Individual Background Research Articles

Racial/ethnic differences in survival and treatment response with PD-1/PD-L1 inhibitors in resectable non-small cell lung cancer: a meta-analysis of randomized controlled trials.

The optimal treatment for resectable Non-Small Cell Lung Cancer (NSCLC) remains under investigation, particularly about its effectiveness across different ethnicities. This meta-analysis aims to investigate the potential benefits of adding PD1/PD-L1 inhibitors for treatment, stratified by ethnicity. We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) that investigated the use of PD1/PD-L1 inhibitors to treat patients with resectable NSCLC. The outcomes evaluated were disease-free survival/event-free survival (DFS/EFS), major pathological response (MPR), and pathological complete response (pCR). Hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs) were computed for all endpoints using DerSimonian and Laird random-effects models. Statistical analyses were performed with R Software, version 4.2.3. A total of six RCTs comprising 3,827 patients with NSCLC were included. In populations of Asian descent, PD1/PD-L1 significantly improved DFS/EFS (HR 0.59; 95% CI 0.44-0.78), MPR (RR 5.76; 95% CI 3.58-9.28), and pCR (RR 25.00; 95% CI 6.17-101.36). Similarly, patients of European ancestry experienced significantly improved DFS/EFS (HR 0.77; 95% CI 0.65-0.90), MPR (RR 2.75; 95% CI 2.00-3.77), and pCR (RR 4.53; 95% CI 2.69-7.6) with PD1/PD-L1 therapy. Notably, patients with mixed ethnicity also demonstrated significant improvement in MPR (RR 4.05; 95% CI 2.60-6.33) and pCR (RR 8.44; 95% CI 3.75-19.00) when receiving PD1/PD-L1 inhibitors. This comprehensive meta-analysis suggests that incorporating PD1/PD-L1 inhibitors into treatments offers a promising benefit for patients with resectable NSCLC, regardless of ethnicity. Future studies with in-depth molecular characterization of patients can further refine these findings and potentially guide the development of personalized treatment strategies based on individual ethnic backgrounds.

A survey of beliefs, attitudes, knowledge, and behaviors about evidence-based practice in physical therapists of Latin America: a cross-sectional study

Evidence-based practice (EBP) refers to the integration of scientific evidence into the clinical setting. This study aimed to determine whether Latin American physiotherapists use EBP, analyze the associated factors, barriers, and facilitators, and examine the relationships between these elements in clinical practice. To conduct this cross-sectional study, the web-based questionnaire survey method was chosen. Survey was self-administered questionnaires to assess understanding of various EBP-related terms and determine their knowledge and ability to apply these concepts in clinical practice. The association between attitudes, awareness, and knowledge scores and the demographic data such as age group, years of experience, professional membership registry, and self-reported education was assessed. The questionnaire was distributed to a total of 5000 physical therapists, of which 4099 (82%) responded from seven Latin American countries (Argentina, Bolivia, Chile, Colombia, México, Perú, and Venezuela), between June 1, 2020, and May 31, 2024. Overall, the physical therapists had positive attitudes, beliefs, and interests in EBP. Their educational background, knowledge, and skills related to assessing and interpreting information were associated to the use of EBP. In addition, 53% of respondents indicated that lack of time was the main obstacle to the use of EBP. The top 3 barriers included insufficient time (53%), lack of information resources (20.8%), and lack of research tools (13.6%). Among Latin American physical therapists, individual characteristics workplace, clinical experience, educational background, and demographic characteristics, may behave as facilitators or barriers when performing an EBP. Thus, identifying methods and strategies to support physical therapists in adopting EBP in the Latin American is necessary. The academization of physiotherapy training might change this in the future.

