3.5. The Mann-Whitney test revealed statistically significant differences in some questions, with GPT-4 generally receiving higher ratings. The median (IQR) cosine similarity score indicated substantial similarity (0.81, IQR 0.05) and consistency in the responses of both versions (GPT-3.5: 0.85, IQR 0.04; GPT-4: 0.83, IQR 0.04). Readability scores for both versions were considered college level, with GPT-4 scoring slightly better in the Flesch Reading Ease Score (34.61) and Flesch-Kincaid Grade Level (12.32) compared to GPT-3.5 (32.98 and 13.32, respectively). Responses by both versions were deemed challenging for the general public. Both GPT-3.5 and GPT-4 demonstrated having the capability to address radiotherapy concepts, with GPT-4 showing superior performance. However, both models present readability challenges for the general population. Although ChatGPT demonstrates potential as a valuable resource for addressing common patient queries related to radiotherapy, it is imperative to acknowledge its limitations, including the risks of misinformation and readability issues. In addition, its implementation should be supported by strategies to enhance accessibility and readability.