High Use Research Articles

Inequalities in the use of dental services by people with and without disabilities in Brazil: a National Health Survey.

The present cross-sectional study aimed to evaluate if social, racial, and gender inequalities disproportionally affect the use of dental services by people with and without disabilities in Brazil in the year 2013. The study used data from the 2013 National Health Survey and the dependent variable was the use of dental services. The outcome was stratified by gender, race, and social variables. Descriptive analysis was represented by absolute and relative frequencies. Two inequality measures were used to investigate the inequalities: the Slope Index of Inequalities (SII) and the Concentration Index of Inequalities (CIX). The SII expresses the absolute difference and the CIX identifies the relative inequality. Of 145,580 adults evaluated, 7.7% reported disability. The proportion of adults without disabilities who used dental services in the last 12 months was higher (45.2%; 95%CI 44.2-46.1) than adults with disabilities (33.9%; 95%CI 32.0-35.9). There was an absolute difference of 40% points (SII 0.40; CI95% (0.36-0.45) in the use of dental services between poorer and richer people with disabilities. Absolute and relative inequalities were identified in the use of dental services, considering the education of the head of the family and family income, with similar results for people with and without disabilities. High inequality is observed concerning race. Racial minorities (Black, Brown, Yellow, and Indigenous) without disabilities presented a higher use of dental services in the last 12 months than racial minorities with disabilities. Our findings demonstrate that social and racial inequities negatively affect individuals with and without disabilities. Inequalities exist in the use of oral health services for people with and without disabilities.

Clinical and histological impact of diffuse inflammation at pouchoscopy

PurposeThe anatomical location of inflammation in and around the ileal pouch affects the pouch survival rate, and diffuse inflammation has poor pouch survival rates. We aimed to clarify the symptoms and histological findings of diffuse inflammation of the pouch.MethodsWe evaluated the symptoms, treatment, and histological findings according to the endoscopic phenotypes of diffuse inflammation, focal inflammation, and normal as the pouch body phenotype and afferent limb involvement, inlet involvement, cuffitis, and fistula as the peripheral findings.ResultsOf the 318 pouchoscopies, 47 had diffuse inflammation, 201 had focal inflammation, and 70 were normal. Symptomatic patients had diffuse inflammation more frequently (46.8%) than focal inflammation (13.4%) and normal (14.2%), with no difference between focal inflammation and normal. Antibiotics and steroids were higher rate administered in cases of diffuse inflammation, but not in cases of focal inflammation or in normal cases. Histological inflammation, inflammatory bowel disease (IBD)–specific finding, and colonic metaplasia showed severity in the order of diffuse inflammation > focal inflammation > normal. The number of peripheral inflammatory findings overlapped in the following order: diffuse inflammation > focal inflammation > normal. The number of symptomatic patients increased as the number of peripheral inflammatory findings increased.ConclusionPouches with diffuse inflammation are more symptomatic, have a higher use of therapeutic agents, and have more severe histological inflammation, IBD-specific finding, and colonic metaplasia accompanying peripheral inflammatory findings than the other groups. The higher the overlap of inflammatory findings in the surrounding tissues, the more symptomatic the patients will appear.

The association of solid fuel use in households for cooking with elevated blood pressure among reproductive-aged married women in Bangladesh.

Bangladesh is experiencing a rapid increase in hypertension prevalence, particularly in socio-economically disadvantaged communities. The higher use of solid fuel in these communities could be one of the significant factors contributing to this trend, but evidence supporting this hypothesis is limited in Bangladesh. Therefore, this study aims to investigate the associations of household solid fuel use and its exposure level with systolic and diastolic blood pressure (DBP) and hypertension. We analysed 7,320 women's data from 2017/18 Bangladesh Demographic and Health Survey. We considered three outcome variables: (i) systolic blood pressure (BP) (continuous response), (ii) DBP (continuous response), and (iii) hypertension status (yes, no). Our primary exposures of interest were fuel type (clean vs solid) and the potential level of household air pollution exposure through solid fuel use (unexposed, moderately exposed, and highly exposed). We used a multilevel mixed-effects Poisson regression model with robust variance to determine association between exposure and outcome variables while adjusting for confounders. Of the total respondents analysed, approximately 82% used solid fuel for cooking. The age-standardised prevalence of hypertension was 28%. Respondents using solid fuel were found to be 1.44 times (95% confidence interval [CI], 1.04-1.89) more likely to develop hypertension compared to clean fuel users. Compared to women using clean fuel, the likelihood of hypertension was found to be 1.61 times (95% CI, 1.07-2.20) higher among the moderately exposed group and 1.80 times (95% CI, 1.27-2.32) higher among the highly exposed group. Similar associations were reported for systolic and DBP. The use of solid fuel increases the risk of becoming hypertensive and elevates systolic and DBP. Policies and programmes are necessary to increase awareness of the adverse effects of solid fuel use on health, including hypertension. Efforts should be made to reduce solid fuel use and ensure proper ventilation systems in households where solid fuel is used.