BRIDGING THE DIGITAL DIVIDE IN MALAYSIA: ENHANCING DIGITAL LITERACY FOR INCLUSIVE STUDENTS IN EDUCATIONAL SYSTEMS

ABSTRACT In Malaysia, integrating digital technology into education has become increasingly prevalent. However, there remains a significant gap in addressing the digital literacy needs of inclusive students, who often face additional challenges in accessing and utilizing digital resources effectively. This paper explores the concept of digital literacy specifically tailored to meet the diverse needs of inclusive students in Malaysia. Despite the growing emphasis on digital literacy in education, inclusive students in Malaysia continue to encounter barriers that hinder their ability to develop essential digital skills. These barriers may include inadequate access to technology, limited training and support, and a lack of educational resources designed to accommodate diverse learning needs. Consequently, many inclusive students are at risk of being left behind in an increasingly digitalized society. This conceptual paper draws on a comprehensive review of existing literature related to digital literacy, inclusive education, and educational technology. The method used is observing and analyzing already existing information about digital literacy for inclusive students. The researcher utilized databases such as Scopus, WoS, and Google Scholar and conducted brief interviews with six teachers. There is a clear need for tailored approaches considering individual learning styles, disabilities, and socioeconomic backgrounds. Additionally, teacher training and professional development programs must be enhanced to ensure educators are equipped with the knowledge and skills needed to support inclusive students in developing digital literacy. In conclusion, this paper underscores the importance of prioritizing digital literacy for inclusive students in Malaysia. Keywords: Digital literacy, Digital skills, Digital divide, Inclusive students, Inclusive education.

Back pain exercise therapy remodels human epigenetic profiles in buccal and human peripheral blood mononuclear cells: an exploratory study in young male participants.

With its high and increasing lifetime prevalence, back pain represents a contemporary challenge for patients and healthcare providers. Monitored exercise therapy is a commonly prescribed treatment to relieve pain and functional limitations. However, the benefits of exercise are often gradual, subtle, and evaluated by subjective self-reported scores. Back pain pathogenesis is interlinked with epigenetically mediated processes that modify gene expression without altering the DNA sequence. Therefore, we hypothesize that therapy effects can be objectively evaluated by measurable epigenetic histone posttranslational modifications and proteome expression. Because epigenetic modifications are dynamic and responsive to environmental exposure, lifestyle choices-such as physical activity-can alter epigenetic profiles, subsequent gene expression, and health traits. Instead of invasive sampling (e.g., muscle biopsy), we collect easily accessible buccal swabs and plasma. The plasma proteome provides a systemic understanding of a person's current health state and is an ideal snapshot of downstream, epigenetically regulated, changes upon therapy. This study investigates how molecular profiles evolve in response to standardized sport therapy and non-controlled lifestyle choices. We report that the therapy improves agility, attenuates back pain, and triggers healthier habits. We find that a subset of participants' histone methylation and acetylation profiles cluster samples according to their therapy status, before or after therapy. Integrating epigenetic reprogramming of both buccal cells and peripheral blood mononuclear cells (PBMCs) reveals that these concomitant changes are concordant with higher levels of self-rated back pain improvement and agility gain. Additionally, epigenetic changes correlate with changes in immune response plasma factors, reflecting their comparable ability to rate therapy effects at the molecular level. We also performed an exploratory analysis to confirm the usability of molecular profiles in (1) mapping lifestyle choices and (2) evaluating the distance of a given participant to an optimal health state. This pre-post cohort study highlights the potential of integrated molecular profiles to score therapy efficiency. Our findings reflect the complex interplay of an individual's background and lifestyle upon therapeutic exposure. Future studies are needed to provide mechanistic insights into back pain pathogenesis and lifestyle-based epigenetic reprogramming upon sport therapy intervention to maintain therapeutic effects in the long run.

