Health Questions Research Articles

ChatGPT and Patients With Heart Failure.

ChatGPT (Generative Pre-trained Transformer) is a large-scale language processing model, with possibilities for professional patient support in a patient-friendly way. The aim of the study was to examine the accuracy and reproducibility of ChatGPT in answering questions about knowledge and management of heart failure (HF). First, we recorded 47 most frequently asked questions by patients about HF. The answers of ChatGPT to these questions were independently assessed by two researchers. ChatGPT was able to render the definition of the disease in a very simple and explanatory way. It listed a number of the most important causes of HF and the most important risk factors for its occurrence. It provided correct answers about the most important diagnostic tests and why they are recommended. In addition, it answered health and dietary questions, such as the daily fluid and the alcohol intake. ChatGPT listed the most important classes of drugs in HF and their mechanism of action. It also answered with arguments to questions about patient's sex life, whether they could work, drive, or travel by plane. The performance of ChatGPT was described as very good as it was able to adequately answer all questions posed to it.

Exploring Factors Associated with Quality of Life in Caregivers of Children and Adolescents with Sickle Cell Disease and HIV: A Comparative Analysis.

Paediatric HIV and sickle cell disease (SCD) are two stigmatising and potentially fatal illnesses that place a significant burden on families. HIV patients benefit from a longstanding free-service national programme in Cameroon, and this could considerably alleviate burden of care on HIV caregivers, possibly leading to better quality of life (QoL) in HIV caregivers compared to SCD caregivers. Our study aimed to compare the QoL between caregivers of children and adolescents with SCD and HIV and explore factors associated with this QoL in Cameroon. We conducted a hospital-based cross-sectional analytic study at Douala Laquintinie Hospital from February to May 2023. A questionnaire was administered to caregivers of paediatric patients (≤18 years) with SCD and HIV. The Pediatrics Quality of Life-Family Impact Module (PedsQL FIM), the 7-item Generalized Anxiety Disorder (GAD-7), and the 9-item Patient Health Question (PHQ-9) tools were used as measures of quality of life, anxiety, and depression, respectively. Multivariable linear regression was used to determine factors associated with quality of life. A significance level was set at p < 0.05. We included 199 caregivers: SCD = 104 and HIV = 95. The mean age of caregivers in our sample was 40.47 ± 10.18 years. Caregivers of paediatric patients with HIV had a better mean quality of life than SCD (93.01 ± 7.35SD versus 64.86 ± 9.20SD, p < 0.001). PHQ-9 score (B = -1.52, 95% CI = [-2.08; -0.96], p=<0.001), GAD-7 score (B = -1.46, 95% CI = [-2.09; -0.83], p=<0.001), spending less than 75 000 FCFA on medications monthly (B = 12.13, 95% CI = [5.73; 18.94], p=<0.001), and being a SCD caregiver (B = -11.62, 95% CI = [-18.46; -4.78], p=0.001) were factors independently associated with quality of life on multivariable analysis. Quality of life is lower in caregivers of children and adolescents with SCD than with HIV. Preventing depression and anxiety as well as advocating for the subsidization of medications through a national SCD program may improve quality of life in SCD caregivers.

When Do Trade Unions Support Universal Demands? Organizational Context and Trade Union Strategies in the US and UK at the Turn of the 20th Century

AbstractWhen do labor movements come to support universal welfare policies? This article examines this question through a comparative account of the British and American labor movements at the turn of the twentieth century. Drawing on newspaper and meeting records from the Amalgamated Society of Engineers (ASE), the Amalgamated Society of Railway Servants (ASRS), the Cigarmakers International Union (CMIU), and the Brotherhood of Locomotive Firemen and Enginemen (BLF) from the mid-nineteenth century to World War I, it considers why, given a common tradition of exclusive benefits, the two movements diverged on the question of universal state health and pension schemes at the turn of the century—with the British labor movement abandoning its voluntarist orientation and the AFL preserving it.Complementing existing sociological accounts that emphasize state and party structure, sectoral composition, pace and quality of industrial change, and the demographic makeup of labor movements, this article builds on approaches from the sociology of organizations in centering the importance of organizational arenas in shaping trade union strategies and aims. In particular, it investigates the role of friendly and fraternal societies in structuring trade union interests over this period. The article demonstrates how changes within the friendly and fraternal society movement shaped the contextual significance and strategic value of benefit provision in each trade union over time. In doing so, it opens the way for a deeper reflection on the importance of organizational reasoning in shaping trade union organizing and the trajectory of welfare institutions.

