High Need Research Articles

The role of personality and the need for cognitive closure in shaping punitiveness to crime

Despite the prevailing negative reactions towards offenders, few studies have investigated the role of psychological factors in shaping punitiveness. The present study explored the effects of personality domains and the need for cognitive closure on punitive attitudes. The sample included 505 individuals (56.8 % women) from the general population in Italy. A self-report questionnaire gathered information on sociodemographic characteristics, personality domains, need for cognitive closure, and punitiveness. A hierarchical multiple regression analysis showed that being female, having a lower level of education and conservative political views were significant predictors of punitive attitudes. Higher need for cognitive closure, extraversion, and conscientiousness and lower open-mindedness were also predictors of punitiveness. These findings underscore the importance of raising awareness of how individuals' attitudes towards crime and punishment are guided by their psychological characteristics, as how they think and feel about crime influences their perspectives on suitable responses.

Retrospective cohort study of the characteristics of traveller patients presenting to the accident and emergency department of a regional hospital in Hong Kong

Background: Traveller patients have distinctive clinical characteristics compared to non-traveller patients. Local information about the clinical features of traveller patients is lacking. Objectives: The objective of this study is to evaluate the clinical characteristics of traveller patients presenting to a hospital near the Hong Kong International Airport. Methods: This was a single-centred, retrospective cohort study. Medical records of all traveller patients presenting to the Accident and Emergency Department of North Lantau Hospital in Hong Kong from 1 January 2019 to 31 December 2019 were reviewed. The demographics, triage category, presentation, outcomes and disposal were retrospectively evaluated and compared between traveller and non-traveller patients. Results: There were 528 traveller patients attending the Accident and Emergency Department of North Lantau Hospital during the study period, constituting 0.6% of total annual attendance. About one-third of the traveller patients required admission. The most common discharge diagnoses were gastrointestinal diseases (14.8%), followed by trauma (12.9%) and other neurological diseases (12.9%). Traveller patients had a higher rate of being triaged as critical and emergency categories (p < 0.001), higher admission rate (p < 0.001), higher need for active resuscitation (p < 0.001) and escort (p < 0.001) when compared to non-traveller patients. Around 1.3% of traveller patients presented with out-of-hospital cardiac arrest and were eventually certified dead in Accident and Emergency Department. Conclusion: The traveller population constitutes a small proportion of the patient population, but they can have a significant impact on the Accident and Emergency Departments in high-impact traveller areas. Additional resources such as manpower support and training programmes would be beneficial for Accident and Emergency Departments in high-impact traveller areas.

The Patient Typology about deprescribing and medication-related decisions: A quantitative exploration.

This study aimed to test the adequacy of a quantitative measure of our qualitatively developed Patient Typology-categories of older adults' attitudes towards medicines and medicine decision-making-and identify characteristics associated with each Typology. We conducted secondary data analyses of a subset of survey item measures of adults (≥65 years) who were members of online survey panels in Australia, the United Kingdom, the United States and the Netherlands (n = 4688). Multinomial logistic regression analyses assessed associations between demographic, psychosocial and medication-related measures. Mean age was 71.5 (5), and 47.5% of participants were female. Factors associated with an increased likelihood of identifying with Typology 1 'Attached to medicines' over Typology 2 'Open to deprescribing' were higher positive attitude towards polypharmacy (RRR = 1.12, p = <0.001) and higher need for certainty (RRR = 1.11, p = 0.039). Factors associated with an increased likelihood of identifying with Typology 3 'Defers (medication decision-making) to others' over Typology 2 were older age (RRR = 1.47 per 10-year age increase, p = <0.001) and a decreased likelihood of prior deprescribing experience (RRR = 0.73, p = 0.033). This study provides validation of the Typology with large samples from four countries, with the quantitatively-measured typologies generally aligning with the qualitatively derived categories. Our Patient Typology measure provides a succinct way researchers can assess attitudes towards deprescribing.

Comparative outcomes of bariatric surgery in patients with ESRD on dialysis in the modern era of renal transplantation: analysis using the 2015-2020 MBSAQIP database.

