General Program Research Articles

Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial

BackgroundPeople with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA).MethodsA hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021–3/31/2021) and fidelity scores (baseline: 5/1/21–7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021–3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections.ResultsGHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03).ConclusionTailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities.Trial registrationClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371.

Contemporary Evaluation of Work-Life Integration and Wellbeing in US Surgical Residents: A National Mixed-Methods Study.

The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI. A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, suicidality). Semi-structured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI. Of 7,233 residents (85.5% response rate) 5,133 had data available on work-life conflicts. 44.3% reported completing non-educational task-work at home, 37.6% were dissatisfied with time for personal life (e.g., hobbies), 51.6% with maintaining healthy habits (e.g., exercise), and 48.0% with performing routine health maintenance (e.g., dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p<0.05). After adjusting for other risk factors (e.g., duty-hour violations, and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p<0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (e.g., therapy); (2) explicitly supporting life outside of work (e.g., prioritizing time with family); and (3) allowing meaningful autonomy in scheduling (e.g., planning for major life events). Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.

Coping Strategies for English Language Anxiety: A Comparative Study of Lecturers and Students Across Disciplines

This study investigates the efficacy of coping strategies for English language anxiety among lecturers and students within religious and general study programs, employing a mixed-methods approach that integrates quantitative T-tests and qualitative interviews. Results indicate significant differences in the anxiety-coping strategies between lecturers and students, with distinct variations across the two types of study programs. While strategies among religious and general program lecturers showed no significant differences, a marked contrast was observed between students of these programs, highlighting the influence of disciplinary context on anxiety management. The study reveals that lecturers and students successfully use tailored strategies to mitigate language anxiety, suggesting the importance of contextualized approaches. Based on these findings, it is recommended that educational institutions develop specific training programs that enhance the capability of educators and students to manage language anxiety effectively. Such programs should focus on communication techniques, psychological resilience, and cultural awareness, which are crucial in diverse academic environments. The implications of this research support a differentiated approach to language education policy, advocating for interventions sensitive to the unique challenges and needs of various academic disciplines.

Дополнительное образование детей и молодежи в Кабардино-Балкарской Республике: история, проблемы, перспективы

The article is devoted to the analysis of the processes of formation and development of the regional system of additional education in the Kabardino-Balkarian Republic. The importance of the system of additional education for children and adolescents at the present stage is considered, as well as the main problems and current directions of its development in the short term. The five most important aspects are highlighted: educational work; early professional orientation for children and its support; modernization of the system of additional education; “networking” in the system of additional education; development of new general education additional programs. The features of the development of a technical direction in additional education for children and the current state of the problem of additional education for children with disabilities are considered.

The Impact of the COVID-19 Pandemic on Geographic Placement of Applicants to General Surgery Residency Programs

COVID-19 greatly influenced medical education and the residency match. As new guidelines were established to promote safety, travel was restricted, visiting rotations discontinued, and residency interviews turned virtual. The purpose of this study is to assess the geographic trends in distribution of successfully matched General Surgery applicants prior to and after the implementation of pandemic guidelines, and what we can learn from them as we move forward. This was a retrospective review of 129 Accreditation Council for Graduate Medical Education (ACGME) accredited, academic General Surgery Residency Programs across 46 states and the District of Columbia. Categorically matched residents' medical schools (i.e., home institutions), medical school states, and medical school regions as defined per the Association of American Medical Colleges (AAMC), were compared to the same geographic datapoints as their residency program. Preliminary residents were excluded. Residents in the 2018, 2019, and 2020 cycles were sub-categorized into the "pre-COVID" group and residents in the 2021 and 2022 applications cycles were sub-categorized into the "post-COVID" group. The percentages of residents who matched at their home institution, in-state, and in-region were examined. Multiple ACGME-accredited, university-affiliated General Surgery Residency Programs across the United States of America. A total of 4033 categorical General Surgery residents were included. Of 4033 categorical residents who matched between 2018 and 2022, 56.1% (n = 2,263) were in the pre-COVID group and 43.9% (n = 1770) were in the post-COVID group. In the pre-COVID group 14.4% (n = 325) of residents remained in-home (IH), 24.4% (n = 553) in-state (IS), and 37.0% (n = 837) in- region (IR), compared to 18.8% IH (n = 333), 27.8% IS (n = 492), and 39.9% IR (n = 706) in the post-COVID group, respectively. Significant increases for IH and IS resident matching at 4.5% and 3.4%, respectively, were noted in the post-COVID period (p < 0.05). The COVID-19 pandemic, and the ensuing changes adopted to promote safety, significantly impacted medical student opportunities and the General Surgery residency application process. General Surgery match data over the last 5 years reveals a statistically significant increase in the percentage of applicants matching at in-home and in-state institutions after the pandemic.

