Half Of Participants Research Articles

"Call 911 - That's my [Advance Care] Plan": Factors that Inform Advance Care Planning Conversation Readiness Among Aging Persons Living With HIV.

Antiretroviral therapy has dramatically increased the lifespan of people living with HIV (PLWH), but advance care planning (ACP) and hospice services are underutilized in this population. The purpose of this study was to understand barriers and facilitators to ACP among this group. PLWH (n = 25) were recruited from an HIV Clinic at a Veterans Affairs (VA) Medical Center in Atlanta, GA to represent a range of sociodemographic characteristics and experiences. Semi-structured interviews were analyzed using thematic analysis. More than half of participants (64%) indicated not engaging in ACP. We identified four key barriers to ACP: (1) a self-image among PLWH as "survivors" (and a reluctance to think about ACP); (2) a history of mistrust and mistreatment; (3) weak social ties and a desire to avoid disclosure of HIV status; and (4) a value for self-reliance. Findings have important implications for interventions to overcome these barriers.

Prevention of Preeclampsia in Saudi Arabia: Knowledge about Risk Factors and Aspirin Use among Obstetrical Care Physicians - A National Survey

Objectives: To assess the level of awareness among obstetrical care providers about preeclampsia prevention including risk factors, good practice in aspirin prophylaxis, and to analyze the associated factors. Methods: A cross-sectional study conducted among gynecologists and obstetricians, maternal and fetal medicine specialists, and internal or family medicine physicians working in public or private care centers whom involved in obstetric care in Saudi Arabia. An online-administered questionnaire was designed to assess familiarity of aspirin role in prevention of preeclampsia and fetal growth restriction including proper dose, timing of intake, gestational age to start and discontinuation of treatment as well as the risk factors of PE among set of 13 conditions. An awareness score was calculated and divided into two levels: adequate and inadequate familiarity and knowledge. Practice in PE prevention and attitude towards aspirin use, in addition to participants’ demographic and professional factors, were investigated and analyzed as profound factors. Results: Hundred sixty physicians were participated, 85% were obstetrician/gynecologists and 13.1 were maternal fetal medicine Specialists. Less than half of participants have adequate knowledge and awareness in aspirin role and a minority provided correct answers regarding the recommended aspiring dose, timing of intake, gestational age to start and discontinuation of treatment. However, knowledge about preeclampsia risk factors was relatively acceptable. Maternal fetal medicine specialist and physicians working in teaching hospitals were remarkably with better knowledge compared to their respective counterparts in primary and secondary centers. The existence of institutional guidelines about ASA use in pregnancy did not improve the knowledge level. Conclusion: The overall familiarity and knowledge in that regard was relatively poor, associating misconceptions about the risk factors and substantial gaps regarding the optimal timing and prescribing practice. Formal and continuous medical education curricula should be reviewed to promote good clinical practice in preeclampsia prevention as an essential dimension of maternal and fetal care.

Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products

Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.

Abstract TP255: Racism, Resilience, and Quality of Life in Black Stroke Survivors

Introduction: Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL. Methods: Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression. Results: Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of < $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p<.001) and anxiety (r=-.66, p<.01). At 6-month follow-up (n=44), QoL domains were very low for social relations ( M =36.83, SD=17.76) and environment ( M= 35.04, SD=14.57), and moderately low for physical ( M =46.49, SD=19.22) and psychological ( M =54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009). Conclusions: This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.

Abstract HUP11: Racism, Resilience, and Quality of Life in Black Stroke Survivors

Introduction: Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL. Methods: Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression. Results: Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of < $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p<.001) and anxiety (r=-.66, p<.01). At 6-month follow-up (n=44), QoL domains were very low for social relations ( M =36.83, SD=17.76) and environment ( M= 35.04, SD=14.57), and moderately low for physical ( M =46.49, SD=19.22) and psychological ( M =54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009). Conclusions: This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.

Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)

AbstractBackgroundRwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.MethodsA secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.ResultsMore than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.ConclusionResults suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.

Public knowledge of risk factors and warning signs of heart attack and stroke

BackgroundKnowledge of the predisposing risk factors and prompt recognition of the warning signs for heart attack and stroke is fundamental in modification of lifestyle behaviors and an imperative precursor to health-seeking behavior. In view of an existing knowledge gap amidst increasing incidence of heart attack and stroke in Tanzania, we conducted this community-based cross-sectional study among residents of Dar es Salaam city.ResultsA total of 1759 respondents were enrolled in this study. The mean age was 45.4 years, females constituted over a half of participants and over two-thirds had attained at least secondary school education. Regarding risk factors, just over 2% of participants displayed satisfactory awareness and only stress was recognized by at least half of participants. With regard to warning signs, barely 1% of participants had satisfactory knowledge for either of the conditions while nearly three-quarters of participants failed to mention even a single warning sign for heart attack. Recognized by about two-thirds of respondents, sudden numbness or weakness in face, arm or leg was the most acknowledged stroke symptom; however, other symptoms were familiar to less than a third of participants. Although over a half of respondents acknowledged going to a hospital as their first resort, over one-tenth of respondents expressed inappropriate reactions towards heart attack and stroke victims. Old age, higher level of education, positive history of heart attack or stroke, high blood pressure and history of dyslipidemia showed association with both risk factors and warning signs knowledge during bivariate analyses.ConclusionsPublic knowledge of common risk factors and typical warning signs for heart attack and stroke was critically suboptimal. These findings herald an utmost need for public health efforts to increase community awareness of risk factors and typical signs of the two conditions to curb the rising prevalence and associated morbimortality.

Determinants of body weight changes during Ramadan fasting in India amid COVID-19: A cross-sectional study.

Ramadan intermittent fasting (RIF) presents unique challenges and opportunities for public health and clinical practice, especially in populations with a high prevalence of non-communicable diseases. This study aims to investigate the impact of RIF on weight change among Indian Muslims and explore the associated demographic, dietary, and behavioral factors. A cross-sectional survey was conducted with a sample of Indian Muslim adults who observed RIF. Participants were asked to report their demographic information, family and personal health history, and dietary and lifestyle behaviors before and during Ramadan month. The primary outcome was body weight change, with secondary outcomes including changes in dietary patterns, physical activity, and other health-related lifestyle behaviors. The study found that during Ramadan, nearly half of the participants (48.5%) self-reported a retained initial weight, while a significant fraction (30.9%) self-reported a modest weight reduction between 0.5 to 2.5 kg at the end of Ramadan. Additionally, self-reported eating practices demonstrated moderately altered by about half (48.4%) of the study participants, with 32.2% reporting minor changes and 8.2% indicating substantial changes. An urban residence was associated with a higher likelihood of weight gain, where urban residents showed 3 times the odds of increased weight compared to rural inhabitants. Employment status emerged as a significant determinant for weight fluctuation, influencing both weight gain and loss. During Ramadan, there was a significant rise in snacking frequency, increasing from 21.7% to 32.6% in comparison with pre-Ramadan. The consumption of large quantities of food more frequently grew from 14.9% to 36%, and the incidence of eating despite not being hungry went up from 17.4% to 33.2%. The study demonstrates that RIF is associated with variable changes in body weight among adult Indian Muslims, influenced by urbanization, employment status, and dietary changes. The findings suggest that clinicians should provide tailored advice about body weight regulation during Ramadan and consider integrating community-based health initiatives within religious settings to improve health outcomes.