Identification of health-related problems in youth: a mixed methods feasibility study evaluating the Youth Health Report System

BackgroundBecause poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study.MethodsThis mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16–23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants’ quantitative Youth Health Report System data were analyzed for descriptive statistics.ResultsFeasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility.ConclusionsThe process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.

Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnaires.

This study aimed to compare the 36-Item Short Form Survey Instrument version 2 (SF-36-v2) (generic) and Celiac Disease Questionnaire (CDQ) (specific) questionnaires used to evaluate the quality of life (QoL) in celiac Portuguese adult individuals. This cross-sectional study used non-probabilistic sampling based on Portuguese celiac patients who accessed the online survey in 2022. The online data collection used a self-reported instrument composed of three parts: (i) socioeconomic, health, and gluten-free diet (GFD) adherence questions; (ii) SF-36 v2 - Portuguese version (generic questionnaire) and (iii) Celiac Disease Questionnaire (CDQ) (specific questionnaire). A total of 234 individuals who accessed the survey completed the questionnaire. Seven of the eight SF-36 domains positively correlated to the specific questionnaire CDQ. The "General Health" domain (domain 4) showed a negative correlation with the CDQ. Differences in content between the two instruments might be able to explain this finding since the CDQ explores issues regarding the specificities of celiac disease (CD) and the lifelong GFD burden. About half of the sample from this study displayed poor diet adherence, it is possible that the SF-36 could not reflect the impact of CD treatment - the complete elimination of gluten from the diet - on patients' health. Therefore, this issue should be carefully evaluated in future research. Specific validated questionnaires for CD individuals, such as the CDQ, contemplate social, economic, and clinical variables that permeate the patient's life context. Therefore, these instruments may be more suitable for evaluating QoL in this public. However, using a general questionnaire such as the SF-36 would be indicated for comparing QOL between celiac patients and the general population or even between CD and other disease individuals. In this case, we recommend assessing GFD compliance for control parallelly.

98 Using youth hippology contest results as a needs assessment as a framework for a train the trainer program

Abstract Land-Grant Institutions and Cooperative Extension Services seek to disseminate science-based information to the general public and strive to develop the next generation of agriculturists. Extension agents across Tennessee implement youth and adult educational programs to build the knowledge and skill sets of producers and youth. However, Extension agents differ in areas of expertise, leaving some counties with minimal ability to provide 4-H horse project members with sufficient content knowledge while agents in other counties are more well versed in equine-specific areas. Youth (n = 224) competed in the 2021 regional 4-H Hippology contest across the Eastern (n = 59), Central (n = 93), and Western (n = 72) regions. Youth competed within their age divisions, where junior (grades 4 and 5, k=60 where k represents number of participants within each age division), junior high (grades 6 to 8, k = 100), and senior (grades 9 to 12, k = 100) divisions competed in written exam and slide identification phases. Contest scores from the Tennessee regional and Eastern National 4-H Hippology contests were used to determine areas of knowledge deficiency. Nutrition, tack, selection, health, and breeds were categories identified as areas in which 4th – 12th grade youth lacked adequate knowledge and a training program and new curriculum was developed and delivered to county extension agents. Statistical analysis was conducted using SAS v9.4 (Cary, NC). Differences were found when comparing across question category (P &amp;lt; 0.0001), age group (P &amp;lt; 0.0001), and year (P &amp;lt; 0.0001). Nutrition questions were most often missed by senior and junior high youth (k = 7.8, 51.94%; k = 7.5, 44.22%) whereas junior youth missed training questions most frequently (k = 4.9, 54.14%). Of the 5 deficient topic areas, selection questions were the lowest percentage missed by senior and junior high youth (k =5.9, 36.81%; k = 7.1, 39.53%) whereas junior youth missed health questions least frequently (k = 4, 39.87%). It was found that training status had no significant on scores from year to year (P &amp;gt;0.05). Despite the lack of training effect, these findings still prove valuable when assessing performance upholding the extension mission of delivering science-based information to the next generation of industry professionals.