Rap poetry as an educational material in classes with middle and high school students on additional general educational programs

Rap poetry as an educational material in classes with middle and high school students on additional general educational programs

Обучение детей младшего школьного возраста в условиях семьи: к постановке проблемы

The article proposes for discussion the current problem of home education for primary schoolchildren, considers the reasons for choosing and ways to implement this form of education, and notes the risks that arise. Options for the possible integration of professional and family pedagogy, the organization of interaction between parents and school teachers to increase the efficiency of students’ mastery of general education programs in primary schools, as well as their successful socialization, are described. Attention is paid to home education of children with disabilities, children with special status, as well as the practice of distance learning, tested during the pandemic.

Assessing the suitability of a surveillance fauna-monitoring program for detecting future changes in reptile occupancy

Context Ecological surveillance monitoring typically targets multiple taxonomic groups by using standardised sampling across large spatial scales. Although surveillance monitoring confers advantages over hypothesis-driven monitoring in its broad taxonomic and spatial scope, the approach has been criticised for its disconnect from ecological management and failure to provide insights on the drivers of ecological change Aims To assess the adequacy of a plot-based general fauna-monitoring program for sampling reptiles as indicators of ecosystem health in a semi-arid upland region of the Northern Territory, Australia. Methods We surveyed reptiles at 90 sites, stratified between major landform and vegetation types, and using standard fauna-sampling methods, across the 2568 km2 Tjoritja National Park in the MacDonnell Ranges. We compiled a full inventory of the reptile fauna of the study area and identified species with potential utility as ecological indicators. We then used single-season occupancy models and power analyses to evaluate the adequacy of sampling for detecting potential future changes in occupancy. Key results We detected 57 of the 68 reptile species known from the protected area, 17 of which are potentially useful indicators of ecological health, mostly related to fire management. There was insufficient power to detect moderate (50%) future changes in reptile occupancy for all but the single most detected species. For the two ecological indicator species with sufficient detections for occupancy modelling, a positive association with a keystone structure (dense spinifex grass) was confirmed. However, increasing detection probability or the number of surveys would result in only minor improvements in power to detect occupancy change in these species. Conclusions Although reptiles are potentially useful indicators of ecological health, particularly in relation to fire regimes, the number of sites required to detect future changes in reptile occupancy by using standardised plot-based monitoring in this protected area is prohibitively high. Implications Our results suggest that once ecological associations are understood, monitoring ecological health remotely by using techniques such as fire-scar mapping to track proportions of long-unburnt vegetation should be considered over labour-intensive surveillance monitoring for reptiles. Targeted monitoring of threatened and other reptile species of conservation or cultural concern may also be warranted.

Pharmacokinetics and Bioequivalence of Two Formulations of Azithromycin Tablets: A Randomized, Single-Dose, Three-Period, Crossover Study in Healthy Chinese Volunteers Under Fasting and Fed Conditions.