Severe obesity is a relative contraindication for renal transplantation, therefore bariatric surgery is an important option as a pre-kidney transplant weight loss strategy. However, comparative data regarding postoperative outcomes of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with or without ESRD on dialysis are scarce. Patients between 18- and 80-year-old who underwent LSG and RYGB were included. To determine the outcomes of patient who underwent bariatric surgery with ESRD on dialysis, a 1:4 PSM was performed between the patients with ESRD on dialysis and those without renal disease. The PSM analyses in both groups were performed using 20 preoperative characteristics. Then 30-day postoperative outcomes were assessed. The operative time and postoperative-LOS were significantly longer in ESRD patients on dialysis compared to those with no renal disease either for LSG (82.37 ± 40.42 vs. 73.62 ± 38.65; P < 0.001, 2.22 ± 3.01 vs. 1.67 ± 1.90; P < 0.001) or for LRYGB (129.13 ± 63.20 vs. 118.72 ± 54.16; P = 0.002, 2.53 ± 1.74 vs. 2.00 ± 1.68; P < 0.001). In the LSG cohort (2137 vs. 8495 matched cases), patients with ESRD on dialysis showed significant increase in mortality (0.7% vs 0.3%; P = 0.019), unplanned ICU admission (3.1% vs 1.3%; P < 0.001), blood transfusions (2.3% vs 0.8%; P 0.001), readmissions (9.1% vs. 4.0%; P < 0.001), reoperations (3.4% vs. 1.2%; P < 0.001), interventions (2.3% vs. 1.0%; P = 0.006). In the LRYGB group (443 vs. 1769 matched cases), patients with ESRD on dialysis showed a significantly higher need for unplanned ICU admission (3.8% vs. 1.4%; P = 0.027), readmissions (12.4% vs. 6.6%; P = 0.011), and interventions (5.2% vs. 2.0%; P = 0.050). Bariatric surgery is a safe procedure for patients with ESRD on dialysis to help them get a kidney transplant. Even though this group experienced a higher incidence of postoperative complications compared to those without kidney disease, the absolute complication rates are low and not associated with bariatric-specific complications. Therefore, ESRD should not be perceived as contraindications to bariatric surgery.

Delivery room resuscitation intensity and associated neonatal outcomes of 24+0–31+6 weeks’ preterm infants in China: a retrospective cross-sectional study

BackgroundThe aim of this study was to review current delivery room (DR) resuscitation intensity in Chinese tertiary neonatal intensive care units and to investigate the association between DR resuscitation intensity and short-term outcomes in preterm infants born at 24+0–31+6 weeks’ gestation age (GA).MethodsThis was a retrospective cross-sectional study. The source population was infants born at 24+0–31+6 weeks’ GA who were enrolled in the Chinese Neonatal Network 2019 cohort. Eligible infants were categorized into five groups: (1) regular care; (2) oxygen supplementation and/or continuous positive airway pressure (O2/CPAP); (3) mask ventilation; (4) endotracheal intubation; and (5) cardiopulmonary resuscitation (CPR). The association between DR resuscitation and short-term outcomes was evaluated by inverse propensity score-weighted logistic regression.ResultsOf 7939 infants included in this cohort, 2419 (30.5%) received regular care, 1994 (25.1%) received O2/CPAP, 1436 (18.1%) received mask ventilation, 1769 (22.3%) received endotracheal intubation, and 321 (4.0%) received CPR in the DR. Advanced maternal age and maternal hypertension correlated with a higher need for resuscitation, and antenatal steroid use tended to be associated with a lower need for resuscitation (P < 0.001). Severe brain impairment increased significantly with increasing amounts of resuscitation in DR after adjusting for perinatal factors. Resuscitation strategies vary widely between centers, with over 50% of preterm infants in eight centers requiring higher intensity resuscitation.ConclusionsIncreased intensity of DR interventions was associated with increased mortality and morbidities in very preterm infants in China. There is wide variation in resuscitative approaches across delivery centers, and ongoing quality improvement to standardize resuscitation practices is needed.