P952 Why do patients with Inflammatory Bowel Disease Take Part in Pharmaceutical Clinical Trials? A qualitative study of Clinical Trial Participants

Abstract Background Recruitment rates to clinical trials in inflammatory bowel disease (IBD) continue to decline. A better understanding of motivations to participate as well as recommendations to reduce barriers to enrolment from a patient perspective may assist in design of future clinical trials. Methods We developed a 32-item electronic questionnaire to explore motivations, experiences and recommendations of patients with IBD, who have participated in pharmaceutical clinical trials in a tertiary centre in Canada. Results We distributed a total of 82 emails with surveys based on the patient details available to the study team. Using the DillMan Total Design Survey method, participants were followed up one week after the initial email with a reminder phone-call and we received 46 responses (56.1% response rate). Participants were mostly, male (58.7%), non-Hispanic white (93.5%), with a mean age of 45.5 years (SD 10.9). Most participants decided to participate in a clinical trial to benefit future patients with IBD (63.0%). Self-reported knowledge of the possibility of being assigned to placebo on a scale from 0 (no knowledge) to 100 (extremely knowledgeable) was a median of 100 (IQR 100-100) (Table 1). Half of participants (50.0%) reported they were worried about the possibility of receiving placebo, although the majority (63.0%) understood they could improve on placebo. The most challenging aspect reported was the number and length of questionnaires (32.6%), as well of the number of colonoscopies (30.4%). Strategies to increase enrolment recommended by participants were reduction in the chance of receiving placebo (43.5%), facilitating inclusion of patients who have failed multiple therapies (43.5%), allowing virtual visits (39.1%), including subtypes of disease that have traditionally been excluded in clinical trials (e.g., ostomies, fistula) (34.8%), and improving outreach to underrepresented populations (28.3%) (Figure 1). The vast majority (80.4%) reported their experience of participation to be better than expected and would recommend taking part in a clinical trial to other patients with IBD (97.8%). Conclusion Patients with IBD who took part in pharmaceutical trials reported a high level of satisfaction overall. The top three recommendations from patients to improve clinical trial design were reducing the chance of receiving placebo, allowing inclusion of patients who have failed multiple therapies and allowing for virtual visits to reduce travel burden to the clinical trial site. These results should help inform the design of patient centric clinical trials in IBD.

P1177 Perceptions of patients with Inflammatory Bowel Disease and first degree relatives on prediction and prevention of disease

Abstract Background Significant advances have been made in understanding the preclinical stages of IBD, and in identifying risk factors and biomarkers to predict IBD onset. With the use of predictive testing to identify patients at risk of developing the disease, it would be possible to intervene and try to mitigate that risk. However, the feasibility of such strategy, would depend on whether individuals at risk of developing IBD would be willing to undergo predictive testing and preventive interventions. Methods A Redcap® electronic survey, available in five languages, was disseminated by clinicians and patient’s associations to patients with IBD, first-degree relatives (FDRs) of those with IBD, parents with IBD and healthy children at risk (based on family history), and healthy couples with multiple children including one with IBD. Participants were asked to express their concerns regarding their own or offspring’s risk of developing IBD and acceptable predictive testing and preventive interventions. Results 817 individuals (75% women, mean age of 41±12 years) living in 28 different countries participated. The majority were parents with IBD of healthy at-risk children (59%). Among individuals with IBD, 50% had Crohn's disease, 55% were on biologic treatment, 25% had undergone surgery, and 62% reported a significant impact on their quality of life. Overall 85% expressed willingness for predictive testing, favoring minimally-invasive methods. Half of participants would agree to cross-sectional imaging and 38% would accept a colonoscopy. The main benefits recognized with predictive testing were the possibility of starting preventive interventions to minimize the risk of developing IBD (74%) and obtaining an earlier diagnosis (63%). Anxiety from a positive result was a concern (57%). A total of 98% would accept preventive interventions. The most accepted were quitting smoking (64%), physical exercise (81%), dietary modification/supplementation (86%/71%) and probiotics (79%); with the optimal duration of the intervention to last up to one year (33%). Participants deemed a risk of minor adverse events up to 10% acceptable, with 33% tolerating a higher risk if disease risk was reduced by 75%. Half agreed that costs should be supported entirely or shared (39%) with the government. Conclusion In this international survey of patients with IBD or parents of children at-risk of developing IBD, minimally-invasive predictive testing would be well accepted as well as non-pharmacological and highly effective preventive interventions.

