Mean Research Articles

Prevalence and Effects of Plantar Fasciitis on Functional Activities among Doctors and Nurses in Sialkot, a Cross- Sectional Survey.

Background: Plantar fasciitis is a debilitating condition that affects a significant number of adults worldwide, characterized by heel pain and functional limitations. Healthcare professionals, particularly nurses and doctors, are at a heightened risk due to their prolonged standing and weight-bearing activities. Despite this, there remains a paucity of research focusing on this demographic, especially within the context of developing countries like Pakistan. Objective: This study aimed to determine the prevalence and impact of plantar fasciitis on the functional activities of doctors and nurses in Sialkot, Pakistan, thereby contributing to the existing literature and providing insights for occupational health interventions. Methods: A cross-sectional survey was conducted in two major hospitals of Sialkot from October 2023 to January 2024. The study recruited 165 participants through non-probability convenient sampling. Inclusion criteria were professionals aged 25-50 with positive windlass tests and experiencing morning pain for over a month, while those with heel fractures, surgeries, infections, or foot deformities were excluded. The Foot Function Index questionnaire was employed to measure pain, disability, and activity limitation. Data were analyzed using SPSS version 25, employing a one-sample t-test to compare group means. Results: The mean scores for pain, disability, and activity limitation were 53.48±12.24, 52.88±10.43, and 9.15±3.36, respectively. The one-sample t-test revealed significant differences from the test value of 50 for pain (t=3.663, p<0.001) and disability (t=3.548, p=0.001), with activity limitation significantly below the test value (t=-155.848, p<0.001). Conclusion: The study confirmed a high prevalence of plantar fasciitis among healthcare professionals, with notable implications for their daily functionality and occupational health. The condition was more prevalent among nurses compared to doctors, and significantly affected their ability to perform daily tasks, leading to increased disability and activity limitations.

Fluoride varnish applications provided in general dental practice for children of primary school age in three areas of the UK.

Introduction Dental guidelines recommend professional application of fluoride varnish (FV) at least twice a year for children from the age of three.Methods NHS dental claims data were reviewed for children born in 2009 for the five-year period 2015-2019 and who attended the dentist in one of three geographical areas, labelled as Bristol, Birmingham and Cardiff. Data for 14,566 children were included in the study.Results Only 3.5% of children had been provided with ten or more FV applications at the dentist in the five-year period. Children in the Cardiff region fared less well for fluoride applications than their Bristol and Birmingham counterparts, including children that were seemingly at high risk of caries for part of the time period reviewed. For all three regions, the mean number of FV applications increased with an increase in the number of fillings provided.Conclusion Awareness of the apparent lack of FV application in the dental surgery may provide an opportunity to improve child dental health.

Multi-sample hypothesis testing of high-dimensional mean vectors under covariance heterogeneity

Multi-sample hypothesis testing of high-dimensional mean vectors under covariance heterogeneity

Level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia: an application of the data envelopment analysis

BackgroundBesides the scarcity of resources, inefficient utilization of available health service resources has been the bottleneck to deliver quality health services in Ethiopia. However, Information regarding the efficiency of health service providers is limited in the country. Health service managers and policy makers must be well informed about the efficiency of health service providers and ways of using limited resources efficiently to make evidence-based decisions. This study aimed to assess the level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among 27 randomly selected health centers in East Gojjam zone, Northwest Ethiopia, from October 30, 2022, to April 30, 2023. Using an interviewer-administered questionnaire and document review checklist, health centers’ data was collected and entered to Epi-Data version 4.6. The data was exported to Microsoft office excel and Stata version 14 for analysis. A two-stage output-oriented data envelopment analysis with a variable return to scale assumption was employed to determine the level of technical efficiencies. Finally, the tobit regression model was applied to identify the associated factors at 5% level of significance.ResultsIn this study, 59.3% of the health centers were technically efficient. The mean technical efficiency score of the health centers was 0.899 ± 0.156. Inefficient health centers could provide more 22, 433 outpatient visits, 1,351 family planning visits, 155 referral services, 206 skilled deliveries and 385 fully vaccinations of children if they were technically efficient as their peer health centers for the same year. From the tobit regression, the catchment population and number of administrative staffs were statistically significant determinants of the technical efficiency of health centers.ConclusionsThe mean technical efficiency of the health centers in East Gojjam zone, Northwest Ethiopia was high. However, nearly half of the health centers were technically inefficient, which indicates the exitance of a space for further improvements in the productivity of these health centers. Employing excess number administrative staffs (above the optimal level) should be discouraged and selecting appropriate sites where the health centers to be constructed (to have large catchment population coverage) could improve the productivity of health centers.