Psycho-social problems among older people residing in community of Chitwan, Nepal—A cross-sectional study

Background Older people are vulnerable to various psycho-social problems such as depression, anxiety, insomnia, dementia, and loneliness that have profound impact on overall health and their quality of life and higher use of health services. Prevention and treatment of psychological problems in this risk group is critical for improving their quality of life. Objective This study aimed to find out the psycho-social problems among older people residing in community. Methods The study was a cross-sectional study design and 388 older people aged 65 years and above residing in different wards of Bharatpur Metropolitan city were selected using probability simple random sampling technique. Data were collected using interview schedule containing geriatric depression scale-15; Geriatric anxiety scale-10, University of California Loss Angels Loneliness Scale (UCLA-20), Anthens Insomnia Scale and Mini-Cog Test. Obtained data were analyzed in SPSS version 20 for windows. Chi-square test was applied to measure the association between psychosocial problems and selected variables. Result Findings of the study revealed that the mean age (± SD) of respondents was 72.92 (±7.12) years. Almost all (93.6%) older people had full functioning of activity of daily living and two third (66.5%) had other co-morbid conditions. More than two third (67.0%) of older adults had depression, 60.3% had anxiety, 53.6% had moderate to high level loneliness, 47.2% had insomnia, and 33.3% had dementia. Age, functional dependency, sex, co-morbidity, financial dependence, education and occupation were significantly associated with the psychosocial problems among older people. Conclusion and recommendation Psychosocial problems are common among older people residing in community of Chitwan. Hence, there is need to develop and implement health care strategy by local health care planner to prevent, treat and manage the psychosocial problems among this risk groups. Further, health care providers working in geriatric problems or psychosocial health need to conduct regular screening programs for the early diagnosis and treatment of these problems.

Post-COVID-19 Yearly Pattern Changes and Gender Variations in Attention Deficit Hyperactivity Disorder Patients at an Urban Mental Health Clinic in Alabama, USA.

Introduction The COVID-19 era has seen an increased trend in attention deficit hyperactivity disorder (ADHD) diagnoses. Historically, males have been diagnosed with ADHD more frequently than females during childhood. Studies have indicated a higher use of stimulant medications among male ADHD cases compared to females. This study examines ADHD cases from 2021 to 2023 to analyze yearly trends following the initial COVID-19 spike and explores gender and age differences between ADHD-positive and ADHD-negative cases. Methods This retrospective study was conducted using data from an urban outpatient mental health clinic in Alabama. Data were extracted from Electronic Health Records (EHR) for patients seen from January 1, 2021, to December 31, 2023. The Institutional Review Board (IRB) approved the study under the exempt research category. Data were analyzed using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and the StatisticalPackage for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk,NY). Diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, and clinical diagnoses and medication information were obtained from the EHR. Results The study included 1,422 patients, of whom 881 (62%) were diagnosed with ADHD. Females with ADHD had significantly higher comorbid conditions, such as major depressive disorder, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder, compared to males with ADHD. Gender differences in ADHD diagnoses were seen over the years, though no significant age differences were observed. Conclusions The study indicates a sustained high rate of ADHD diagnoses even after the initial COVID-19 spike. Females showed a higher ADHD diagnoses compared to males, but stimulant medication use remained consistent across genders. No significant age differences were observed between males and females with ADHD. Further research is needed to explore the reasons behind these gender differences and to evaluate their implications.