Vocal Hygiene Habits in College Students With and Without Self-Reported Symptoms of a Voice Problem

PurposeThe purpose of this study was to determine the prevalence of symptoms of a voice problem in college students and to assess if general health factors and vocal hygiene habits serve as risk factors for symptoms of a voice problem in this population. MethodsParticipants (n = 289) from a university in the United States completed an online survey that included demographic and general health questions, the Screen6 questionnaire, and a list of 23 vocal hygiene habits. Four participants were excluded due to receiving voice therapy and the remaining 285 participants were divided into two groups based on the results of the Screen6 questionnaire: those with two or more symptoms of a voice problem daily or weekly (n = 84) and those with fewer symptoms (n = 201). Results29.5% of the college students in this study experienced two or more symptoms weekly or daily. Throat clearing was the most commonly reported symptom. Risk factors included having a postnasal drip, experiencing severe seasonal allergies, and taking medication for depression or anxiety. The following vocal hygiene habits were reported to occur more frequently in those with symptoms of a voice problem: use your voice until it hurts, use extra muscular effort while talking, use extra respiratory effort while talking, use a pitch that you think is too high, and use a pitch that you think is too low. Non-use behaviors, such as water and caffeine consumption, did not vary significantly between groups. ConclusionsPeople with two or more symptoms of a voice problem daily or weekly report using their voice in a way that may contribute to experiencing these symptoms. Vocal hygiene education for this demographic may be more impactful if it is catered to how the voice is used rather than non-use voice care.

Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.

(264) Prioritizing Sexual and Reproductive Health Research and Care for People with Cystic Fibrosis: A 2023 Workshop Report From the Cystic Fibrosis Foundation Sexual Health, Reproduction, and Gender Research (SHARING) Working Group

Abstract Introduction With therapy advances, people with cystic fibrosis (CF) are living longer, healthier lives, and thus increasingly have general and CF-specific sexual and reproductive health (SRH) questions. The CF Foundation is supporting the Sexual Health, Reproduction, and Gender Research (SHARING) Working Group to identify knowledge gaps, research priorities, and infrastructure needed for CF SRH research. SHARING includes pulmonologists, nurses, research coordinators, registered dieticians, psychiatrists, endocrinologists, reproductive urologists, and community members with CF. Objective In Spring 2023, SHARING developed and distributed a SRH prioritization survey for the CF community. During the annual in-person workshop, the group used these results to establish research priorities and develop studies that would address identified knowledge gaps. Methods SHARING partnered with Community Voice, a virtual platform for people with CF and their caregivers to share their perspectives on ongoing and future CF SRH research, care, and programming. We provided a list of 15 SRH research topics and asked respondents to rank the top five. We analyzed survey results using descriptive statistics. We also summarized discussions and future key directions for CF SRH research. Results A total of 303 respondents (85% people with CF and 15% caregivers) completed the survey. Sixty-five percent of people with CF were women and 37% of the people with CF for whom caregivers responded were women/girls. The majority (95% of adults, 98% of people with CF for whom caregivers responded) identified as White; 5% of adults and 10% of people with CF for whom caregivers responded were Hispanic/Latino. The majority (73%) of people with CF were &amp;gt;30 years old and 68% of those with CF for whom caregivers responded were &amp;lt;18 years old. Table 1 summarizes respondent demographics. The top five SRH topics were: 1) effects of CF modulator therapy (elexacaftor/tezacaftor/ivacaftor, ETI) on sex hormones; 2) effects of sex hormones on CF; 3) fertility; 4) pregnancy; and 5) SRH/mental health (Figure 1). People with CF prioritized pregnancy, sexual functioning, parenthood, and menopause, while caregivers prioritized ETI effects on sex hormones, fertility, mental health, and assisted reproductive technology (ART). SRH priorities differed by gender identity. Men and caregivers of men/boys prioritized fertility, mental health, SRH care provision, sexual functioning, and ART, while women and caregivers of women/girls prioritized the effect of sex hormones in CF, pregnancy, menopause, and contraception. During workshop proceedings, SHARING identified the need for further research on the interplay between sex hormones, CF pathophysiology, ETI, fertility, and ART, and a focus on the impact of infertility on mental health for males with CF. Conclusions SRH is an important and emerging area of research in CF. Research priorities are not uniform among people with CF and their caregivers, particularly across genders. Thoughtful consideration of such perspectives can ensure that future CF SRH research is relevant and responsive to CF community needs. SRH providers should be aware of the concerns in this understudied population from research and patient care perspectives. Disclosure No.