Semiotics of Sasak Puppets (Study of Sasak Puppets Kembang Kuning East Lombok)

The purpose of this study is to investigate the meaning and symbolic values of Jayengrana actor in Wong Menak Wayang Sasak story. This study is descriptive qualitative using observation, interview, and documentation as data collection techniques. To obtain the meaning, the researcher use semiotic perspective method analysis from Roland Barthes' theory. After significance analysis is done, a conclusion can be drawn that the symbolic values of the Jayengrana character are interpreted through naming and characterization in playing his main actor role. Each name of the actor reflects his identity or personality which is reflected from character shows on their performance.

Effectiveness of a Self-efficacy Enhanced Program Using Cartoon Animation for Self-care Behaviors Among Schoolchildren with Epilepsy: A Quasi-experimental Study

Epilepsy is one of the most common chronic neurological diseases in children and may cause repeated seizures and complications. Thus, self-care behavior is vital for effective seizure control. This quasi-experimental study examined the effectiveness of the Self-efficacy Enhanced Program Using Cartoon Animation for self-care behaviors among school children with epilepsy. The study was conducted at a pediatric neurological clinic in the outpatient department of a tertiary hospital in Bangkok, Thailand. There were 42 children with epilepsy, aged 10 to 12 years, who participated in the study: 21 in the experiment group and 21 in the control group. The experimental group received the program, which used two cartoon animation videos to enhance self-care behaviors for eight weeks, while the control group received regular care only. The data were collected using demographic and self-care behavior questionnaires and were analyzed using chi-square and t-tests.The results demonstrated that after program completion, the mean scores of total self-care behavior and subscale on medication taking, avoiding triggers seizures, and self-care of abnormal symptoms and seeking information in the experimental group were significantly higher than before receiving it and higher than those in the control group significantly. Nurses should use this program to increase self-care behaviors among children with epilepsy. However, testing the program in other settings with long-term follow-up is needed before it can be used widely.

A Pushover analysis approach considering structural and loading uncertainties for seismic performance assessment

This paper proposes an approach for evaluating the seismic performance of buildings. By considering the uncertainties in material and geometrical properties of the structural elements as well as those related to the seismic loading, this method aims to delimit the performance zone of the structure rather than focusing on a single performance point commonly used in pushover analysis. This zone makes it possible to identify the probable levels of performance of the building linked to uncertainties and to indicate the most severe level of damage. Reasoning by performance points leads to an answer that gives a single state of damage. The performance zone is defined by capacity curves and response spectrum representing the mean values plus and minus standard deviation obtained by Monte Carlo simulations. These simulations consider the stiffnesses of the structural elements, the natural periods, and the damping ratio of the response spectrum as random variables. The application of the procedure to a case of a building made it possible to identify the upper limit of damage corresponding to the most unfavourable scenario of uncertainties, as well as the situation of the response value of the studied structure in the performance zone, indicating a less critical level of damage (minor damage) to the building. The calculation of the performance point revealed a level of damage oscillating between Immediate Occupancy (IO) and Life Safety (LS). Considering the uncertainties in the material and geometric properties of the structural elements as well as those linked to the response spectrum, the probable extreme damage state is between the LS and CP levels (severe damage).