Applying the Theory of Planned Behavior in Sexuality Education: Educators’ Behavioral Intentions Toward Sexuality Issues

Grounded on Ajzen’s theory of planned behavior (1991), the current project in two studies (N = 402) examined Greek and Spanish pre-service early childhood educators’ behavioral intentions (i.e., approach and avoidance intentions) toward young children’s sexual curiosities. Specifically, the current research project aimed to examine whether Greek and Spanish pre-service early childhood educators’ views on sexuality education were linked to their behavioral intentions toward children’s sexual curiosities. The current research also examined whether conservative ideology (religiosity and right-wing political orientation) moderates the link between educators’ views and their behavioral intentions. This study’s findings showed that educators’ views influence their behavioral intentions toward children’s curiosity about sexual issues. In addition, moderation analysis showed religiosity’s role in avoidance intention. This result provides evidence that there are theoretical and empirical grounds to assume that conservative worldviews (i.e., religiosity) significantly influence behavioral intentions concerning sexuality education. The theory of planned behavior not only represents the factors influencing intention but also provides an opportunity to comprehend the impacts of contextual and individual background elements that may be relevant to a particular behavior.

Structural Alterations in Diverticular Disease

AbstractClinicians appreciate the structural alterations of diverticular disease when navigating narrow, angulated colons with a colonoscope or removing stiff, fixed sigmoid colons at surgery. Investigation of these tissues reveals increased thickness of smooth muscle, alterations in the amount and structure of the extracellular matrix, and changes to the motility of the colon. More sophisticated technologies now allow scientists to unravel the connections between these alterations and the individual genetic background. This article explores the structural alterations of diverticular disease including collagen, smooth muscle, the enteric nervous system, and the interstitial cells of Cajal.

Monetized Interactions in the Sexual Minorities Network at Daneshjoo Park (Tehran, Iran)

AbstractDaneshjoo Park is located in the center of Tehran and is the first hang-out for modern life in the city, gathering different communities such as students, artists, and various lifestyles. Over the years, it has become the most famous hang-out for LGBTQ communities. Despite its significance and hundreds of visitors per day from different parts of the country, Daneshjoo Park has faced years of neglect. This study, employing grounded theory as a research method and in-depth interview as a gathering data method, investigates the emergence of sex work in the park. Participants, aged 18–40, active or retired sex workers, were selected using theoretical and snowball sampling. The findings highlight that underlying individual circumstances, such as poverty, act as catalysts for creating conditions conducive to engaging in sex work, referred to as “Individual Background Conditions.” These conditions facilitate entry into the social network of sex workers, thereby enabling the manifestation of the phenomenon of sex work within Daneshjoo Park, where individuals are gravitated to engage in sex work. The study identifies “Actualizing Interaction Conditions” as the supportive and reproductive causal mechanism through which the network operates, bringing individuals with these background conditions into the fold. This mechanism has enabled the manifestation of the phenomenon of sex work within Daneshjoo Park. The research also identifies a significant historical shift, termed the “Historical Factor,” indicating a transition in the logic of interaction from traditional forms of interaction to monetary exchanges, which has fundamentally altered the landscape of sex work in the park. Ultimately, the study suggests social empowerment strategies as a response to these findings.

The People behind the Research: How Three Researchers Utilized Their Diverse Positionality to Study LGBTQ+ Archives

ABSTRACTIn this panel, three researchers with distinct positionalities will discuss how their unique perspectives contributed to the overall success of one research project (though with some inherent challenges). First, we review our respective positions with regards to the research project, a study of LGBTQ+ archives. Then we describe how our subjective pasts and experiences interacted as we conducted the research. With this panel, we intend to open a conversation about how one's individual background and perspective can both conflict and harmonize with others, leading to interesting differences in research approaches, methods, and analysis. This panel will explicitly include time for the audience to reflect on their own positionality with respect to their research; we anticipate a richly nuanced discussion.