Strategies to Reduce Frequent Emergency Department Use among Persons Experiencing Homelessness with Mental Health Conditions: a Scoping Review.

The USA has some of the highest utilization rates of the Emergency Department (ED) worldwide, leading to increased healthcare costs, constrained resources, and fragmented care. Many of the highest ED utilizers are persons experiencing homelessness (PEH) and those with mental health conditions, with even higher use by those with comorbid social challenges. This study reviewed the literature assessing interventional approaches in the ED to minimize the burden of ED utilization by PEH with associated mental health conditions. We first conducted an informal literature review of high ED utilizers and their most common presenting symptoms. We then conducted a scoping review of articles according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines; we used PubMed and Web of Science databases as well as Google Scholar. We screened the titles and abstracts of studies that evaluated programs that aimed to reduce ED usage by patients with mental illness who were also experiencing homelessness. Of the 1574 titles and abstracts screened, 49 full texts were examined for eligibility. Of those, 35 articles were excluded for a final count of 14 included studies. We found that the studies fell under two main interventional categories: housing support and care management. There were various approaches to reduce ED visits from PEH with mental illness around the world. Overall, these studies found varying degrees of success in reducing ED visits for both housing intervention and care management strategies. Comparison of these studies reveals that the success of related strategies like housing support often have different outcomes which can be attributed to the differences between the populations studied, previously available community resources, and other psychosocial factors affecting study participants. Overall, the most successful studies found that a tailored approach that addresses the unique needs of participants had the greatest impact on reducing ED visits and hospitalizations. Further research is needed to determine the best strategies for specific populations and how to promote health equity among PEH with associated mental health conditions.

“ChatGPT seems too good to be true”: College students’ use and perceptions of generative AI

This study investigates how U.S. college students (N = 1001) perceive and use ChatGPT, exploring its relationship with societal structures and student characteristics. Regression results show that gender, age, major, institution type, and institutional policy significantly influenced ChatGPT use for general, writing, and programming tasks. Students in their 30s–40s were more likely to use ChatGPT frequently than younger students. Non-native English speakers were more likely than native speakers to use ChatGPT frequently for writing, suggesting its potential as a support tool for language learners. Institutional policies allowing ChatGPT use predicted higher use of ChatGPT. Thematic analysis and natural language processing of open-ended responses revealed varied attitudes towards ChatGPT, with some fearing institutional punishment for using ChatGPT and others confident in their appropriate use of ChatGPT. Computer science majors expressed concerns about job displacement due to the advent of generative AI. Higher-income students generally viewed ChatGPT more positively than their lower-income counterparts. Our research underscores how technology can both empower and marginalize within educational settings; we advocate for equitable integration of AI in academic environments for diverse students.

Evaluation of a voluntary passive surveillance component in cattle through notification of excess mortality

Passive surveillance can be most effective in the early detection of disease outbreaks given that farmers observe their animals daily. The European Animal Health Law states that unexplained excess mortality should be reported to the veterinary authorities. In the Netherlands, in addition to notifications to the competent authority, Royal GD is commissioned a passive surveillance component that consists of a veterinary helpdesk and postmortem examination for early detection of emerging diseases. The aim of this study was to evaluate this voluntary passive surveillance component through excess mortality in cattle.Weekly on-farm mortality was calculated using the cattle Identification and Registration records. Mortality was assessed on regional level for dairy, veal and other beef cattle using a Generalized Linear Model (GLM) (log-link, negative binomial). We used a cumulative sum of the model residuals to identify periods of excess mortality. The mortality was defined as excessive when above five times the standard error. The analysis was also conducted on herd level, but these models did not converge.We checked for an association between the two passive surveillance components elements and excess mortality. A GLM (log-link, negative binomial) with the number of contacts or submissions per region as the dependent variables and excess mortality per region and year as independent variables was carried out.Overall, the models showed significantly higher use of passive surveillance components in periods of excess mortality compared to non-excess periods. In dairy cattle the odds for contact or submission were between 1.72 (1.59–1.86) and 2.02 (1.82–2.25). For veal calves we found the odds of 2.19 (1.18–4.04) and 2.24 (1.78–2.83) relative to periods without excess mortality. Beef cattle operations, other than veal, showed only an increased odds for postmortem submissions in calves of 3.71 (2.74–5.01), submissions for cattle and contact in general was not increased for this farm type.In conclusion, the voluntary passive surveillance component in the Netherlands is used more often in periods of excess mortality in cattle. The chance of getting a timely response is highest for dairy farms. For veal calf operations the chance of receiving a timely response is more likely for postmortem submissions. A comparison with passive surveillance for excess mortality in other countries was not possible because no literature could be found. However, the method of this study can be used by other countries to evaluate their passive surveillance. This would make comparison of the performance of passive surveillance in different countries possible.