Directionally sensitive adaptive MEWMA charts with fixed and variable sampling rates

AbstractA primary objective in detecting disease outbreaks is to precisely identify substantial increases in process means to control the spread of outbreaks. In this paper, we introduce a novel directionally sensitive adaptive multivariate exponentially weighted moving average chart for efficiently detecting either increases or decreases in the mean vector of a multivariate normally distributed process. In addition, the chart's sensitivity is enhanced through features such as variable sample size, variable sampling interval, and a combination of both. Monte Carlo simulation is employed to estimate zero‐state and steady‐state average time‐to‐signal (ATS) profiles. Performance measures, including expected weighted and relative ATS, are used for evaluating the performances of multivariate charts. Our results indicate that the proposed charts outperform existing charts in detecting various mean shift sizes. The application of these multivariate charts is demonstrated through illustrative examples.

Teachers' pedagogical attitude on using digital lesson contents in teaching and learning in Zanzibar secondary schools

Digital curricula have been emphasized to improve the quality of education at all levels of education. Implementing a new curriculum depends on teachers' attitudes to integrate it during teaching and learning. This study investigated the attitudes of teachers and factors that affect them towards using digital lesson content in Zanzibar, the case of Wete District. One hundred fifty-four secondary school teachers responded to the questionnaire. The SPSS version 25 was used to run the Chi-squared test and descriptive statistics to analyse the data. The overall attitude was calculated by finding the questions' mean value per Likert level. The study found that teachers’ pedagogical attitude is positive, but implementing digital lesson content in Zanzibar is still challenging. It was also observed that the attitude was significantly associated with gender (p=0.0084), whereby female respondents had higher positive attitudes (68.82%) compared to male respondents (47.44%). The paper concludes that most teachers have a positive attitude towards using digital lesson content in teaching in secondary schools. However, they lack enough relevant digital resources that support digital lesson content. Based on that, policymakers, curriculum developers, and other education stakeholders should take serious action to improve the quality of education practice in Zanzibar. Therefore, this paper recommends that the availability of digital lesson content and in-service training may encourage teachers’ pedagogical attitude to integrate digital materials into their everyday teaching process.

Chaotic‐quasi‐opposition based whale optimization technique applied to multi‐objective complementary scheduling of grid connected hydro‐thermal–wind–solar‐electric vehicle system

AbstractThe sources of fossil fuel are impoverishing in upcoming future. In the current research scenario, sincere effort has been taken worldwide to explore the use of renewable energy sources in electrical power system for the economic benefits and environmental consciousness. The main contribution of the proposed work is first, to find optimal hydro‐thermal scheduling (HTS) with wind, solar, and electric vehicles (EVs) for variable load. The target is to find out maximum utilization of renewable energy sources for economic power generation with less emission. Thus, a new approach of EV to grid has been adopted with wind–solar based HTS system for improving grid reliability and resilience. Second, there is a requirement to overcome the local optima problems with less convergence speed. This is obtained by employing a relatively new methodology, known as chaotic‐quasi‐opposition‐based whale optimization algorithm (WOA) (CQOWOA). The proposed algorithm is tested on HTS and wind–solar‐electric vehicle‐based HTS (HTWSVS) for three different cases. Different nonlinearities like valve point effect of thermal units, transmission losses, spillage rate of hydro reservoir units and uncertainties of wind, solar as well as EV are considered to judge the effectiveness of the proposed CQOWOA technique on realistic problems. The presence of wind, solar, and EV energy sources with HTS is evident from the test results of CQOWOA, for multi‐objective problem where cost and emission both are reduced significantly. The robustness of the proposed solution has been verified by implementing the statistical analysis on two systems with least variation of mean and optimal values of cost with the tolerance of less than 0.025%. The comparative analysis of CQOWOA with the other optimization techniques validates its superiority on both the test systems by minimizing the generation cost and emission.