Key Factors Influencing Urban Regenerative Strategies in Public Open Spaces: A Case-Study in Lhasa

Abstract In the last decades, significant efforts have been made in urban construction to achieve rapid economic development. However, with climate change on the agenda, there is a growing recognition of the importance of urban sustainable development and of its potential impacts on residents. Reflection reveals that many policies, measures, and tools are inadequate; therefore, public open spaces are regarded as a potential target of urban regeneration strategies. This study explores users’ perceptions of public open spaces through participatory methods. The developed methodology is applied to specific areas of Lhasa, the major city of the Tibet region, which was selected as a test-bed site. The survey involved a selected pool of participants and emphasized the coverage of different types of public open spaces. Investigate factors including personal background, overall satisfaction, user evaluation, usage preference, and willingness to change, analyze key factors based on quantitative survey results. Subsequently, identify the key regenerative design elements that require highlighting. The findings indicate that comfort and safety are emphasized by users of all types of public open spaces. Additionally, their initial impression upon entering a space significantly influences their overall satisfaction with it. Besides, although individual background differences play a role, they are not sufficient to significantly influence the user’s evaluation of the space. However, variations in the purpose of space use result in differences in user evaluations and needs, impacting their attitudes based on the type of space. Finally, urban regeneration design strategies are proposed for various types of public open spaces and users.

Where does the future lie? Initial aspirations for return among newly arrived Ukrainian refugees in Norway

ABSTRACT The lives of millions of people, who fled from Ukraine after Russia's full-scale invasion in February 2022, were turned upside down from one day to the next. When faced with such an abrupt escape, what initial thoughts do refugees have about whether to remain in their new host country or to return when the war ends? In this study, we focus on refugees' initial return aspirations soon after their escape. We conduct an in-depth analysis of how individual background factors and circumstances affect refugees' aspirations to remain or return. Based on unique data collected during the months immediately following Russia's invasion of Ukraine, we use survey data on Ukrainian refugees in Norway to examine their return aspirations and what individual factors that affect these aspirations and qualitative interviews with Ukrainian refugees to explore the rationales for their initial aspirations. We find that only one-fourth plan to return to Ukraine as soon as the war ends. Our analysis of how individual factors affect initial return aspirations both support and contradict previous research. Thus, we discuss how our apparently contradictory findings provide theoretical nuances of how host country and refugee group characteristics interplay with individual predictors of initial return aspirations.

Perception of MBA Students Towards Their Career Choice in Kathmandu Valley: Evidence from Structural Equation Modelling

Background: Making a career decision is a crucial moment in any student's life. A good career decision leads to bridge the gap between where you are and where you want to be. Identification of the factors that influence student’s career decision making helps them to achieve their goal. Objective: Therefore, this study looks into MBA student’s perception towards their Career Choice. Method: The explanatory research design was adopted for this study based upon social cognitive theory. The study area of the research is Kathmandu valley where Structural questionnaires were used using KOBO toolbox to collect the data. Using the Stratified sampling methods, data were collected on a sample of 229 students pursuing MBA from different University. Structural Equation Modeling is used to see the MBA students’ perception towards career choice using SPSS and SPSS AMOS software. Finding: Findings reveal that the majority of the students were female, which suggests that lack of guidance, lack of experience, and financial circumstances are the main problems that may be overcome by good supervision as well as practical/experimental exposure to improve students' career choices. Moreover, SEM result indicates that individual background and self-efficacy are significance causal relationship to career choice. Conclusion: The idea of career should be focused on freedom to do job in flexible timing and to get credit for result for idea and result. Factors such as Career advancement, status of the organization i.e. size, status and image are the major indicators for choice of career. Paper Types: Research Paper Keywords: Entrepreneurship, Employment, Career Choice, MBA program JEL Classification: C26, E24, M10, C12

Digital threads of architectural heritage: navigating tourism destination image through social media reviews and machine learning insights

ABSTRACT While emphasizing sustainable development goals for cultural heritage preservation, tourism destination image based on the predefined traditional survey often fails to meet the dynamic tourist demands. Taking the Nanjing Museum of Modern History in China as a case study, this paper innovatively combined the Latent Dirichlet Allocation (LDA) and Importance-Performance Analysis (IPA) to quantitatively extract and assess the destination image from the social media data. The results demonstrated that the tourists mainly focused on 12 topics from individual, environmental, and social backgrounds, mostly on architectural style, transportation, and location. Tourists perceived most positive sentiments in historical culture (84.94%), and architectural style (70.54%), but most negative sentiments in ticket purchasing experience (27.60%), living and service facilities (14.09%). The IPA results reveal that historical culture is the strength, yet there is an overemphasis on historical events. This research marked a methodological advancement by combining LDA and IPA, enabling a detailed analysis of vast online reviews and providing critical insights for improving the tourism destination image in architectural heritage studies.