Ethnobotanical survey of five wild medicinal plants used by local population in Taza province (Northeastern Morocco)

Since ancient times, Moroccan people have used medicinal and aromatic plants as traditional medicine to treat various ailments. However, few studies have been made to document and promote traditional knowledge. The present study aims to collect information about folk knowledge on the medicinal use of five plants, namely Globularia alypum, Inula viscosa, Chenopodium ambrosioides, Ajuga iva, and Urtica dioca in Taza province (northeastern Morocco). We used semi-structured and unstructured interviews with herbalists, traditional healers, and the local population in Taza province. Indeed, 240 questionnaires were collected to gather information about each plant (parts used, methods of preparation and administration, treatable diseases, etc.). The collected data were analyzed using quantitative indices such as the use value (UV), fidelity level (FL), and informant agreement ratio factor (IAR). Most of the interviewees were 60 years old (58.33%), and 70% of them were women. Nearly 60 % of the interviewees were illiterate, and heritage related to traditional medicine, was the main source of knowledge (50%). Ten indications were reported for the studied species in traditional medicine where dermatological and gastrointestinal disorders had the highest use reports, and two species had the highest FL (100%). The highest UV was found for C. ambrosioides (0.44) and A. iva (0.31). The main preparation forms were infusion (40%) and decoction (22%). The most frequently used plant parts were leaves (55.83%). The wide traditional uses of the studied species are largely supported. Future experimental research should be focused on their pharmacological properties and mechanisms of action.

Daily use of self-leadership strategies and employee work engagement while working from home and the office

Employees’ work engagement may vary by work location (office vs. home office), assuming that working at home requires greater self-regulation. Hence, self-leadership may play an important role when employees work at home. The present study investigates whether employees use self-leadership strategies (self-goal setting, self‐reward, self‐punishment, self‐cueing, and visualization of successful performance) more often on home days than on office days. We also examine how these strategies are related to daily work engagement, and whether they are more effective for promoting work engagement depending on the work location. One hundred and one employees completed daily questionnaires on office and home days, resulting in 514 observations. Multilevel analyses revealed that employees reported higher use of self-goal setting, self-reward, and visualization on home days than on office days. Furthermore, we found that applying these strategies was positively related to day-specific work engagement. Nevertheless, self-cueing had no effect and self-punishment was detrimental to work engagement. Moreover, we found no support for the idea that the effectiveness of self-leadership strategies for promoting work engagement depends on the work location. These findings contribute to our understanding of self-leadership strategies promoting work engagement on home and office days.

The Effect of Metacognitive Intervention on the Listening Performance and Metacognitive Awareness of High- and Low-Working Memory Capacity EFL Learners.

EFL listening comprehension has been a stark challenge for language learners, but little is known about the combined effect of individual differences, such as working memory capacity, and metacognitive intervention. Thus, the present experimental study investigates the effect of metacognitive intervention on the listening performance and metacognitive awareness of high- and low-WMC EFL learners. For this purpose, Oxford Placement Tests were distributed among 120 male Iranian EFL learners, of which 94 were identified as intermediate. Then, backward visual digit span tests were administered to measure their working memory capacity. Based on the median of all scores, 80 learners were selected and randomly assigned to two experimental groups and two control groups each with 20 participants. Next, their performance on the International English Language Testing System and the Metacognitive Awareness Listening Questionnaire was measured before and after the 8-session metacognitive intervention. Results showed that high-WMC experimental learners had a higher gain with a large effect size in terms of listening performance compared with all the other groups. In addition, the experimental group learners reported the significantly higher use of the metacognitive strategies with a moderate effect size. Interestingly, low-WMC learners' listening performance and metacognitive awareness also improved as a result of the intervention. Our findings bear pedagogical significance in that individual differences in WMC should be considered more in both EFL language classes and the future line of research involving the metacognitive intervention.