Plethysmography: A game changer for chronic venous insufficiency diagnosis, treatment, and follow-up.

Chronic Venous Insufficiency (CVI) presents a various clinical symptoms and treatment options. Although it is generally known which treatment option is more appropriate in which situations in CVI, it is even more difficult to find the right option in some uncertain situations. In this study, we aimed to evaluate the potential contribution of Digital Photoplethysmography (D-PPG) in the diagnosis of CVI and especially in the selection of treatment options. This retrospective study was conducted at Bursa Heart and Arrhythmia Hospital, involving 721 consecutive patients diagnosed with CVI and with Endovenous Laser Ablation (EVLA) indication. The patients were divided into 2 groups according to the extent of the failure in Doppler USG. In Group 1, the insufficiency ended above the knee, and in Group 2, the insufficiency progressed to below the knee. Patients were evaluated based on anamnesis, physical examination, Doppler USG, and D-PPG. Clinical classification, Venous Clinic Severity Score (VCSS), Quality of Life (QoL) assessment, venous pump capacity (VPC), and venous refill time (VRT) were measured. The study included 263 male and 458 female patients with a mean age of 52.37 ± 12.26years. Significant differences were observed between Group 1 (above knee reflux) and Group 2 (below knee reflux) patients in terms of VCSS, QoL, VPC, and VRT values. The mean values of VCSS, patient complaints, VPC, and VRT were higher in Group 2 patients. Similar findings were observed within the CEAP 2 subgroup. D-PPG shows potential as a valuable tool in the diagnosis and treatment of CVI. By providing information about venous hemodynamics and volume changes, it can assist in optimizing treatment decisions, including saphenous vein preservation. Combining D-PPG with Doppler USG may improve the comprehensive assessment of CVI and change the treatment option, especially for CEAP 2 patients. More research is needed to confirm these findings and explore wider applications of plethysmographic methods in the management of CVI.

Topological Phase Diagram of an Interacting Kitaev Chain: Mean Field versus DMRG Study

In this work, we study the topological phase transitions of a Kitaev chain generalized by the addition of nearest-neighbor Coulomb interaction. We show the presence of a robust topological phase as a function of the interaction strength and of the on-site energy with associated non-zero energy Majorana states localized at the chain edges. We provide an effective mean-field model that allows for the self-consistent computation of the mean value of the local particle number operator, and we also perform Density Matrix Renormalization Group numerical simulations based on a tensor network approach. We find that the two methods show a good agreement in reporting the phase transition between trivial and topological superconductivity. Temperature robustness within a physically relevant threshold has also been demonstrated. These findings shed light on an entire class of topological interacting one-dimensional systems in which the effects of residual Coulomb interactions play a relevant role.

A validity study of COMLEX-USA Level 3 with the new test design.