'Status Quo' on Different Aspects of Gender Distribution in Rheumatology in Germany-Results from a Nationwide Online Survey among Physicians.

Despite the increasing number of female medical students and fellows in Europe, women are still under-represented in higher academic careers and positions in medicine. The aim of this survey was to assess the 'status quo' on gender distribution among rheumatologists in Germany. A web-based anonymous survey (21 questions with multiple answers and free text) using QuestionPro® was distributed among rheumatologists in Germany via newsletters, social media and personal contact, including questions regarding hierarchical positions and work characteristics. Among the total of 170 respondents (72% women, 28% men, 1% diverse), 48% were rheumatologists in training, 35% were trained rheumatologists and 7% were heads of rheumatology departments. Regarding the gender ratio at different hierarchical levels, 74% of respondents reported more men than women in leadership positions. Part-time work was possible in the departments of 86% of respondents, with more women working part-time (56%) compared to men (29%). Most respondents stated their impression that employees working part-time did not have the same career chances as full-time workers in their departments. In total, 66% agreed that activities to improve gender equity are necessary. The highest need was seen in reconciling work and family through, e.g., part-time models, flexible childcare options at work and a higher acceptance of part-time work in leadership positions. According to our results, a gender imbalance is prevalent among rheumatologists in Germany, with lower numbers of women evident at higher hierarchical levels. Traditional role assignments are still represented by a higher proportion of part-time work in women. The establishment of structural changes to achieve better gender equity is needed.

P-367 Women with endometriosis have impaired fertility, but give birth to at least one child as often as reference group - A population-based cohort analysis

Abstract Study question Do women with endometriosis have decreased fertility and decreased number of children compared with women without endometriosis in a population-based study setting? Summary answer Women with endometriosis have decreased fertility compared with women without endometriosis but give birth to at least one child as often as women without endometriosis. What is known already Endometriosis is known to be associated with infertility. It is estimated that 25-50% of patients undergoing fertility treatments have diagnosis of endometriosis. Up to date, population-based studies investigating the association of endometriosis and fertility are lacking. Study design, size, duration In a large follow-up national birth cohort (n = 5889), a postal questionnaire was sent to women at ages 31 and 46 years (response rates 76% and 65%, respectively). At age 46, the postal questionnaire included a question on previously diagnosed endometriosis (n = 261). Furthermore, the cohort was linked to Finnish national register for health care to get the register-based diagnosis for endometriosis (n = 257) and to the national birth register for all births from 1987 to 2014. Participants/materials, setting, methods The final study population included 319 women with endometriosis and 2714 women without endometriosis. Time to pregnancy and fertility treatments were inquired via questionnaire at ages 31 and 46 years. Number of deliveries and mother`s age at the birth of the first child was derived from national birth register between 1987-2014. Pearson’s Chi-square tests, Mann-WhitneyU test and Kaplan-Meier method (with Mantel-Cox test) for survival analysis were carried out using IBM SPSS Statistics 27. Main results and the role of chance At age 31 years, women with endometriosis had decreased fecundability as they reported more often more often over 12 months time to pregnancy (11.2% vs. 22.9%, p &amp;lt; 0.001) when compared with women without endometriosis. At ages 31 years and 46 years women with endometriosis reported higher need for fertility treatments (OR 2.80 [95%CI 1.35 – 5.81], p = 0.005 and 46yrs OR 2.82 [95% CI 1.80-4.43], p &amp;lt; 0.001). Survival analysis showed that according to the birth register by age 48 years, women with endometriosis had given birth to their first child at an older age (median 29.79yrs [95%CI 28.74 – 30.85] vs. 27.51yrs [95%CI 27.24 – 27.78], p &amp;lt; 0.001) and had fewer children (mean 2.29 vs 2.63, p = 0.001) when compared with women without endometriosis. However, women with endometriosis had at least one child as often as women without endometriosis (85.3% vs. 88.6%, p = 0.074) by age 48 years. Limitations, reasons for caution Fecundability was asked in the postal questionnaire only at age 31 years but not at 46 years. Infertility was evaluated based on self-report. Wider implications of the findings This unique, population-based data showed that fertility among women with endometriosis is compromised, as these women had decreased fecundability, increased need for fertility treatments and less children compared with the reference group. The awareness of the effects of endometriosis on fertility should be increased and met with adequate care. Trial registration number Not applicable