HUBUNGAN PERAN BIDAN DAN DUKUNGAN SUAMI TERHADAP PENGGUNAAN IUD DI WILAYAH KERJA PUSKESMAS SRANDAKAN

Indonesia prioritizes the Family Planning (KB) program, especially Long Term Contraceptive Methods (MKJP) such as the Intrauterine Device (IUD). The use of IUDs in DI Yogyakarta is more popular even though injectable hormonal contraceptives are still dominant in Indonesia, the Srandakan Community Health Center in Bantul recorded the highest use of IUDs (44.5%). National development targets in the strategic plan and target setting for the 2020-2024 BKKBN program, as well as international agreements in the SDGs development goals to increase participation rates in the use of MKJP, this makes it an important issue for participation in the use of MKJP, especially the IUD, which is a contraceptive device that is considered effective. The availability of information and social support from midwives and husbands is key in increasing the acceptance and continued use of IUD contraception by WUS. This study aims to determine the relationship between the role of midwives and husband's support on the use of IUDs by WUS in the Srandakan Community Health Center Work Area, Bantul Yogyakarta. This research is a quantitative study with a correlational analytical design and a cross-sectional approach. The sampling technique used accidental sampling with a total population of 1,034 WUS and a sample of 92 respondents. The research instrument used a questionnaire. The research results were obtained from the Fisher's Exact Test which showed a significant relationship between the role of the midwife (p=0.019) and husband's support (p= <0.001) on IUD use. Based on these results, it can be concluded that the role of the midwife and the husband's support influence the decision to use IUD contraception.

EXPRESS: Who Shares Fake News? Uncovering Insights from Social Media Users' Post Histories

We propose that social-media users’ own post histories are an underused yet valuable resource for studying fake-news sharing. By extracting textual cues from their prior posts, and contrasting their prevalence against random social-media users and others (e.g., those with similar socio-demographics, political news-sharers, and fact-check sharers), researchers can identify cues that distinguish fake-news sharers, predict those most likely to share fake news, and identify promising constructs to build interventions. Our research includes studies along these lines. In Study 1, we explore the distinctive language patterns of fake-news sharers, highlighting elements such as their higher use of anger and power-related words. In Study 2, we show that adding textual cues into predictive models enhances their accuracy in predicting fake-news sharers. In Study 3, we explore the contrasting role of trait and situational anger, and show trait anger is associated with a greater propensity to share both true and fake news. In Study 4, we introduce a way to authenticate Twitter accounts in surveys, before using it to explore how crafting an ad copy that resonates with users’ sense of power encourages the adoption of fact-checking tools. We hope to encourage the use of novel research methods for marketers and misinformation researchers.

Variasjonar i psykisk helsevern – status og forklaringsfaktorar

Introduction: Reducing unwanted variation is one of the goals of Norwegian health policy. We mapped variations among municipalities in Health Region West in the use of specialist health services that fall under the chapter on mental health care and substance use in ICD-10, and looked at various variables that may be related to these. Method: Data were retrieved from the Samhandlingsbarometer, an online open-source portal, and systematized by the authors. The annual rate per 1,000 inhabitants of hospital admissions and outpatient/day treatments per municipality was used as the result variables. Bivariate and multivariable linear regression were useful for investigating the association between independent variables and outcome variables. Results: The results showed large differences in the use of specialist health services in the municipalities, with a factor of 6.7 (hospital admissions) and 8.3 (outpatient clinic contacts). In adjusted analyses, we found that higher overall costs for health and care services in the municipalities were associated with fewer hospital admissions (β –.378 – 95% CI –.616; –.142) and fewer outpatient/day treatments (β –.541 –.649; –.323). The number of users in municipal mental health services was associated with more hospital admissions (β .514 .298; .726) and more use of psychotropic drugs in connection with outpatient/day treatments (β .485 .263; .703). Home-based care for younger inhabitants (< 67 years) was also positively associated with the use of both hospital admissions (β .494, .266; .724) and outpatient/day treatments (β .471 .239; .703). Both the prevalence of marginalisation (not in employment, education or training) and a high level of education were associated with higher use of outpatient clinics (β .355 .132; .577 and β .296 .064; .528), while a dispersed housing pattern was associated with fewer hospital admissions (β –.421 –.679; –.158) and outpatient day treatments (β –.386 –.627; –.145). The explained variance of the multivariable models was small to moderately high (R2 .07 – .51). Conclusion: Morbidity, use of resources for municipal health care, and sociodemographic differences are related to the rate of admissions and outpatient/day treatments. The findings do not unequivocally indicate that greater resource use in the municipalities covaries with less use of specialist health services, although some of the findings point in that direction. Relative inequalities in municipalities, where many inhabitants have a high level of education and where many experience marginalisation (not in employment, education or training) are associated with high consumption of specialist health services in mental health care. Keywords: practice variation, specialist health service, psychiatry, substance use treatment