Intranasal Naloxone Repeat Dosing Strategies and Fentanyl Overdose

Questions have emerged as to whether standard intranasal naloxone dosing recommendations (ie, 1 dose with readministration every 2-3 minutes if needed) are adequate in the era of illicitly manufactured fentanyl and its derivatives (hereinafter, fentanyl). To compare naloxone plasma concentrations between different intranasal naloxone repeat dosing strategies and to estimate their effect on fentanyl overdose. This unblinded crossover randomized clinical trial was conducted with healthy participants in a clinical pharmacology unit (Spaulding Clinical Research, West Bend, Wisconsin) in March 2021. Inclusion criteria included age 18 to 55 years, nonsmoking status, and negative test results for the presence of alcohol or drugs of abuse. Data analysis was performed from October 2021 to May 2023. Naloxone administered as 1 dose (4 mg/0.1 mL) at 0, 2.5, 5, and 7.5 minutes (test), 2 doses at 0 and 2.5 minutes (test), and 1 dose at 0 and 2.5 minutes (reference). The primary outcome was the first prespecified time with higher naloxone plasma concentration. The secondary outcome was estimated brain hypoxia time following simulated fentanyl overdoses using a physiologic pharmacokinetic-pharmacodynamic model. Naloxone concentrations were compared using paired tests at 3 prespecified times across the 3 groups, and simulation results were summarized using descriptive statistics. This study included 21 participants, and 18 (86%) completed the trial. The median participant age was 34 years (IQR, 27-50 years), and slightly more than half of participants were men (11 [52%]). Compared with 1 naloxone dose at 0 and 2.5 minutes, 1 dose at 0, 2.5, 5, and 7.5 minutes significantly increased naloxone plasma concentration at 10 minutes (7.95 vs 4.42 ng/mL; geometric mean ratio, 1.95 [1-sided 97.8% CI, 1.28-∞]), whereas 2 doses at 0 and 2.5 minutes significantly increased the plasma concentration at 4.5 minutes (2.24 vs 1.23 ng/mL; geometric mean ratio, 1.98 [1-sided 97.8% CI, 1.03-∞]). No drug-related serious adverse events were reported. The median brain hypoxia time after a simulated fentanyl 2.97-mg intravenous bolus was 4.5 minutes (IQR, 2.1-∞ minutes) with 1 naloxone dose at 0 and 2.5 minutes, 4.5 minutes (IQR, 2.1-∞ minutes) with 1 naloxone dose at 0, 2.5, 5, and 7.5 minutes, and 3.7 minutes (IQR, 1.5-∞ minutes) with 2 naloxone doses at 0 and 2.5 minutes. In this clinical trial with healthy participants, compared with 1 intranasal naloxone dose administered at 0 and 2.5 minutes, 1 dose at 0, 2.5, 5, and 7.5 minutes significantly increased naloxone plasma concentration at 10 minutes, whereas 2 doses at 0 and 2.5 minutes significantly increased naloxone plasma concentration at 4.5 minutes. Additional research is needed to determine optimal naloxone dosing in the community setting. ClinicalTrials.gov Identifier: NCT04764630.

Exploring Perceptions and Practices Regarding Adult Vaccination against Seasonal Influenza, Tetanus, Pneumococcal Disease, Herpes Zoster and COVID-19: A Mixed-Methods Study in Greece.