PREVALENCE OF MAXILOFACIAL ABNORMALITIES AMONG CHILDREN AND ADOLESCENTS IN UZHGOROD

The article presents a comparative analysis of maxillofacial abnormalities in children and adolescents in Uzhhorod. There is a tendency to increase maxillofacial anomalies depending on the age of the patient. It was established that the smallest number of anomalies is observed in children with a temporary bite, and the largest – in children with a permanent bite. In the conditions of a high level of orthodontic morbidity in the population, the purposeful reduction of the level of pathology and solving the problems of improving orthodontic care for children become especially relevant. Data on the prevalence and structure of maxillofacial anomalies and dentition defects determine the indications for treatment and the scope of treatment and prevention measures in the region.&#x0D; Purpose and task. To study the prevalence of maxillofacial anomalies in children of Uzhgorod in order to determine the scope of treatment and prevention measures.&#x0D; Materials and research methods. The total number of examined patients is 946 children aged 6 to 18, including 447 boys and 499 girls. According to the stages of bite formation of temporary and permanent teeth, the examined children were divided into 4 age groups: 6-9 years early variable bite; 10-12 years late variable bite; 13-15 years the beginning of formation of the bite of permanent teeth: 16-18 years permanent bite 6-9 years early mixed eruption of teeth; 10-12 years late mixed teething; 13-15 years the beginning of the formation of the bite of permanent teeth: 16-18 years the permanent dentition. Statistical data processing was performed on a personal computer using licensed software for the Windows operating system and the standard Statsoft software package. Inc STATISTICA 6.0 2300 East 14th Street Tulsa, OK 74104 USA. The Student's t-test value was used to determine the reliability of the difference in results.&#x0D; Results of the research. The study revealed a high prevalence of dento-maxillary anomalies, reaching 47.1%. The highest need for orthodontic treatment was observed in 16-18 year olds. The most common pathologies were diastema (15.1%), crowding of lower jaw teeth (14.9%), dystopia (12.7%), deep bite (11.4%), crowding of teeth on both jaws (5.9%), crowding of upper jaw teeth (5.3%), tortoamalia (4.0%), progeny (3.2%), cross bite (2.2%), open bite (1.9%), abnormalities in tooth size and shape (1.8%), and prognathia (1.2%).&#x0D; Conclusion. The study revealed a high prevalence of dental mandibular anomalies (47.1%) among children aged 6 to 18 years in Uzhhorod. Therefore, there is a need to expand sanitary and educational efforts, including promoting a healthy lifestyle and early detection and treatment of dental mandibular anomalies.

Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation.

Whether sex affects selection for and outcomes after heart transplantation (HTx) remains unclear. We aimed to show sex differences in pre-transplant characteristics and outcomes after HTx. From 1995 to 2019, 49200 HTx recipients were prospectively enrolled in the Organ Procurement and Transplantation Network. Logistic regression models were used to evaluate clinical characteristics by sex. Multivariable Cox regression models were fitted to assess sex differences in all-cause mortality, cardiovascular mortality, graft failure, cardiac allograft vasculopathy (CAV), and malignancy. In 49200 patients (median age 55years, interquartile range 46-62; 24.6% women), 49732 events occurred during a median follow-up of 8.1years. Men were older than women, had more often ischaemic cardiomyopathy (odds ratio [OR] 3.26, 95% confidence interval [CI] 3.11-3.42; P<0.001), and a higher burden of cardiovascular risk factors, whereas women had less malignancies (OR 0.47, CI 0.44-0.51; P<0.001). Men were more often treated in intensive care unit (OR 1.24, CI 1.12-1.37; P<0.001) with a higher need for ventilatory (OR 1.24, CI 1.17-1.32; P<0.001) or VAD (OR 1.53, CI 1.45-1.63; P<0.001) support. After multivariable adjustment, men had a higher risk for CAV (hazard ratio [HR] 1.21, CI 1.13-1.29; P<0.001) and malignancy (HR 1.80, CI 1.62-2.00; P<0.001). There were no differences in all-cause mortality, cardiovascular mortality, and graft failure between sexes. In this US transplant registry, men and women differed in pre-transplant characteristics. Male sex was independently associated with incident CAV and malignancy even after multivariable adjustment. Our results underline the need for better personalized post-HTx management and care.