Association of Gender and Personal Choices with Salaries of New Emergency Medicine Graduates.

The medical literature has demonstrated disparities and variability in physician salaries and, specifically, emergency physician (EP) salaries. We sought to investigate individual physician characteristics, including sex and educational background, together with individual preferences of graduating EPs, and their association with the salary of their first job. The American College of Emergency Physicians and the George Washington University Mullan Institute surveyed 2019 graduating EPs. The survey included respondents' demographic and educational background, post-training job characteristics and location, hospital characteristics, importance of different personal priorities, and starting salaries. We performed a multivariable regression analysis to determine how salaries were associated with job types and individuals' characteristics. We sent surveys to 2,192 graduating residents in 2019. Of these, 487 (22.2%) responded, and 270 (55.4%) accepted first-time clinical jobs and included salary data (12.3% of all surveys sent). Male sex, osteopathic training, and full-time work were significantly associated with higher salary. Men and women prioritized different factors in their job search. Women were more likely to consider such factors as parental leave policy, proximity to family, desired practice setting, type of hospital, and desired location as important. Salary/compensation was considered very important by 51.8% of men and 29.6% of women. Men's median salary was $30,000 more than women's (p = 0.01, 95% CI +$6,929 -+$53,071), a significant pay differential. Salaries of graduating emergency medicine residents are associated with the resident's sex and degree type: doctor of osteopathic medicine or doctor of allopathic medicine. Multiple factors may contribute to men having higher salaries than women, and some of this difference reflects different priorities in their job search. Women were more likely to consider job conditions and setting to be more important, while men considered salary and compensation more important.

Characteristics, Treatment, and Prognosis in Octogenarian and Older Patients With Acute Heart Failure in Japan - Prospective Observational Study on Acute Pharmacotherapy and Prognosis in Management of Acute Heart Failure (POPEYE-AHF Registry).

The number of older people in Japan is increasing more quickly than in other countries; with this aging of society, the number of elderly patients hospitalized for acute heart failure (HF) is also increasing. The treatment and prognosis of acute HF may be changing, but there are insufficient recent data, especially for octogenarian and older patients. This study investigated the characteristics and treatment of acute HF patients in Japan. From 2018 to 2020, 1,146 patients from 7 Tokai area hospitals were followed for at least 1 year. The mean age was 78 years. Compared with patients aged <80 years, those aged ≥80 years were more likely to be female (57.4% vs. 34.2%), have a lower body mass index (22.2 vs. 24.9 kg/m2), and have HF with preserved ejection fraction (43.1% vs. 21.4%), and less likely to have HF with reduced ejection fraction (38.9% vs. 61.7%). During hospitalization, 6.5% died. After discharge, patients faced high risks of rehospitalization for HF and death (27.6 and 14.2 per 100 patient-years, respectively). Notably, prescription rates of HF medications have declined over time for all patients, but especially for those aged ≥80 years. Guideline-directed medical therapy should be provided based on a thorough understanding of an individual's background rather than withheld simply because of clinical inertia due to a patient's advanced age.

Participation in Multidisciplinary Teams Among Healthcare Professionals: A Discrete Choice Experiment in Tertiary Public Hospitals in China.