The National Board of Osteopathic Medical Examiners (NBOME) administers the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), a three-level examination designed for licensure for the practice of osteopathic medicine. The examination design for COMLEX-USA Level 3 (L3) was changed in September 2018 to a two-day computer-based examination with two components: a multiple-choice question (MCQ) component with single best answer and a clinical decision-making (CDM) case component with extended multiple-choice (EMC) and short answer (SA) questions. Continued validation of the L3 examination, especially with the new design, is essential for the appropriate interpretation and use of the test scores. The purpose of this study is to gather evidence to support the validity of the L3 examination scores under the new design utilizing sources of evidence based on Kane's validity framework. Kane's validity framework contains four components of evidence to support the validity argument: Scoring, Generalization, Extrapolation, and Implication/Decision. In this study, we gathered data from various sources and conducted analyses to provide evidence that the L3 examination is validly measuring what it is supposed to measure. These include reviewing content coverage of the L3 examination, documenting scoring and reporting processes, estimating the reliability and decision accuracy/consistency of the scores, quantifying associations between the scores from the MCQ and CDM components and between scores from different competency domains of the L3 examination, exploring the relationships between L3 scores and scores from a performance-based assessment that measures related constructs, performing subgroup comparisons, and describing and justifying the criterion-referenced standard setting process. The analysis data contains first-attempt testscores for 8,366 candidates who took the L3 examination between September 2018 and December 2019. The performance-based assessment utilized as a criterion measure in this study is COMLEX-USA Level 2 Performance Evaluation (L2-PE). All assessment forms were built through the automated test assembly (ATA) procedure to maximize parallelism in terms of content coverage and statistical properties across the forms. Scoring and reporting follows industry-standard quality-control procedures. The inter-rater reliability of SA rating, decision accuracy, and decision consistency for pass/fail classifications are all very high. There is a statistically significant positive association between the MCQ and the CDM components of the L3 examination. The patterns of associations, both within the L3 subscores and with L2-PE domain scores, fit with what is being measured. The subgroup comparisons by gender, race, and first language showed expected small differences in mean scores between the subgroups within each category and yielded findings that are consistent with those described in the literature. The L3 pass/fail standard was established through implementation of a defensible criterion-referenced procedure. This study provides some additional validity evidence for the L3 examination based on Kane's validity framework. The validity of any measurement must be established through ongoing evaluation of the related evidence. The NBOME will continue to collect evidence to support validity arguments for the COMLEX-USA examination series.

On the effect of pressure coefficient source on the energy demand of an isolated cross-ventilated building

Natural ventilation is a simple and effective measure to both reduce the cooling demand of buildings and improve the indoor air quality. In the prediction of heating and cooling demands by means of building energy simulations (BES), the use of pressure coefficients (Cp) from databases as input for the airflow network model is the common approach. Cp values for the same building typology may differ according to the adopted database and are generally unavailable for buildings with complex geometry. Employed Cp values may lead to differences in BES results. This manuscript presents a comparison, for different wind directions, between the Cp distributions and mean values on the facades of a detached building obtained with full-scale CFD – Reynolds-averaged Navier-Stokes (RANS) and large eddy simulation (LES) – simulations, from a database and from wind-tunnel experiments. The obtained pressure coefficients are used in the BES of a naturally ventilated building and the energy demand difference between the four approaches is quantified. Four climate zones (tropical, dry/desertic, temperate, continental) are considered. Although, in terms of accuracy of Cp prediction, LES outperforms RANS for all the wind directions considered, annual cooling energy demand is found to be relatively insensitive to the source of Cp for the current case study, while predicted peak cooling values differ up to 10.8%. On the other hand, the prediction of annual heating energy demand in cold climates varies up to 3% depending on the Cp source employed for BES simulations.

Quantitative Assessment of Breast Tumor: Comparison of Four Methods of Positioning Region of Interest for Synthetic Relaxometry and Diffusion Measurement

ObjectivesTo compare the differences in apparent diffusion coefficient (ADC) and synthetic magnetic resonance (MR) measurements of four region of interest (ROI) placement methods for breast tumor and to investigate their diagnostic performance. Methods110 (70 malignant, 40 benign) newly diagnosed breast tumors were evaluated. The patients underwent 3.0T MR examinations including diffusion-weighted imaging and synthetic MR. Two radiologists independently measured ADCs, T1 relaxation time (T1), T2 relaxation time (T2), and proton density (PD) using four ROI methods: round, square, freehand, and whole-tumor volume (WTV). The interclass correlation coefficient (ICC) was used to assess their measurement reliability. Diagnostic performance was evaluated using multivariate logistic regression analysis and the receiver operating characteristic (ROC) curves. ResultsThe mean values of all ROI methods showed good or excellent interobserver reproducibility (0.79~0.99) and showed the best diagnostic performance compared to the minimum and maximum values. The square ROI exhibited superior performance in differentiating between benign from malignant breast lesions, followed by the freehand ROI. T2, PD, and ADC values were significantly lower in malignant breast lesions compared to benign ones for all ROI methods (p < 0.05). Multiparameters of T2 + ADC demonstrated the highest AUC values (0.82~0.95), surpassing the diagnostic efficacy of ADC or T2 alone (p < 0.05). ConclusionsROI placement significantly influences ADC and synthetic MR values measured in breast tumors. Square ROI and mean values showed superior performance in differentiating benign and malignant breast lesions. The multiparameters of T2 + ADC surpassed the diagnostic efficacy of a single parameter.