The Impact of Maternal Obesity on Neonatal Outcomes of Pregnancies Complicated by Fetal Growth Restriction.

This study aimed to characterize the relationship between maternal obesity, fetal abdominal size, and neonatal morbidity in pregnancies complicated by fetal growth restriction (FGR). Pregnancies complicated by FGR, which resulted in delivery of a live, singleton, nonanomalous infant at a single center between 2002 and 2013 were identified in a large, National Institutes of Health-funded database of detailed pregnancy and delivery information extracted by trained research nurses. Pregnancies complicated by diabetes were excluded. Fetal biometry measurements from third trimester ultrasounds performed at the same institution were extracted from another institutional database. Pregnancies were divided into cohorts based on fetal abdominal circumference (AC) gestational age percentile (<10th centile, 10-29th centile, 30-49th centile, and ≥50th centile) at the ultrasound closes to the date of delivery. Obesity was defined by prepregnancy body mass index >30 kg/m2. The primary outcome was a composite of neonatal morbidity (CM) including 5-minute Apgar < 7, arterial cord pH <7.0, sepsis, respiratory support, chest compressions, phototherapy, exchange transfusion, hypoglycemia requiring treatment, or neonatal death. Outcomes were compared between women with versus without prepregnancy obesity overall and then stratified by AC cohort. A total of 379 pregnancies met criteria; CM occurred in 136 (36%). Overall, there was no difference in CM between infants born to women with versus without obesity (risk ratio (RR): 1.11, 95% confidence interval: 0.79-1.56). When stratified according to AC at ultrasound closest to delivery, there was higher prevalence of CM occurring among women with prepregnancy obesity than those without prepregnancy obesity when the fetal AC was >50th or 30 to 49th centile However, these differences did not reach statistical significance. Our study identified no significant difference in risk of CM among growth-restricted infants of obese versus nonobese mothers, including among infants with very small AC. More research is needed to further examine the potential relationships postulated here. · No significant differences in neonatal outcomes of FGR pregnancies in obese versus nonobese patients.. · No significant differences in AC percentile distribution in FGR pregnancies in obese versus nonobese.. · Pregnancies complicated by obesity had a higher need for cardiac support but not chest compressions..

Comprehensive performance evaluation of coordinated development of industrial economy and its air pollution control

Exploring coordinated pathways that can promote not only the sustainable development of the industrial economy but also air quality is of great significance for the prevention and control of air pollution in China. Currently, the joint development pathways of the industrial economy-environment nexus remain unclear and poorly evaluated. In this study, we proposed a comprehensive performance evaluation combining objective and subjective weighting to identify industrial enterprises' economic-environment nexus benefits. It would be one of the most important steps to explore the coordinated pathways. Based on data envelopment analysis (DEA), the proposed method integrated with the index integration was used to evaluate the comprehensive performances of 41 industrial sectors in China's 13th five-year plan (2016–2020). Evaluation results showed that the comprehensive performances of the economy-environment nexus of the industrial sectors varied significantly, with the five-year average comprehensive technical efficiency (TE) of 0.11–1. Overall, the best two performances were realized by the industries of equipment manufacturing and living consumption, whereas the worst one belonged to the industry of bulk raw materials, with average comprehensive TE values of 0.50, 0.43, and 0.19, respectively. The results of the quantitative evaluation were consistent with those of the qualitative analysis in terms of the developmental status of the industrial sectors. According to the analyses of pure technical efficiency and scale effect, the proposed method identified the industrial sectors with the highest developmental value and with the highest need to control air pollution. Compared with those of the original DEA model, the results of the proposed method showed pronounced differences in terms of the performances of industrial sectors with high energy consumption and high particulate matter (PM) emissions and with low energy consumption and low PM emissions. The proposed evaluation method combining the weighting was suitable for identifying the comprehensive performance of the industrial economy-environment nexus and provides the basis for the prevention and control of air pollution.