Healthcare professionals' participation is crucial for the efficient implementation of multidisciplinary team (MDT) collaboration models. We identified the key factors influencing healthcare professionals' preference to participate in MDTs in tertiary hospitals. To clarify the attributes and levels of the discrete choice experiment (DCE), we conducted a targeted literature review and conducted in-depth interviews with MDT service providers. Following this, a DCE was designed to evaluate healthcare professionals' preferences for MDT participation, and the influence of factors such as salary subsidies, leadership attention, patient participation, quality assessment, working intensity, and case complexity. A conditional logit model estimated the utility of each attribute. Willingness-to-pay estimates were derived by taking the negative ratio of the coefficients of non-economic and economic attributes. A series of policy simulation analyses were conducted. Two hundred healthcare professionals completed the questionnaire, with 180 valid responses used for analysis. All attributes were statistically significant. Leadership attention and working intensity were the primary factors influencing staff willingness to participate in MDTs, followed by quality assessment and salary subsidies. Significant preference differences were observed between respondents; compared with mid-level staff, senior-level healthcare professionals believed patient engagement would be more helpful in boosting participation. The policy simulation showed that changing leadership attention from "neglect" to "emphasis" would increase the probability of staff choosing to participate in MDTs from 24.4% to 66.98%. Leadership attention was the primary concern for healthcare professionals in MDTs. To effectively motivate staff participation in MDTs, policymakers should adopt a holistic approach that considers work motivation and individual backgrounds, including competitive salary packages and a positive work environment. They should concurrently introduce MDT case complexity measurement tools to optimize resource allocation. Addressing staff members' unique needs and career aspirations by creating targeted training programs, pathways for advancement, and personalized career development plans are also crucial.

Gaming Disorders: Navigating the Fine Line between Entertainment and Addiction-Gaming History, Health Risks, Social Consequences, and Pathways to Prevention.

The number of people immersed in excessive gaming has increased in this age of rapid digitalization. The World Health Organization and American Psychiatric Association Organization recognize a gaming disorder as a condition that results in significant problems in daily life as a result of excessive gaming. Both organizations emphasize the similarities to behavioral addictions such as gambling. We examined the appropriate usage of video games from the perspectives of health and management in this study. For the general population, video games provide positive impacts such as stress alleviation and memory improvement. Game playing leads to a loss of time and money for the individual. It also has a negative impact on the individual's family and social life, evolving into a social problem. Gaming addiction is often accompanied by psychological disorders and other addictions, and long-term medical treatment, including approaches to the individual's psychological background and cognitive-behavioral therapy, is necessary. Therefore, the prevention of gaming disorder is essential. From a societal standpoint, action is required in three contexts: the government, game developers, and within the household as a whole. Simultaneously, the public needs to understand the positive potential of gaming, such as e-sports.

Analysis of Interest Rate Determinants: Evidence from Lending Club

Nowadays, high interest rates hit the whole lending market, a number of people consider online lending institutions to trade. This dynamic generates a viable alternative to traditional bank services, allowing borrowers to choose their optimal lending plan. This paper focuses on online lending services, investigating the factors influencing the interest rate offered by Lending club institutions. Using OLS and machine learning models, the author analyses the influence of different dimensions of factors (debt level, FICO score, lending purpose, and normalized debt-to-income ratio) on the average interest rate. The results emphasize the results emphasize that Personal characteristics count for lending rate evaluation. People who have lower credit scores and bear a high debt ratio would be offered a higher interest rate than those who have a good individual background. Contrary to the conclusions achieved in other studies, when loans are given for longer durations, they tend to have higher interest rates. This is mainly because lenders have to consider factors like the risk of inflation and the potential earnings they might miss out on during that extended period.