ÜNİVERSİTE ÖĞRENCİLERİNİN KİŞİSEL HİJYEN BİLGİ DÜZEYİ VE SAĞLIK ALGI DÜZEYLERİNİN DEĞERLENDİRİLMESİ

The aim of this study was to determine the level of personal hygiene knowledge in university students and assess the level of health perception. This cross-sectional study was conducted with 946 students studying at a state university in Ankara. A questionnaire which included the Perception of Health Scale and questions to determine socio-demographic characteristics and level of personal hygiene knowledge of students was used to collect data. Data were collected by face-to-face survey method. The students ages ranged from 16 to 39 with years. Median score of the students obtained from the questions on personal hygiene knowledge and from the Perception of Health Scale was 24.0 (Min-Max= 0.0-30.0)and 48.5 (Min-Max=22.0-75.0), respectively. While the most accurately answered question on personal hygiene was “Hands should be washed with generous amounts of soap and water after using the toilet” (95%), the least accurately answered question was “It is beneficial to walk around barefoot at home” (37.2%). In this study, the level of personal hygiene knowledge was determined to be higher in students of medical faculty, women, non-smokers, non-drinkers and those who had previous information on personal hygiene before (p&lt; 0.05).A weak positive relationship was determined between the level of personal hygiene level and health perception (r=0.397; p=0.001).It was determined in the study that the students had a good level of personal hygiene knowledge and medium level of health perception.

The longitudinal association between caregivers' perceived competence and autonomy and children's dietary consumption before and 10 months into the COVID-19 pandemic

The COVID-19 pandemic has been stressful, potentially affecting caregivers' feeding choices. Caregivers play a role in shaping children's diets, yet few studies have explored how their competence and autonomy, defined by the Self-Determination Theory, impact children's diets. We examined the relationship between caregivers' autonomy and competence and their feeding practices before and during the first year of the pandemic. A national convenience sample of caregivers with 3–12-year-old children completed an online survey during two time-periods. Questions adapted from the Intrinsic Motivation Inventory measured perceived competence and autonomy for feeding fruits and vegetables (F/V) and limiting sugar-sweetened beverages (SSBs) and desserts. National Health and Nutrition Examination Survey Dietary Screener questions measured children's consumption of F/V, SSBs, and desserts. Paired t-tests examined how child consumption and caregiver's perceived competence and autonomy changed, and logistic regressions examined whether caregivers' competence and autonomy predicted the change in child consumption and if changes in competence and autonomy were associated with changes in child consumption. Caregivers (n = 597) were mostly Black/African American (33.0%) or Latina/o/x (42.7%) and older than 30 years (84.1%). Children's consumption did not change overall, but caregivers' competence for feeding F/V increased, and their competence for limiting SSBs and desserts decreased. Caregiver competence and autonomy before COVID-19 did not predict child dietary consumption during the pandemic. However, change in competence was a significant predictor of the change in child consumption of F/V [OR (95%CI): 0.70 (0.57, 0.86)]. The association between caregiver's perceived competence for feeding F/V and child consumption remained positive and significant in both periods [OR (95%CI) pre and during COVID: 2.09 (1.69, 2.57) - 2.40 (1.88, 3.06)]. This study can inform behavioral interventions supporting caregivers' competence and autonomy around feeding choices.