Family functioning and problematic internet pornography use among adolescents: a moderated mediation model.

In recent years, the issue of problematic Internet pornography use (PIPU) among adolescents has become increasingly prominent, attracting widespread attention from society. Family functioning has been recognized as a protective factor for PIPU, but the underlying mediating and moderating mechanisms remain unclear. The purpose of this study is (a) to investigate the mediating role of self-esteem in the relationship between family functioning and PIPU, and (b) to examine the moderating role of the need to belong in this mediating pathway. A total of 771 high school students (Mage = 16.19, SD = 0.90) were surveyed using the Problematic Internet Pornography Use Scale, Family Assessment Device, Rosenberg Self-Esteem Scale, and the Need to Belong Scale. Correlation analysis showed a significant negative correlation between family functioning and PIPU (r = -0.25, p < 0.001), a significant positive correlation between self-esteem and family functioning (r = 0.38, p < 0.001), a significant negative correlation between self-esteem and PIPU (r = -0.24, p < 0.001), and a significant positive correlation between need to belong and PIPU (r = 0.16, p < 0.01). Mediation analysis showed that self-esteem partially mediated the relationship between family functioning and PIPU, with a mediation effect of -0.06. Further moderated mediation analysis showed that for adolescents with higher need to belong, the mediating effect of self-esteem was stronger. For adolescents with high belonging needs who are at high risk for PIPU, good family functioning may have a protective effect by boosting self-esteem.

Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece.

Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.

Implementing Active Assisted Living Technology in the Long-term Care of People Living With Dementia to Address Loneliness: European Survey.

In the lives of people with dementia, loneliness is an important issue with psychological and physical consequences. Active assisted living (AAL) technology has been gaining visibility in the care of persons living with dementia, including addressing loneliness. However, to the best of our knowledge, there is a lack of evidence concerning the factors influencing the implementation of AAL technology within the context of dementia, loneliness, and long-term care (LTC). We aimed to identify the familiarity with AAL technology that is promising for addressing loneliness in persons living with dementia in LTC in Europe and the factors influencing AAL technology implementation. A web-based survey was developed based on findings from our previous literature review. The Consolidated Framework for Implementation Research guided the development and analysis of the survey. Participants included 24 representatives of Alzheimer Europe member associations from 15 European countries. The data were analyzed using basic statistical methods (descriptive statistics). The baby seal robot Paro was reported to be the most familiar AAL technology by 19 of 24 participants addressing loneliness in people with dementia living in LTC. Participants from Norway (n=2) reported familiarity with 14 AAL technologies, and participants from Serbia (n=1) reported zero familiarity. It seems that countries that invest less in LTC facilities are familiar with fewer AAL technologies. At the same time, these countries report a more positive attitude toward AAL technology, express a higher need for it, and see more advantages than disadvantages than those countries that invest more in LTC. However, a country's investment in LTC facilities does not seem to be linked to other implementation aspects such as costs, planning, and the impact of infrastructure. Implementation of AAL technology to address loneliness in dementia seems to be linked to familiarity with the technology in a country as well as national investment in LTC facilities. This survey confirms the literature on higher investment countries' critical stance in regard to AAL technology implementation to address loneliness in persons living with dementia living in LTC. Further research is needed to clarify the potential reasons why familiarity with more AAL technology does not seem to be directly linked with acceptance, positive attitude, or satisfaction with AAL technology addressing loneliness in persons living with dementia.

Is the Standard Artificial Urinary Sphincter AMS 800 Still a Treatment Option for the Irradiated Male Patient Presenting with a Devastated Bladder Outlet?

Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan-Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis.