We aimed to document vaccination coverage for five vaccines, predictors of each vaccine's uptake and attitudes regarding adult vaccination. Adults visiting four pharmacies were randomly invited to participate during summer 2022. Among 395 participants (mean age 51.2 years, range 19-96), vaccination rates were 78.1% for influenza and 25.8% for herpes zoster (≥60 years old), 64.3% for pneumococcal disease (≥65 years old), 33.1% for tetanus, while 11.4% had received two and 74.8% ≥3 COVID-19 vaccine doses. Half of participants (50.1%) voiced some degree of hesitancy, and 1.3% were refusers. The strongest predictor of each vaccine's uptake was doctor's recommendation (OR range 11.33-37.66, p < 0.001) and pharmacist's recommendation (4.01-19.52, p < 0.05), except for the COVID-19 vaccine, where the Attitude Towards Adult VACcination (ATAVAC) value of adult vaccination subscale's score was the only predictor (OR: 5.75, p < 0.001). Regarding insufficient coverage, thematic content analysis revealed seven main themes. Insufficient knowledge, the absence of health professionals' recommendation, perception of low susceptibility to disease, negligence and dispute of vaccine effectiveness were universal themes, whereas safety concerns and distrust in authorities were reported solely for COVID-19 vaccination. Designing public interventions aiming to increase trust in adult vaccination is essential in the aftermath of the COVID-19 pandemic. Health professionals' role in recommending strongly adult vaccination is crucial.

Awareness, knowledge, and beliefs about probiotics and prebiotics among Saudi adults: a cross-sectional study.

Probiotics and Prebiotics are essential for supporting both overall health and gastrointestinal health. However, the perception of these dietary components among the general public in Saudi Arabia is not well understood. The purpose of this study was to evaluate public awareness, knowledge, and beliefs regarding prebiotics and probiotics across Saudi Arabia. Our cross-sectional study included 1,306 participants aged 18 years and above. Data were collected in Saudi Arabia between May and July 2023 using a self-administered online questionnaire via convenience sampling. A high level of awareness was self-reported by only 21.9% of participants, whereas more than half (51.8%) of participants rated their level of awareness as low. Overall, 37.5% of participants displayed a high level of knowledge about probiotics and prebiotics, whereas 15.5% had a low level of knowledge. The majority of participants believed in the beneficial effects of probiotics and prebiotics on overall digestion/gut health (84.1%) and supporting the immune system (72.5%). However, less than half of participants believed in their beneficial effects on overweight/obesity (42.3%), stress management (35%), mental health/stress (29.2%), and heart health (28.7%). The obtained findings indicate sufficient levels of knowledge about prebiotics and probiotics among a population sample of Saudi adults. However, enhanced educational efforts and optimized strategies for promoting a comprehensive awareness and understanding of probiotics and prebiotics are recommended.

Clinical use of nadofaragene firadenovec-vncg.

Non-muscle-invasive bladder cancer (NMIBC), which is restricted to the mucosa (stage Ta, carcinoma in situ (CIS)) or submucosa (stage T1), comprises 75% of bladder cancer diagnoses. Intravesical bacillus Calmette-Guérin (BCG) therapy is the standard-of-care initial treatment for high-risk NMIBC; however, a significant proportion of patients have BCG-unresponsive disease. While radical cystectomy is a definitive treatment in this setting, not all patients are willing or able to undergo this complex procedure associated with morbidity, mortality, and decreased quality of life. Bladder-preserving options for patients with BCG-unresponsive NMIBC represent an unmet need in this patient population. Nadofaragene firadenovec-vncg (Adstiladrin) is a nonreplicating adenoviral vector-based gene therapy indicated for the treatment of adult patients with high-risk BCG-unresponsive NMIBC with CIS with or without papillary tumors. The antitumor efficacy of nadofaragene firadenovec is driven by its local delivery of copies of the gene encoding for interferon alpha-2b (IFNα-2b) to urothelial cells. In the phase III CS-003 study, over half of participants with CIS exhibited a complete response by month 3 after instillation, with minimal serious adverse events. The favorable efficacy and safety profile, clinical utility, novel mechanism of action, and every 3-month dosing schedule give nadofaragene firadenovec a unique role in the treatment of high-risk BCG-unresponsive NMIBC. This review provides a practical approach to the effective clinical use of nadofaragene firadenovec regarding pre-instillation visit arrangements, storage, handling, instillation procedures, and post-instillation procedures. Implementation of these recommendations will ensure efficient real-world use of nadofaragene firadenovec and the development of useful training materials and relevant standard operating procedures to help support a clinic's treatment for patients with BCG-unresponsive NMIBC with CIS. Video Abstract https://vimeo.com/user17898099/review/953723559/e18af7ec43.