Delivering COVID-19 vaccine trials at speed: the implementation of a phase IV UK multi-centre randomised controlled trial to determine safety and immunogenicity of COVID-19 vaccines co-administered with seasonal influenza vaccines (ComFluCOV)

BackgroundIn February 2021, the UK Department of Health and Social Care sought evidence on the safety and immunogenicity of COVID-19 and influenza vaccine co-administration to inform the 2021/2022 influenza vaccine policy. Co-administration could support vaccine uptake and reduce healthcare appointments. ComFluCOV was a randomised controlled trial designed to provide this evidence. This report outlines the methods used to deliver the trial in 6 months to answer an urgent public health question as part of the COVID-19 pandemic response.MethodsComFluCOV was commissioned by the Department of Health and Social Care and was managed by the Bristol Trials Centre, a UK-registered clinical trials unit. It was classed as an Urgent Public Health trial which facilitated fast-track regulatory approvals. Trial materials and databases were developed using in-house templates and those used in other COVID-19 vaccine trials. Participants were recruited by advertising, and via a trial website. Electronic trial systems enabled daily review of participant data. Weekly virtual meetings were held with stakeholders and trial sites.ResultsComFluCOV was delivered within 6 months from inception to reporting, and trial milestones to inform the Department of Health and Social Care policy were met. Set-up was achieved within 1 month. Regulators provided expedited reviews, with feedback ahead of submission. Recruitment took place at 12 sites. Over 380 site staff were trained. Overall, 679 participants were recruited in two months. The final report to the Department of Health and Social Care was submitted in September 2021, following a preliminary safety report in May 2021. Trial results have been published.ConclusionThe rapid delivery of ComFluCOV was resource intensive. It was made possible in part due to a unique set of circumstances created by the pandemic situation including measures put in place to support urgent public health research and public support for COVID-19 vaccine research. Elements of the trial could be adopted to increase efficiency in ‘non-pandemic’ situations including working with a clinical trials unit to enable immediate mobilisation of a team of experienced researchers, greater sharing of resources between clinical trials units, use of electronic trial systems and virtual meetings.Trial registrationISRCTN14391248, submitted on 17/03/2021. Registered on 30/03/2021.

Incorporating patient-reported outcome data into a predictive calculator for allogeneic hematopoietic cell transplantation recipients.

The Center for International Blood and Marrow Transplant Research (CIBMTR) provides a 1-year overall survival calculator to estimate outcomes for individual patients before they undergo allogeneic hematopoietic cell transplantation (HCT) to inform risk. The calculator considers pre-HCT clinical and demographic characteristics, but not patient-reported outcomes (PROs). Because pre-HCT PRO scores have been associated with post-HCT outcomes, the authors hypothesized that adding PRO scores to the calculator would enhance its predictive power. Clinical data were obtained from the CIBMTR and the Blood and Marrow Transplant Clinical Trials Network. The PRO measures used were the 36-Item Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation. One thousand thirty-three adult patients were included. When adjusted for clinical characteristics, the SF-36 physical component score was significantly predictive of 1-year survival (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.81-0.95; p=.0015), whereas the mental component score was not (HR, 1.02; 95% CI, 0.95-1.10; p=0.6396). The baseline single general health question on the SF-36 was also significantly associated with mortality (HR, 1.91 for those reporting fair/poor health vs. good, very good, or excellent health; 95% CI, 1.33-2.76; p=.0005). The addition of PRO scores to the calculator did not result in a significant change in the model's predictive ability. Self-reported pre-HCT scores were strongly predictive of self-reported health status (odds ratio, 3.35; 95% CI, 1.66-6.75; p=.0007) and quality of life (odds ratio, 3.24; 95% CI, 1.93-5.41; p<.0001) after HCT. The authors confirmed the significant, independent association of pre-HCT PRO scores with overall survival, although adding PRO scores to the survival calculator did not improve its performance. They also demonstrated that a single general health question was as accurate as the full measure for predicting survival, an important finding that may reduce respondent burden and promote its inclusion in routine clinical practice. Validation of these findings should be performed.