Management of osteoporosis in men based Ukrainian version of FRAX

Objective. The aim of the study was to evaluate the impact of the previous published FRAX thresholds in a male referral cohort from Ukraine. Methods. The cohort comprised 653 men aged 40‒88 years (mean age 60.5 ± 11.8). The 10-year probabilities of hip fracture and a major osteoporotic fracture werecalculated using the Ukrainian FRAX model. The intervention threshold was set at the age specific fracture probability as first used by the National Osteoporosis Guideline Group for FRAXbased guidelines in the UK and adapted for the Ukraine. Treatment pathways were compared with a previously published female referral cohort from Ukraine. Results. 27 % of men and 51 % of women referred for skeletal assessment had a prior fracture that categorized eligibility for treatment that was more frequent in women than in men. The requirement for BMD testing was also higher in women than in men (18.3 % vs. 4.9 %, respectively). If referral for fracture risk assessment was contingent on the presence of at least one FRAX risk, the proportion of men and women eligible for treatment would rise from 5 % to 89 % in men and from 57 % to 93 % in women. Conclusions. This study demonstrated a higher need for both antiosteoporotic treatment without DХA and additional densitometric examination to further assess the osteoporotic fractures risk in Ukrainian women compared to men and the need for special attention in fracture risk assessment in men with previous fractures. The developmentof National guidelines together with a validation based on cost-effectiveness would help drive a cohesive national approach to risk assessment in both men and women.

Assessing Perceptions and Medication Disposal Habits in Rural Michigan.

Background: Inadequate or inappropriate medication disposal is a public health concern that may lead to increased community risk of accidental poisonings, substance misuse, and environmental pollution. Objective: The study's primary objective was to assess medication disposal knowledge and practices of Michigan residents living in rural, underserved areas. Secondary objectives included determining baseline perceptions of at-home drug disposal kits and examining the impact of an educational video intervention on at-home drug disposal kit perceptions. Methods: To measure the objectives, an online 15-question survey was deployed to the general public via convenience sampling from local organizations working with drug disposal. The survey questions assessed medication disposal knowledge and practices in underserved, rural Michigan. Participant responses were assessed categorically and numerically. Results: Inclusion criteria were met by 97 survey participants. Results indicated that Michigan rural residents, regardless of various demographic factors, would benefit from increased drug disposal education. Specifically, at-home drug disposal kits and medication drop boxes have the highest need for additional education. Perceptions related to home disposal safety and ease of use improved significantly with an educational video intervention. Conclusion: All rural residents, regardless of demographics, would benefit from increased drug disposal education. A short, educational video can impact thoughts and attitudes related to at-home drug disposal kits. Similar interventions may be successful in other rural, underserved areas.

Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19

Background: COVID-19 has emerged as a rapidly spreading pandemic with millions of deaths. We aimed to investigate whether metabolic syndrome can be used as a prognostic factor for the outcome of patients infected with this viral disease, regarding the ICU stay, the requirement of mechanical ventilation (MV) and mortality. Methodology: This retrospective study included 90 patients admitted to intensive care unit (ICU) of Ain Shams University for pneumonic COVID-19 with a confirmed positive RT-PCR for COVID-19 and positive changes on chest computed tomography, over a period of 10 months from July 2021 to April 2022. They were divided into two groups according to the presence or absence of metabolic syndrome. The primary outcome measured was the length of ICU stay. Secondary outcome was the percentage of patients requiring mechanical ventilation (MV) and the mortality rate in the two groups. Results: Patients with metabolic syndrome had higher liver transaminases, random blood glucose, triglycerides, ferritin, and P/F ratio compared to those without metabolic syndrome (P &lt; 0.05). Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus, and obesity significantly increased the risk of hospitalization and mortality in COVID-19 patients (P &lt; 0.05). Conclusion: Metabolic syndrome is a better prognostic indicator for severe disease outcomes in patients with COVID-19 than its individual components. Although patients with metabolic syndrome didn’t have a higher need for mechanical ventilation, they had longer duration of ICU stay and a higher mortality rate. Abbreviations: ACE-2: angiotensin-converting enzyme-2, hs-CRP: High sensitivity C-reactive protein,ICU: Intensive care unit, MV: Mechanical ventilation, MS: Metabolic syndrome, ROC: Receiver operating characteristic Key words: Metabolic Syndrome; COVID-19; ICU; Mechanical ventilation; Mortality Citation: Refaat SA, Elshaer AN, Hamza AH, Abdou AMH, SakrHAM. Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19. Anaesth. pain intensive care 2023;27(3):343−350. DOI: 10.35975/apic.v27i3.2225 Received: February 14, 2023; Reviewed: March 08, 2023; Accepted: March 16, 2023