Azithromycin is the first azalide antibiotic that is related to the macrolide family of antibiotics. Bioequivalence studies in China are initiated by the National Medical Products Administration (NMPA), which supports a generic consistency evaluation program for ensuring that generic products manufactured in China meet the required standards and provide equivalent therapeutic effects to their reference products. This study aimed to assess the bioequivalence of two azithromycin tablets under both fasting and fed conditions in healthy Chinese volunteers. This was a single-center, open-label, single-dose, randomized, three-way crossover trial with two independent groups (fasting group and fed group). A total of 72 healthy Chinese subjects (36 subjects in the fasting state and 36 subjects in the fed state) were enrolled and randomized to treatment. Blood samples were collected from 0 to 120 h after a single oral dose of a 250-mg generic azithromycin tablet (test, T) or branded azithromycin tablet (reference, R). The plasma concentrations of azithromycin were determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC‒MS/MS). A non-compartmental analysis method was used to estimate the pharmacokinetic parameters. Adverse events were documented. In a fasting state, the bioequivalence of maximum plasma concentration (Cmax) was evaluated using the reference-scaled average bioequivalence (RSABE) approach (within-subject standard deviation, SWR >0.294), and the bioequivalence of area under the concentration-time curve from time 0 to the time of the last measurable plasma concentration (AUC0-t) and area under the concentration-time curve from time 0 extrapolated to infinity (AUC0-∞) were evaluated by the average bioequivalence (ABE) method (SWR < 0.294). The geometric mean ratio (GMR) of T/R for Cmax was 106.49%, while the 95% upper confidence bound was < 0. The GMRs of AUC0-t and AUC0-∞ were 103.34% and 101.28%, and the 90% confidence intervals (CIs) of the test/reference were 95.90-111.35%/94.85-108.15%, respectively. In the fed state, the RSABE approach was applied to estimate the bioequivalence of Cmax (SWR >0.294), and the ABE approach was applied to estimate the bioequivalence of AUC0-t and AUC0-∞ (SWR < 0.294). The GMR for Cmax was 99.80%, while the 95% upper confidence bound value was < 0. The GMRs of AUC0-t and AUC0-∞ were 97.07% and 98.15%, and the 90% CIs of the T/R were 90.02-104.68% and 90.66-106.25%, respectively. All adverse events were mild and transient. The trial indicated that the test and the reference azithromycin tablets were bioequivalent and well tolerated in healthy Chinese volunteers under both fasting and fed conditions. Clinicaltrials, ChiCTR2300071630 (retrospectively registered in 19/05/2023).

Effect of Inspiratory Muscle Training on Cough Strength in Older People With Frailty: A Single-Blind Randomized Controlled Trial

ObjectiveTo investigate the effect of inspiratory muscle training (IMT) on cough strength in older people with frailty. DesignSingle-blind randomized controlled trial. SettingDay health care centers at 2 sites. ParticipantsOlder people with frailty (N=60). InterventionsEligible people were randomly assigned to receive IMT program in addition to general exercise training (IMT group), or general exercise training alone (control group). The IMT group performed training using a threshold IMT device with the load set at 30% of maximum inspiratory mouth pressure in addition to the general exercise training program throughout the 8 weeks. The IMT took place twice a day and each session consisted of 30 breaths. Main Outcome MeasuresPrimary outcome was cough strength, measured as the cough peak flow (CPF), at the beginning and the end of the program. ResultsData from 52 participants (26 in each group) were available for the analysis. The mean age was 82.6 years; 33% were men. The change in CPF at the end of the program was 28.7±44.4 L/min in the IMT group and −7.4±26.6 L/min in the control group. A linear regression model showed that the presence or absence of IMT was associated with changes in CPF (mean difference between groups, 36.3; 95% confidence interval, 16.7-55.9; effect size, 0.99). ConclusionsIMT may be a useful intervention to improve cough strength in frail older people.

A Grounded Theory Exploration of Addictions Treatment Within a Commercial Airline Setting.