Telemedicine decision-making in primary care during the COVID-19 pandemic: Balancing patient agency and provider expertise

ObjectivesThe COVID-19 pandemic precipitated the expansion of telemedicine use worldwide, introducing a new dimension of healthcare decision-making – choosing a visit format – not previously experienced by most patients or providers. To date, the pandemic's impact on decisions about using telemedicine versus in-person visits in primary care has not been fully explored. The purpose of this study was to examine patient and provider accounts of decision-making about the choice between telemedicine and in-person care during the COVID-19 pandemic. MethodsPrimary care providers and patients were recruited from four healthcare systems across three states in the United States. Participants completed semi-structured interviews about their experiences using telemedicine for primary care during the pandemic. Data pertaining to decision-making about telemedicine were examined as a secondary analysis using interpretive description. ResultsTwenty-one providers and 65 patients completed interviews. Patients’ ability to choose their own visit format influenced their level of satisfaction with telemedicine care, while providers expressed concern about leaving visit format entirely up to their patients. Patients and providers generally agreed that telemedicine was well-suited for routine follow-ups, reviewing results, and medication management. However, in cases of urgent health problems, patients and providers differed in their criteria for determining what visit format is most appropriate but agreed that telemedicine could be a useful tool for “quick fixes” and for fast and effective triage. ConclusionsPrimary care patients and providers emphasized the importance of agency during care delivery and shared opportunities for effective triage via telemedicine. Further research should focus on developing tools to support shared healthcare decisions regarding telemedicine use under changing healthcare conditions, particularly for urgent health questions. Public Interest SummaryThe COVID-19 pandemic has increased telemedicine use around the world. This study looked at patient and provider decisions about using telemedicine versus in-person care during the pandemic. We asked 21 primary care providers and 65 patients from four healthcare systems across three U.S. states about their experiences using telemedicine during the pandemic. Patients were more satisfied if they were able to choose whether to have an in-person or video visit, while providers worried that allowing patients to choose the visit format could get in the way of care when patients need physical exams or laboratory testing. Patients and providers gave different reasons for choosing a visit format, but both agreed that telemedicine was useful for “quick fixes” and making decisions together in emergencies. Healthcare systems should create tools to help patients and providers decide when to use telemedicine, especially when managing urgent health issues.

Predictors associated with symptoms of depression & anxiety during the COVID-19 among MENA immigrants in Houston, Texas