“A stratified pathway to stent-free reperfusion: Selecting suitable patients in ST-elevation myocardial infarction”

BackgroundThe DANAMI-3 DEFER study demonstrated that deferring stent implantation in ST-elevation myocardial infarction (STEMI) is safe, although not superior to immediate stenting. It is possible that an individualized revascularization strategy in STEMI, achieved through appropriate patient selection, could be feasible and effective. MethodsThis prospective, non-randomized study included 198 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between October 2019 and November 2021. Patients were assigned to either the deferred stenting (DS) group (n = 19) or the control group (C) undergoing immediate stenting (n = 179) based on a multimodal approach integrating coronary angiography, intravascular imaging, physiological assessments, and clinical judgment. The primary endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). ResultsThe DS group showed a significantly lower rate of stent implantation (10.5 % vs. 97.7 %, p < 0.001) and a higher use of thrombus aspiration (89.5 % vs. 30.7 %, p < 0.001) and glycoprotein IIb/IIIa inhibitors (31.6 % vs. 6.7 %, p < 0.001) compared to the C group. No significant differences were observed between the groups in terms of all-cause mortality (5.3 % vs. 8.9 %, p = 0.59) or MACCE (10.5 % vs. 8.4 %, p = 0.71). ConclusionsThis study demonstrates the feasibility of implementing individualized reperfusion strategies in STEMI within a real-world clinical setting. The findings, while limited by the study design, generate valuable hypotheses that warrant further investigation to refine patient selection criteria and optimize outcomes.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

The clinical characteristics associated with the ratio between the main pulmonary artery and ascending aorta diameter in patients with acute exacerbation of chronic obstructive pulmonary disease.

A pulmonary artery-to-aorta (PA/A) ratio of ≥1 is a reliable indicator of pulmonary hypertension and is associated with an increased risk of acute exacerbation of chronic obstructive pulmonary disease (COPD) and long-term mortality in patients with stable COPD. However, it is unclear whether a PA/A ratio of ≥1 is associated with mortality in patients hospitalized with acute exacerbation of COPD. The purpose of this study was to evaluate the clinical course and mortality of patients with PA/A ratios of ≥1 who were hospitalized with acute exacerbation of COPD. We retrospectively reviewed the medical charts of patients admitted to a tertiary referral hospital and a secondary hospital with acute exacerbation of COPD between 2016 and 2021. Chest computed tomography was used to measure the pulmonary artery (PA), aorta (A) diameter, and the PA/A ratio. The study involved 324 and 111 patients with PA/A ratios <1 and ≥1, respectively. The average age in the two groups was 74.1 and 74.5 years, which was not significantly different. When compared with the group with PA/A ratios of <1, the group with PA/A ratios of ≥1 had a lower proportion of males (71.2% vs. 89.5%, P<0.001), more patients with type 2 respiratory failure (35.1% vs. 18.8%), higher high-flow nasal cannula use (10.8% vs. 4.6%), higher use of non-invasive ventilation (NIV) (21.6% vs. 7.7%), and longer hospital stay (10.9 vs. 9.5 days). In-hospital mortality was not significantly different between the two groups. A PA/A ratio of ≥1 was identified as an independent predictor of the need for high-flow nasal cannula, NIV, and intubation in COPD patients. Patients with PA/A ratios of ≥1 had a high incidence of type 2 acute respiratory failure and required advanced treatment, including high-flow nasal cannula, NIV, and intubation. Therefore, hospitalized patients with acute exacerbation of COPD and PA/A ratios of ≥1 require more aggressive treatment.