INTRODUCTION: An Australasian Airline's Alcohol and Other Drug (AOD) Program demonstrates abstinence rates that exceed those of general AOD programs. The reasons for this are unclear. The purpose of this research was to develop a theory as to why this program is successful.METHODS: A qualitative examination following grounded theory methodology was undertaken. AOD program patients and healthcare professionals were interviewed until content saturation was reached. Data analysis followed grounded theory to identify the key concepts associated with the program's success.RESULTS: The core theory that emerged highlighted the pivotal roles of a strong employee-company relationship, shared values, and a safety-focused culture in explicating the program's success. This moves beyond the "carrot and stick" model of motivation, where belonging to this organization and safety consciousness serve as powerful drivers for abstinence. Challenges and barriers highlighted some unique challenges to the program in managing the coronavirus pandemic and the difference in approach to substance use in community spaces versus safety-critical employment.DISCUSSION: This research expands the understanding of this AOD program's success in a safety-critical industry, emphasizing the elements of a working relationship that are beyond positive or negative reinforcement. Future research should work to quantify and test the generalizability of these findings.Nairn J, Bell E, Myers J, Higgins M, Johnston B, Newton-Howes G. A grounded theory exploration of addictions treatment within a commercial airline setting. Aerosp Med Hum Perform. 2024; 95(6):313-320.

An efficient branch-and-bound algorithm using an adaptive branching rule with quadratic convex relaxation for globally solving general linear multiplicative programs

This article proposes an efficient global algorithm for solving general linear multiplicative programming problem (GLMP). The new algorithm combines the quadratic convex relaxation problem, adaptive branching rule, region reduction technique and branch-and-bound scheme. Firstly, a transformation technique can transform GLMP into a non-convex quadratic program with quadratic and linear constraints. The non-convexity parts of the equivalent problem are addressed by employing secant lines, so that a quadratic convex relaxation problem is structured. Secondly, we introduce the adaptive branching rule to improve the upper bound of the optimal value. Thirdly, the convergence of the proposed algorithm is analyzed and its worst-case complexity is provided. Finally, numerical experiments demonstrate the efficiency and advantage of the proposed algorithm for obtaining the global ɛ-optimal solutions of test instances.

Exploring the gender gap: A nationwide comparative analysis of general surgery residency program leadership

BackgroundThe gender disparity in surgery leadership roles is well-reported. However, the effect of program type and region on mean number of men or women occupying a particular leadership role has yet to be explored. This study aims to investigate the gender disparity of leadership positions in different types of General Surgery Residency Programs (GSRPs). MethodsLeadership roles of the general surgery departments were collected from the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) database. Each GSRP was categorized by region and program type using FRIEDA. Analysis of the mean number of men and women holding various leadership positions by program type and region was conducted using one-way ANOVA with post-hoc tests. ResultsA total of 345 GSRPs were analyzed. The mean number of women occupying various leadership roles was significantly higher at university-based programs when compared to community-based programs. No significant difference in mean number of women leaders was observed by region. ConclusionsWomen consistently occupy a lower number of GSRP leadership positions when compared to men, regardless of program type or region. University-based GSRP leadership positions have significantly greater gender inclusion compared to community-based GSRPs. Key messagesUniversity-based general surgery residency programs had a higher mean number of women in all leadership roles compared to other program types. In comparison, region did not appear to be a significant factor impacting the leadership gender disparity. Improvement is needed in community-based general surgery residency programs to bridge the gender gap in leadership roles.

Assessment of the Implementation of Flipped Classroom Setup in DIFEQUATIONS at Holy Angel University – School of Engineering and Architecture

Flipped classroom is an interactive teaching approach which provides active learning. In the first semester of school year 2023-2024, flipped classroom was implemented in DIFEQUATIONS under the School of Engineering and Architecture of Holy Angel University. Basic knowledge about each topic were provided by the instructors to the students before the in-campus sessions with the aid of asynchronous discussions such as pre-recorded videos and module resources and online assignments through the university’s learning management system. Students were equipped with fundamental principles and knowledge which were utilized during their in-campus sessions where active and interactive learning took place, acquiring them with mathematical skills and competencies. This study was conducted to know the perception of the second year engineering students who were enrolled in DIFEQUATIONS when flipped classroom was carried out. Ten statements regarding the evaluation of the General Engineering program, which was the implementation of flipped classroom in DIFEQUATIONS, were rated by the students and indicated strongly agree response with an average rating of 4.34. Students responded agree with the flipped classroom approach, getting an average rating of 4.10, which were the evaluations from thirty statements regarding flipped classroom. Suggestions and comments were solicited from the students to recognize the challenges, know the feedback and identify ways to improve the implementation of flipped classroom. Flipped classroom was a good way of understanding, studying and learning, where students were able to grasp each lesson in a more accessible and engaging process.