Very limited knowledge is available regarding the mental health of the immigrant population in the USA. We aim to assess the factors affecting the mental health of immigrants living in Houston from war-inflicted and stable countries of Middle Eastern and North African (MENA) origin during the pandemic. This cross-sectional study was conducted among the MENA immigrants using a validated survey of sociodemographic, general health, and COVID-19 questions. Multivariable logistic regression models assessed sociodemographic and clinical predictors of depression and anxiety. The outcome of interest was categorized as “moderate or severe” versus “minimal or mild” for depression and anxiety. Total of 94 participants completed the study, with the sample rate of "moderate or severe" symptoms of anxiety and depression being 29.78% and 64.89%, respectively. Multivariable regression analysis for depression showed that immigrants from war-inflicted countries of origin were less likely to report “moderate or severe” depression compared to immigrants from stable countries (OR = 0.082, 95% CI 0.012–0.551). Individuals with excellent overall health (OR = 0.074, 95% CI = 0.013–0.414) had a significantly lower likelihood of “moderate or severe” depression than those who reported fair/poor health. Non-smokers (OR = 0.068, 95% CI = 0.012–0.377) were less likely to report “moderate or severe” depression in comparison to those who engage in smoking behavior. Participants who responded to the question that they tried hard to avoid thoughts of COVID-19 were less likely to have symptoms of “moderate or severe” depression compared to participants who responded, “No” (OR = 0.110, 95% CI = 0.017–0.712). Those who have” excellent/good knowledge” (OR = 0.0146, 95% CI = 0.022–0.946) about the prevention of COVID-19 spread were less likely to have “moderate or severe” depression compared to those who had “average/poor/terrible”. Multivariable regression analysis revealed smoking as a significant predictor of anxiety, with non-smokers demonstrating a lower likelihood of experiencing "moderate or severe" anxiety than smokers (OR = 0.21, 95% CI = 0.06–0.84). MENA immigrant communities in the USA have diverse immigration experiences, cultural backgrounds, and instability issues in their home countries, possibly elevating the risk of depression and anxiety during the COVID-19 crisis. Predictors identified should be considered by policymakers when developing targeted interventions to ensure the mental and social well-being of immigrant communities in the USA.

Citizens' perspectives on relocating healthcare.

Healthcare systems around the globe are facing challenges. There are increasing demands and costs at the same time as a diminishing health workforce. Without change, healthcare will become unsustainable. The Dutch government is searching for solutions, one of which is relocating healthcare. Relocating healthcare from expensive institutions to sites closer to patients' homes is an important part of this. This relocation is expected to reduce costs and lessen shortages of personnel. However, although citizens have an important stake in this, little is known about how they think about this topic. This research aims at investigating citizens' perspectives on relocating care. In December 2021, three open-ended questions were sent to 1,500 members of Nivel's Dutch Healthcare Consumer Panel, 796 respondents responded. In addition, two citizen platforms were organised in March and April 2022. A total of 23 citizens participated. Our results indicated that the following aspects are important for citizens in healthcare delivery: being treated by someone with expertise in the area of their need, familiarity with the healthcare provider and the treatment of less complex care close to home. When certain conditions are met, citizens prefer treatment for less complex care from their general practitioner rather than in a hospital. The most important condition is that the general practitioner has the right expertise regarding their health question. The willingness to relocate care from the general practitioner to other healthcare providers or to self-care is also present. One of the problems, however, is that citizens often do not know to which healthcare provider they should go or what they should do to increase self-care. From a citizens' perspective, relocating care is an acceptable solution for keeping healthcare sustainable in the future, provided that certain conditions are met.

Fadiga vocal de professores brasileiros da rede pública durante o ensino remoto: estudo multicêntrico

ABSTRACT Purpose To analyze teachers’ self-perception of vocal fatigue and its relationship with the amount of the speech and loudness, vocal disorders, mask usage, and working conditions. Methods A multicenter, exploratory, observational, analytical, and cross-sectional study of the web survey type during the period of emergency remote teaching. Convenience sampling was used, comprising 263 public school teachers from the cities of Belo Horizonte, Campinas, São Paulo and Salvador, working inEducation. The Google form was sent with sociodemographic, work and health questions, use of a face mask, in addition to self-assessment protocols and self-assessment Voice Disorder Screening Index (VDSI), Degree of Speech Quantity and Vocal Intensity (DSQVI), and Vocal Fatigue Index (VFI). Results Most of the teachers showed a suspected vocal disorder (55.9%) and perceived vocal fatigue (83.7%), with good voice recovery after rest (74.5%). There was a statistical association between self-perceived vocal fatigue and suspected voice disorder (OR: 25.64 / CI: 95% 7.60-86.45) and working in high school (OR: 0.35 / CI: 95%: 0.16-0.76). Conclusion Teachers reported a high prevalence of vocal fatigue, with satisfactory voice recovery while conducting online classes during the pandemic. The presence of vocal disorder increased the likelihood of self-perceived vocal fatigue symptoms, and working in high school reduced this likelihood.