Does technique matter? A multilevel meta-analysis on the association between psychotherapeutic techniques and outcome.

The extent to which psychotherapeutic techniques have an impact on outcome has been studied on a regular basis. To date, there are no meta-analytic attempts to clarify the association between techniques and outcome in multi-therapeutic approach measures. This study aims to conduct a meta-analysis of the described association. A three-level meta-analysis and moderator-analysis were used. The meta-analysis revealed 13 studies with a total of 177 effect sizes. There was a significant effect r=.193 (t[176]=4.77, p<.01) with higher use of psychotherapeutic techniques being associated with better outcome. Significant moderator was therapeutic approach-specific subscales. The mean effect of cognitive-behavioral techniques was r=.088 (t[147]=1.50, p=.14, d=0.18; s=11, k=79), and the mean effect of psychodynamic techniques was r=.286 (t[147]=5.06, p<.01, d=0.60; s=11, k=70). The measurements for psychotherapeutic technique (Comparative Psychotherapy Process Scale and Psychotherapy-Process Q-Sort) showed no significant difference related to the association between technique and outcome (F[1, 175]=0.38, p=.54). This meta-analysis showed a positive relation between psychotherapeutic techniques and outcome. This leads to the assumption that specific psychotherapeutic techniques have positive effects on post-treatment outcome.

Predictors of child restraint usage among Chinese parents

Objective: To investigate psychological predictors of the use of child restraints among Chinese parents following passage of national law requiring their use. Methods: Grounded in the Prototype Willingness Model (PWM) and guidance from previous research, we developed and administered a questionnaire to assess child restraint usage and understand psychological factors that predict usage. 413 parents with child(ren) aged 0–8 years completed the questionnaire through the WenJuanXing online survey platform. Results: Among the 413 parents, 321 (77.7%) used child restraints regularly when taking their children on car trips, with the highest use reported among parents with children under 1 year (83.8%). Among the psychological predictors, willingness to use a restraint was the strongest predictor of intention and self-reported behavior to use restraints, but the predictive effect of intention on behavior was not significant. Descriptive norms – a belief that trusted friends and family use restraints – was the strongest predictor of behavior to use child restraints, and prototype favorability – the belief that prototypical parents of similar age and gender use restraints – also showed significant effects in predicting behavior. Conclusions: Following the passage of national laws requiring child restraints in China, it is becoming more common for parents to use restraints when their children travel by car. Parents’ use of child restraints for children follows a socially reactive (through willingness) decision-making path rather than a reasoned (through intention) decision-making pattern. The influence of the behavior of others, both trusted friends and family (descriptive norms) and prototypical similar parents (prototype favorability) are strong predictive factors for use of child restraints, suggesting prevention programs might leverage behavior of others to impact parents and encourage use of child restraints.

Characteristics, Treatment, and Prognosis of Heart Failure Patients with Chronic Obstructive Pulmonary Disease in the Colombian Heart Failure Registry (RECOLFACA).

The impact of chronic obstructive pulmonary disease (COPD) on heart failure (HF) has yet to be well assessed in the Latin American population. This study aimed to analyze the impact of COPD on HF patients from the Colombian Heart Failure Registry (RECOLFACA). The primary outcome was all-cause mortality. A Cox proportional-hazards regression model was used to assess the impact of COPD on mortality. From the total of 2528 patients in the registry, 2514 patients had information regarding COPD diagnosis. COPD diagnosis was associated with a worse functional class and higher use of diuretics than non-COPD patients (p < 0.001). Patients with this comorbidity had a significantly better ejection fraction (median ejection fraction 35% vs. 32% in non-COPD patients; p = 0.004), with a higher occurrence of HF with preserved ejection fraction (HFpEF) in the COPD group (p = 0.000). Finally, patients with COPD had a significantly higher risk of mortality in the multivariate regression model (HR 1.47; 95% CI 1.02, 2.11). COPD is a prevalent comorbidity among patients with HF in Colombia, showing a different clinical profile and a worse functional class than patients without this condition. Patients with COPD and HFpEF have a high mortality risk according to our results.