Clinicopathological factors associated with sentinel lymph node detection in non-small-cell lung cancer

BackgroundMapping of the pulmonary lymphatic system by near-infrared (NIR) fluorescence imaging might not always identify the first lymph node relay. The aim of this study was to determine the clinicopathologic factors allowing the identification of sentinel lymph nodes (SLNs) by NIR fluorescence imaging in thoracic surgery for non-small-cell lung cancer (NSCLC).MethodsWe conducted a retrospective review of 92 patients treated for suspected or confirmed cN0 lung cancer with curative intent who underwent an intraoperative injection of indocyanine green (ICG) either by direct peritumoral injection or by endobronchial injection using electromagnetic navigational bronchoscopy (ENB). After exclusion of patients for technical failure, benign disease and metastasis, we analyzed the clinicopathologic findings of 65 patients treated for localized-stage NSCLC, comparing the group with identification of SLNs (SLN-positive group) with the group without identification of SLNs (SLN-negative group).ResultsForty-eight patients (73.8%) were SLN-positive. Patients with SLN positivity were more frequently female (50%) than the SLN-negative patients were (11.8%) (p = 0.006). The mean value of diffusing capacity for carbon monoxide (DLCO) was lower among the patients in the SLN-negative group (64.7% ± 16.7%) than the SLN-positive group (77.6% ± 17.2%, p < 0.01). The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FCV) was higher in the SLN-positive group (69.0% vs. 60.8%, p = 0.02). Patients who were SLN-negative were characterized by a severe degree of emphysema (p = 0.003). There was no significant difference in pathologic characteristics. On univariate analyses, age, female sex, DLCO, FEV1/FVC, degree of emphysema, and tumor size were significantly associated with SLN detection. On multivariate analysis, DLCO > 75% (HR = 4.92, 95% CI: 1.27–24.7; p = 0.03) and female sex (HR = 5.55, 95% CI: 1.25–39.33; p = 0.04) were independently associated with SLN detection.ConclusionsAt a time of resurgence in the use of the sentinel lymph node mapping technique in the field of thoracic surgery, this study enabled us to identify, using multivariate analysis, two predictive factors for success: DLCO > 75% and female sex. Larger datasets are needed to confirm our results.

Hydrogeochemical and microbial constituents of groundwater in Lephalale municipality, Limpopo province, South Africa

This study assessed the hydrogeochemical characteristics and microbial constituents of groundwater in Lephalale Municipality, South Africa. A total of 71 borehole water samples were collected from 15 villages within the Lephalale Municipality between April 2019 and October 2020. The results of the parameters such pH, EC, TDS, and alkalinity range from 6.69 to 7.87, 620.30 to 1937.00 μS/cm, 330.35 to1035.50 mg/L and 50.00-390.00 mg/L, respectively. The mean values of major cations and anions were found to be in the order of Na+>Ca2+>Mg2+>K+ and HCO3−>Cl−>NO3−>SO42−>F−, respectively. About 35 % of the tested samples had F− concentrations above 1.5 mg/L recommended by the world health organization (WHO) to eliminate the risk of fluorosis. The hydrogeochemical facies determined using a piper diagram revealed the dominance of mixed CaMgCl and CaHCO3 water types. The Gibbs plot analysis revealed that the main composition-controlling hydrogeochemical processes in the study area is the rock-water interaction. The microbial constituent's analysis showed that faecal coliform in groundwater samples were ranging between 0 and 71 CFU/ 100 mL with an average of 0.56 CFU/100 mL, while total coliform (TC) counts were between 0 and 360.5 CFU/100mL with the average of 30.81 CFU/100mL, respectively. This study revealed that groundwater in some boreholes from Lephalale Municipality poses risk of fluorosis and pathogen related diseases. Therefore, the study recommends improving of water quality within the study area prior to consumption.