Approximating optimal solutions to biconvex parametric programs

AbstractConvex programming has been a research topic for a long time, both theoretically and algorithmically. Frequently, these programs lack complete data or contain rapidly shifting data. In response, we consider solving parametric programs, which allow for fast evaluation of the optimal solutions once the data is known. It has been established that, when the objective and constraint functions are convex in both variables and parameters, the optimal solutions can be estimated via linear interpolation. Many applications of parametric optimization violate the necessary convexity assumption. However, the linear interpolation is still useful; as such, we extend this interpolation to more general parametric programs in which the objective and constraint functions are biconvex. The resulting algorithm can be applied to scalarized multiobjective problems, which are inherently parametric, or be used in a gradient dual ascent method. We also provide two termination conditions and perform a numerical study on synthetic parametric biconvex optimization problems to compare their effectiveness.

Behind the pattern: General surgery resident autonomy in robotic surgery

ObjectiveRobotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents’ opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). MethodsGeneral surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2–5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. ResultsResident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons’ perceived operative time pressure inversely affected resident ICT. ConclusionsThis study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.

Analysis of a European general wildlife health surveillance program: Chances, challenges and recommendations.

In a One Health perspective general wildlife health surveillance (GWHS) gains importance worldwide, as pathogen transmission among wildlife, domestic animals and humans raises health, conservation and economic concerns. However, GWHS programs operate in the face of legal, geographical, financial, or administrative challenges. The present study uses a multi-tiered approach to understand the current characteristics, strengths and gaps of a European GWHS that operates in a fragmented legislative and multi-stakeholder environment. The aim is to support the implementation or improvement of other GWHS systems by managers, surveillance experts, and administrations. To assess the current state of wildlife health investigations and trends within the GWHS, we retrospectively analyzed 20 years of wildlife diagnostic data to explore alterations in annual case numbers, diagnosed diseases, and submitter types, conducted an online survey and phone interviews with official field partners (hunting administrators, game wardens and hunters) to assess their case submission criteria as well as their needs for post-mortem investigations, and performed in-house time estimations of post-mortem investigations to conduct a time-per-task analysis. Firstly, we found that infectious disease dynamics, the level of public awareness for specific diseases, research activities and increasing population sizes of in depth-monitored protected species, together with biogeographical and political boundaries all impacted case numbers and can present unexpected challenges to a GWHS. Secondly, we found that even a seemingly comprehensive GWHS can feature pronounced information gaps, with underrepresentation of common or easily recognizable diseases, blind spots in non-hunted species and only a fraction of discovered carcasses being submitted. Thirdly, we found that substantial amounts of wildlife health data may be available at local hunting administrations or disease specialist centers, but outside the reach of the GWHS and its processes. In conclusion, we recommend that fragmented and federalist GWHS programs like the one addressed require a central, consistent and accessible collection of wildlife health data. Also, considering the growing role of citizen observers in environmental research, we recommend using online reporting systems to harness decentrally available information and fill wildlife health information gaps.