A National Needs Assessment in Simulation Based Training in Vascular Surgery

The aim of this research was to ascertain the highest need areas for vascular simulation, in order to tailor training for the highest impact. A needs assessment was conducted according to best practices using the Delphi method. All consultant vascular surgeons/trainers in the training jurisdiction (n=33) were approached through an independent intermediary to contribute and generate a prioritized list of procedures for training. The research team were blinded to participant identities. Three rounds were conducted according to the Delphi process and scored according to the Copenhagen Needs Assessment Formula (CAMES-NAF). A final list of 34 vascular procedures was selected and prioritized by surgical trainers. Principles of arterial repair and endarterectomy/patching were considered the highest priority. Complex major interventions such as open abdominal aortic aneurysm (AAA) repair, carotid endarterectomy, and endovascular aortic repair (EVAR) consistently ranked higher than rarer, such as first rib resection and more basic procedures, such as foam injection for varicose veins. Major lower limb amputations typically ranked lower overall compared to arterial interventions. Surgical trainers generally agreed with the ranking according to the CAMES-NAF. There was some disagreement for a select few procedures such as iliac stenting (which rose 13 places) and open radial artery exposure (which fell 6 places) on subsequent iterations. Core operative principles and common major operative cases should remain the priority for vascular technical skills training. Other procedures which may be less invasive, but have the potential for major complications should also not be overlooked. In designing simulators the main focus should center on specific skill acquisition for commonly performed major procedures and management of the recognized potential complications. Lower limb amputations are considered adequately taught in clinical practice, or are too challenging to simulate in simulator models apart from cadaveric models.

Impact of initial fluid resuscitation volume on clinical outcomes in patients with heart failure and septic shock

BackgroundFluid resuscitation is a key treatment for sepsis, but limited data exists in patients with existing heart failure (HF) and septic shock. The objective of this study was to determine the impact of initial fluid resuscitation volume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) with septic shock. MethodsThis multicenter, retrospective, cohort study included patients with known HF (LVEF ≤50%) presenting with septic shock. Patients were divided into two groups based on the volume of fluid resuscitation in the first 6 h; <30 mL/kg or ≥30 mL/kg. The primary outcome was a composite of in-hospital mortality or renal replacement therapy (RRT) within 7 days. Secondary outcomes included acute kidney injury (AKI), initiation of mechanical ventilation, and length of stay (LOS). All related data were collected and compared between the two groups. A generalized logistic mixed model was used to assess the association between fluid groups and the primary outcome while adjusting for baseline LVEF, Acute Physiology and Chronic Health Evaluation (APACHE) II score, inappropriate empiric antibiotics, and receipt of corticosteroids. ResultsOne hundred and fifty-four patients were included (93 patients in <30 mL/kg group and 61 patients in ≥30 mL/kg group). The median weight-based volume in the first 6 h was 17.7 (12.2–23.0) mL/kg in the <30 mL/kg group vs. 40.5 (34.2–53.1) mL/kg in the ≥30 mL/kg group (P <0.01). No statistical difference was detected in the composite of in-hospital mortality or RRT between the <30 mL/kg group compared to the ≥30 mL/kg group (55.9% vs. 45.9%, P=0.25), respectively. The <30 mL/kg group had a higher incidence of AKI, mechanical ventilation, and longer hospital LOS. ConclusionsIn patients with known reduced or mildly reduced LVEF presenting with septic shock, no difference was detected for in-hospital mortality or RRT in patients who received ≥30 mL/kg of resuscitation fluid compared to less fluid, although this study was underpowered to detect a difference. Importantly, ≥30 mL/kg fluid did not result in a higher need for mechanical ventilation.