Occupational Therapy for Parenting: Perspectives of Parents With Physical Disability.

Parenting with a physical disability often brings with it a range of challenges. Occupational therapists are well positioned to support parents to address these challenges, yet occupational therapy research and practice around parenting is relatively scarce. This paper addresses the questions: (1) How should occupational therapists support parenting occupations for people with physical disability? (2) How do parents with physical disability experience occupational therapy? An anonymous survey of 62 parents, primarily mothers, with physical disability about their experiences with parenting challenges and occupational therapy was analysed using both quantitative and qualitative techniques. Parents experienced challenges in engaging in a range of parenting tasks with children over a range of age groups. Parents reported that support was often needed and indicated that occupational therapy could assist them directly with specific parenting goals as well as the more usual biomechanical goals that influence parenting. Yet less than half of participants who received occupational therapy services reported that parenting tasks were addressed, and only one-fifth reported that their goals had been fully met. The data also indicated that the knowledge, skills, and attitudes of occupational therapists with regard to working with parents with disability can be improved. Findings suggest a need to better incorporate parenting occupations in standard occupational therapy training to increase occupational therapists' comfort and competence in working with clients on parenting issues.

Enhancing Consistency of Maximal Responding in Behavior Description Interviews: An Exploration of Priming and Response Length

In a Behavior Description Interview (BDI), candidates are asked to describe past experiences that demonstrate skills and abilities important for the position (Janz, 1982). A recent study by Huffcutt et al. (2020) found that only around half of participants (48.1 percent) describe an experience reflecting maximal performance capability. Random mixing of maximal capability with day-to-day typical performance tendencies is problematic psychometrically because candidates are not all providing comparable information and top candidates could be overlooked. Given notable methodological concerns with Huffcutt et al.’s approach, our first purpose was to provide empirical confirmation that maximal responding in BDIs is, in fact, inconsistent. Our estimate of the proportion of maximal responding was even lower (41.3 percent), further amplifying concerns when assessment of maximal performance capability is desired (e.g., for many professional positions). The second purpose was to investigate two factors that could increase the consistency of maximal responding: rewording the main BDI question to focus directly on absolute top-end experiences (i.e., priming) and longer response length. Both were found to have significant effects. A number of directions for future research were identified, which, along with these findings, could help researchers move closer to the long-term goal of uniform description of experiences that reflect each candidate’s maximal capability (or typical tendencies if so desired).

Unveiling metabolic dysfunction-associated fatty liver disease: Knowledge gaps and attitudes among Lebanese university students.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a rapidly growing global health problem. Despite its growing incidence and potential for significant repercussions, MAFLD is still widely misunderstood and underdiagnosed. The purpose of this study was to investigate MAFLD-related knowledge, attitudes, and risk profiles among university students aged 17 to 26. A cross-sectional study with 406 university students in Lebanon, equally distributed among males and females, was conducted using a questionnaire that includes demographics, medical information, dietary habits, physical activity, and MAFLD-related knowledge and attitudes. The findings demonstrated a significant lack of knowledge regarding MAFLD, with more than half of participants (54.7%) having no prior knowledge of the illness. Students exhibited unhealthy lifestyle behaviors such as smoking (68%), insufficient physical exercise (44.1%), and poor food habits (52.5%). Having a family history of heart disease, personal history of diabetes mellitus, a balanced diet and prior knowledge of the disease were associated with a higher knowledge score (p<0.05). A higher attitude score existed among those who have a personal or family history of chronic diseases and those who have a prior negative impression about the disease, prior knowledge of the disease, and those who are physically active (p<0.05). Despite knowledge gaps, university students in Lebanon have, in general, an appropriate and positive attitude towards MAFLD. We recommend the introduction of focused educational interventions to address the necessity of lifestyle changes among university students and the community as a whole. Developing comprehensive MAFLD prevention methods requires future studies in different age groups and demographics.