Mental health, an ecosystem issue

The question of mental health can be approached using the three-dimensional model. In the light of the biological, environmental and circumstantial ingredients characterizing it, a critical analysis of both diagnosis and treatment can be proposed. The environment, like the individual, is both a factor and a player in psychological suffering. Treating one as well as the other is therefore the challenge of an ecosystemic approach.

Longitudinal study of childhood sleep trajectories and adolescent mental health problems.

To investigate whether childhood sleep trajectories are associated with mental health symptoms such as social phobia, generalized anxiety, depression, attention deficit hyperactivity disorder (ADHD), conduct problems, and opposition at age 15. A total of 2120 children took part in the Quebec Longitudinal Study of Child Development. Childhood sleep trajectories were computed from maternal reports at 2.5, 3.5, 4, 6, 8, 10, and/or 12 years. At age 15, 1446 adolescents filled out mental health and sleep questions. A path analysis model was assessed in the full sample. Four childhood nocturnal sleep duration trajectories were identified: (1) a short pattern (7.5%), (2) a short-increasing pattern (5.8%), (3) a 10 hours pattern (50.7%), and (4) an 11 hours pattern (36.0%). Three childhood sleep latency trajectories were found: (1) a short pattern (31.7%), (2) an intermediate pattern (59.9%), and (3) a long pattern (8.4%). Finally, two childhood wakefulness after sleep-onset trajectories were found: (1) a normative pattern (73.0%) and (2) a long pattern (27.0%). The path analysis model indicated that children following a long childhood sleep latency trajectory were more likely to experience symptoms of depression (β = 0.06, 95% CI: 0.01 to 0.12), ADHD (β = 0.07, 95% CI: 0.02 to 0.13), conduct problems (β = 0.05, 95% CI: 0.00 to 0.10) and opposition (β = 0.08, 95% CI: 0.02 to 0.13) at age 15. This longitudinal study revealed that children presenting a long sleep latency throughout childhood are at greater risk of symptoms of depression, ADHD, conduct problems, and opposition in adolescence.

Analytic optimization of Plasmodium falciparum marker gene haplotype recovery from amplicon deep sequencing of complex mixtures.

Molecular epidemiologic studies of malaria parasites and other pathogens commonly employ amplicon deep sequencing (AmpSeq) of marker genes derived from dried blood spots (DBS) to answer public health questions related to topics such as transmission and drug resistance. As these methods are increasingly employed to inform direct public health action, it is important to rigorously evaluate the risk of false positive and false negative haplotypes derived from clinically-relevant sample types. We performed a control experiment evaluating haplotype recovery from AmpSeq of 5 marker genes (ama1, csp, msp7, sera2, and trap) from DBS containing mixtures of DNA from 1 to 10 known P. falciparum reference strains across 3 parasite densities in triplicate (n = 270 samples). While false positive haplotypes were present across all parasite densities and mixtures, we optimized censoring criteria to remove 83% (148/179) of false positives while removing only 8% (67/859) of true positives. Post-censoring, the median pairwise Jaccard distance between replicates was 0.83. We failed to recover 35% (477/1365) of haplotypes expected to be present in the sample. Haplotypes were more likely to be missed in low-density samples with <1.5 genomes/μL (OR: 3.88, CI: 1.82-8.27, vs. high-density samples with ≥75 genomes/μL) and in samples with lower read depth (OR per 10,000 reads: 0.61, CI: 0.54-0.69). Furthermore, minority haplotypes within a sample were more likely to be missed than dominant haplotypes (OR per 0.01 increase in proportion: 0.96, CI: 0.96-0.97). Finally, in clinical samples the percent concordance across markers for multiplicity of infection ranged from 40%-80%. Taken together, our observations indicate that, with sufficient read depth, the majority of haplotypes can be successfully recovered from DBS while limiting the false positive rate.