Out of the shadows: mental health of physicians in Germany – a narrative mini-review

Burnout, depression, and suicide are major problems among physicians that can significantly impact patient care. This project aimed to gather studies and evaluations concerning the mental health of physicians in Germany through PubMed and websites of the government and large medical associations, with a focus on psychiatrists and compile those in a narrative mini-review. A pre-pandemic study by the “Marburger Bund” found that physicians were overwhelmed by workload and felt that extended working hours were damaging their private lives. According to this study, around 15% of physicians underwent psychiatric or psychotherapeutic treatment due to work-related mental issues such as exhaustion or depression. During the SARS-CoV-2 pandemic, the occurrence of depressive and anxiety symptoms among physicians was substantially greater than before the outbreak. A minimum of 76% of trainees questioned by the “Hartmannbund” expressed that their professional workload had a detrimental impact on their personal lives. Going back to the study of the “Marburger Bund”, physicians tend to trivialize their psychological issues and describe them as not severe enough to seek help. A general program for preventing mental disorders or helping physicians to deal with stress does not exist in Germany. Some attempts have been made to rectify this, however not all programmes are in effect yet. In conclusion, burnout and depression are major problems among physicians in Germany that require further attention and support. While some efforts have been made to address these issues, more needs to be done to provide comprehensive support for the mental health of physicians. There is a major lack of information about the well-being of trainees in terms of mental health in Germany and no systemic approach or help program for physicians struggling with their mental health.

Discontinuation of HIV oral pre-exposure prophylaxis: findings from programmatic surveillance within two general population HIV programs in Nigeria

BackgroundAs oral PrEP scales up in Nigeria, information about uptake, use pattern and client preference in a real-world, implementation setting is invaluable to guide refining service provision and incorporation of oral PrEP and other prevention measures into routine health services. To add to this body of knowledge, our study examines factors associated with discontinuation of PrEP among HIV negative individuals across two large scale programs in Nigeria.MethodsUsing program implementation data from two large-scale HIV projects in Akwa Ibom and Cross River states in Nigeria between January 2020 and July 2021, we used logistic regression to explore factors associated with early discontinuation (i.e., stopping PrEP within one month of starting) among HIV-negative individuals who initiated PrEP in the programs.ResultsOf a total of 26,325 clients; 22,034 (84%) discontinued PrEP within the first month. The odds of PrEP discontinuation were higher among clients who enrolled in community-based distribution sites (aOR 2.72; 95% C.I: 2.50–2.96) compared to those who enrolled in program-supported facilities and never married (aOR 1.76; 95% C.I: 1.61–1.92) compared to married clients. Clients who initiated PrEP because of high-risk sexual behaviour (aOR 1.15, 95% C.I 1.03–1.30) or inconsistent use or non-use of condoms (aOR 1.96, 95% C.I 1.60–2.41) had greater odds of discontinuing PrEPthan those who initiated PrEP because they were in a serodifferent relationship.ConclusionThe behavioural and demographic factors associated with early discontinuation of PrEP suggest that risk stratification of pre-initiation and follow up counselling may be helpful in raising continuation rates. On the service delivery side, strategies to strengthen follow-up services provided by community-based distribution sites need to be introduced. Overall, the low continuation rate calls for a review of programmatic approaches in provision of PrEP services in Nigeria.

Association between sarcopenic obesity and knee osteoarthritis: A narrative review

Sarcopenia and obesity have been studied independently as risk factors for knee osteoarthritis. However, there is now research interest in investigating whether the co-existence of sarcopenia and obesity (sarcopenic obesity) within the same individual significantly increases the risk of knee osteoarthritis, compared to sarcopenia or obesity alone. This review synthesises current literature to explore the association between sarcopenic obesity and knee osteoarthritis, emphasising both the clinical evidence and existing gaps. We highlight the challenges and progress in defining sarcopenic obesity and discuss the impact that the lack of a consensus definition of sarcopenic obesity has on comparing outcomes of studies investigating the relationship between sarcopenic obesity and knee OA. We offer methodological insights to guide future studies investigating whether sarcopenic obesity increases the risk of knee osteoarthritis above and beyond the risk associated with each condition on its own. The implications for clinical practice are discussed, including the need to incorporate effective resistance exercise into weight loss programs for individuals with sarcopenic obesity. This is critical as a general weight loss program alone among individuals with sarcopenic obesity can include substantial loss of muscle mass, potentially predisposing patients to further functional decline.