Impact of coronavirus disease 2019 on medical practice in endocrine and metabolic diseases in Japan: a nationwide surveillance study conducted by the Japan Endocrine Society.

We investigated the impact of the Coronavirus disease 2019 (COVID-19) pandemic on the management of endocrine and metabolic disorders in Japan. We conducted a cross-sectional nationwide questionnaire survey targeting board-certified endocrinologists under the auspices of the Japan Endocrine Society. The questionnaire consisted of multiple-choice questions and open-ended responses. Out of approximately 2,700 specialists, 528 (19.5%) opted to participate, suggesting a high level of interest in COVID-19 management among endocrinologists. The study found that almost half of participants had encountered cases of endocrine and metabolic disorders following COVID-19 infection or vaccination. Conditions related to thyroid diseases, glucose metabolism disorders/diabetes, and hypothalamic-pituitary disorders were particularly prevalent. Diabetes and obesity were identified as having high rates of severe cases or fatalities due to COVID-19. The study also highlighted challenges in routine diagnosis and treatment, emphasizing the potential benefits of combining remote consultations with in-person visits to optimize the frequency of examinations and check-ups during infectious disease outbreak which disrupts access to healthcare providers. The insights obtained from this survey are expected to contribute to ensuring appropriate healthcare provision for patients with endocrine and metabolic disorders by using flexible consultation formats, particularly even in the conditions where medical access may be limited due to future outbreaks of emerging or re-emerging infectious diseases.

Gout Knowledge: A Survey of Australian Outpatients with Gout.

The prevalence of gout has increased in the Western societies due to ageing and increasing BMI. Recently, lifestyle and dietary factors have been linked in epidemiological studies with an alteration of the risk of gout; however, there remains a lack of data on patient knowledge of these factors. The purpose of this survey-based study was to determine the knowledge of gout and its treatment both in the community and specialist care settings. Participants were recruited from a hospital rheumatology outpatient department, consumer organization and a random sample of participants from a population-based cohort who had self-reported gout in South Australia. Participants completed a survey regarding basic demographics, the Single Item Literacy Screener, use of medication and diet for treatment of their gout and knowledge of gout. Seventy-four people were recruited (87% male) with a mean age of 66 years (range 35-88). The mean duration of gout was 16.6 years (range 0-60). On screening with SILS, 19.0% were identified as having limited reading ability. Most gout was managed by the family practitioner (81.1%) and/or rheumatologist (18.9%). In regard to current gout medications, 52.7% were taking allopurinol, 17.6% colchicine, 9.5% non-steroidal anti-inflammatory drugs, 6.8% prednisolone and 5.4% herbal preparations. For further information regarding gout, participants would most commonly approach their general practitioner (85.1%). Most participants correctly identified certain triggers to gout attacks and almost half of participants (41.9%) reported that they had altered their diet due to gout. Conversely, participants often incorrectly identified common risk or protective factors for gout. Gout remains a common, yet undertreated, chronic condition. Our study highlights a lack of knowledge amongst patients of risk and protective factors in relation to gout. The increasing prevalence of gout within the population indicates a need to improve education and understanding among those with the condition.

Post-traumatic stress disorders in women victims-survivors of intimate partner violence: a mixed-methods pilot study in a French coordinated structure

ObjectivesThis study aimed to examine the prevalence of post-traumatic stress disorder (PTSD) in victims-survivors of intimate partner violence (IPV) consulting at the specialised and original facility ‘Maison des Femmes’ (MdF)...