Uncovering the hidden structure of small-world networks

The small-world (SW) network model introduced by Watts and Strogatz has significantly influenced the study of complex systems, spurring the development of network science as an interdisciplinary field. The Newman-Watts model is widely applied to analyze SW networks by adding several randomly placed shortcuts to a regular lattice. We meticulously examine related previous works and conclude that the scaling of various pertinent quantities lacks convincing evidence. We demonstrate that the SW property primarily stems from the existence of clusters of nodes linked by shortcuts rather than just the mean number of shortcuts. Introducing the mean degree of clusters linked by shortcuts as a new key parameter resolves the scaling ambiguity, yielding a more precise characterization of the network. Our findings provide a new framework for analyzing SW networks, highlighting the significance of considering emergent structures in complex systems. We also develop a phase diagram of the crossover transition from the small to the large world, offering profound insights into the nature of complex networks and highlighting the power of emergence in shaping their behavior.

The Effectiveness of a Cognitive-Behavioral Counseling Program in Reducing Cognitive Distortions among Residents of the Juvenile House in Taif

This study aimed to examine the effectiveness of a cognitive-behavioral counseling program in reducing cognitive distortions. The quasi-experimental, one-group pretest-posttest design was employed. The sample comprised 30 residents of the Juvenile House in Taif who were randomly chosen. The findings indicated statistically significant differences at (α≤0.01) between the pretest and posttest mean scores on all cognitive distortions dimensions in favor of the post-administration. In addition, the cognitive-behavioral counseling program had a large effect size on the sample's cognitive distortions. The Modified Blake's Gain Ratio for the effectiveness of the counseling program in reducing cognitive distortions was (1.24). The study recommended activating counseling centers in all institutions of the Kingdom of Saudi Arabia and educating workers at the juvenile houses on guiding clients to improve their cognitive distortions.

Knowledge, attitude, and practice of pre-diabetic older people regarding pre-diabetes.

One of the risk factors of diabetes is the pre-diabetes stage which is significantly prevalent in older people. Knowledge, attitude, and practice of the pre-diabetic stage are of great importance and can decrease complications. The present study aimed to determine the knowledge, attitude, and practice of the pre-diabetic older people. This cross-sectional study was conducted from April 2022 to August 2022 on 219 pre-diabetic older people referring to Sina Hospital in Tabriz, one of the most populated cities in the northwest of Iran. Data were collected using questionnaires of Knowledge, Attitude, Practice-Prediabetes Assessment Questionnaire (KAP-PAQ). The data were analyzed by SPSS 21. The mean scores of knowledge (in the range of 0-17), attitude (in the range of -10, + 10), and practice (in the range of 0-26) were 1.72 ± 1.0, 2.24 ± 1.92, and 5.76 ± 2.61, respectively. The older people's knowledge and practice levels in the pre-diabetes stage were low and about 50% of them had negative views. According to the Spearman correlation test, there was a positive significant relationship between the older people's knowledge and practice (p < 0.001, r = 0.234). The older people in the pre-diabetes stage had low knowledge and attitude and a negative viewpoint towards correcting lifestyle on diet, exercising and physical activity, weight control, diagnostic and screening methods. Increased knowledge about pre-diabetes and strengthened positive attitude towards correcting lifestyle through counseling as well as empowering the pre-diabetic older people can increase the efficiency of pre-diabetes prevention and control programs and prevent its progression to the diabetes stage.