Muslim-friendly tourist destination image in travel and hospitality industry: Conceptualization and scale development

The image of a place is subjective and open to change: it depends on an individual's perspective and cultural background. Notwithstanding years of research on destination image, no attempt has been made so far to evaluate the Muslim-Friendly Tourist Destination Image (MFTDI) in the travel and hospitality industry, in which Muslim visitors not only evaluate cognitive and emotional attributes but also Muslim-friendly attributes. In this research a qualitative research and literature review was carried out to develop the items of the proposed scale. The study began with a pilot study in which a committee of experts, and focus groups reduced the topic quantitatively and qualitatively. A follow-up quantitative assessment was then carried out to evaluate and authenticate the suggested scale, using two studies (n1 = 481 and n2 = 269). The significance of the proposed scale was conceptually justified. The scale measured reliability, discriminant validity, convergent validity, and external validity. As a result, the outcomes suggest that the 31 items to be considered fall into three factor categories: cognitive, emotional, and Muslim-friendly qualities. Finally, this paper assesses the article's significant implications for theory and practice, as well as its limitations.

Prevalence, associated factors and consequence of problematic smartphone use among adolescents and young adults in Bangladesh: A cross-sectional study.

Problematic smartphone use (PSU) and attention deficit hyperactivity disorder (ADHD) in children, adolescents, and young adults are of major concern to parents. However, the prevalence and associated factors related to these issues in Bangladeshi adolescents and young adults remain unclear to the best of our knowledge. The aim of this study is to assess PSU and ADHD in the context of adolescent and young adult age groups in Bangladesh. The present study collected data from diverse geographical locations in Bangladesh via face-to-face surveys using stratified random sampling methods. We considered age, sex, and geographic location stratification criteria. A total of 578 respondents participated in the survey initially. From this, we discarded 36 responses after screening because the information provided was insufficient or incomplete response. In the end, 542 replies were incorporated into the final analysis. PSU and ADHD depend on several factors, including the individual's demographic background. The prevalence of PSU and ADHD symptoms in adolescents and young adults in Bangladesh is 61.44% and 37.45%, respectively based on our findings. The symptoms of PSU are correlated with age, education level, family type (nuclear/joint), sleeping pattern, physical exercise, and residence area. ADHD symptoms are correlated with age, education level, living with family, smoking habit, physical disability, sleeping pattern, physical exercise, residence area, and PSU. Also, we observed that ADHD and PSU symptoms are positively correlated with each other. A large proportion of young adults and adolescents reported PSU and ADHD symptoms. The present findings have practical implications in clinical psychology, psychotherapy, and related policy considerations. We propose to develop an inclusive interventional strategy and community-based programs to address PSU and ADHD-related issues.

Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study

BackgroundOlder adults requiring care often have multiple morbidities that lead to polypharmacy, including the use of potentially inappropriate medications (PIMs), leading to increased medical costs and adverse drug effects. We conducted a cross-sectional study to clarify the actual state of drug prescriptions and the background of polypharmacy and PIMs.MethodsUsing long-term care (LTC) and medical insurance claims data in the Ibaraki Prefecture from April 2018 to March 2019, we included individuals aged ≥ 65 who used LTC services. The number of drugs prescribed for ≥ 14 days and the number of PIMs were counted. A generalized linear model was used to analyze the association between the backgrounds of individuals and the number of drugs; logistic regression analysis was used for the presence of PIMs. PIMs were defined by STOPP-J and Beers Criteria.ResultsHerein, 67,531 older adults who received LTC services were included. The median number of total prescribed medications and PIMs was 7(IQR 5–9) and 1(IQR 0–1), respectively. The main PIMs were loop diuretics/aldosterone antagonists (STOPP-J), long-term use of proton pump inhibitors (Beers Criteria), benzodiazepines/similar hypnotics (STOPP-J and Beers Criteria), and nonsteroidal anti-inflammatory drugs (STOPP-J and Beers Criteria). Multivariate analysis revealed that the number of medications and presence of PIMs were significantly higher in patients with comorbidities and in those visiting multiple medical institutions. However, patients requiring care level ≥1, nursing home residents, users of short-stay service, and senior daycare were negatively associated with polypharmacy and PIMs.ConclusionsPolypharmacy and PIMs are frequently observed in older adults who require LTC. This was prominent among individuals with comorbidities and at multiple consulting institutions. Utilization of nursing care facilities may contribute to reducing polypharmacy and PIMs.Graphical