Score Mean Research Articles

Seeking greener pastures: attitudes towards brain drain among turkish medical students

BackgroundMedical brain drain is a critical issue for healthcare systems worldwide. This study investigated attitudes toward brain drain and influencing factors among medical students at Pamukkale University.MethodsA cross-sectional study was conducted with 1,129 students (80.8% response rate) during the 2021–2022 academic year. Data, including sociodemographics, views on studying/working abroad, and the 16-item Brain Drain Attitude Scale (BDAS), were collected via a structured online questionnaire. Descriptive statistics, the Mann‒Whitney U test, the Kruskal‒Wallis test, and multiple linear regression were used for analysis.ResultsOver half (52.9%) of the students desired to work abroad, motivated by better working conditions (73.7%), higher salaries (57.8%), and social living conditions (66.8%). The BDAS score (mean = 61.26) indicated a moderate tendency toward brain drain. Key factors associated with higher brain drain attitude scores included financial constraints (B = 0.389, p = 0.001), independent living (B = 0.296, p < 0.001), initial reluctance to attend medical school (B = 0.598, p < 0.001), having friends or relatives abroad (B = 0.347, p < 0.001), considering exchange programs (B = 1.004, p < 0.001), and moderate foreign language proficiency (B = 0.300, p < 0.001).ConclusionA significant portion of Turkish medical students expressed a desire to work abroad, driven primarily by better working conditions, social living conditions, higher salaries, and excessive workloads in Türkiye. Financial constraints, independent living, dissatisfaction with medical school choices, and social networks with international experiences emerged as significant factors influencing attitudes toward brain drain.

A Comparative Study on Traditional and Case Based Teaching Learning Methods and Its Impact on Academic Performance Among First Year Medical Students

Background: The goal of medical education is to develop skilled practitioners who are attuned to the health issues faced by the community. Although lectures are commonly employed to impart new information, a drawback is that the audience tends to be passive and may thus become disengaged. Learning is made up of various interconnected components and involves complex mental processes like problem-solving and analytical thinking. The goal of using structured methods and organized resources is to equip students with effective learning tools. This enables them to gain a deep understanding of cognitive processes and develop the relevant skills needed for their careers. Case-Based Learning (CBL) involves examining a health issue presented by a patient, analysing and understanding pertinent details from past cases, systematically exploring and evaluating the situation, and planning the appropriate management for the patient. Materials and methods: The present study was cross sectional case control study conducted in the department of anatomy, Sri Siddhartha Medical College, Tumkur, Karnataka, India. Results: A total of 192 first year MBBS students participated in the first session of the study and 172 first year MBBS students participated in the second session of the study. The pre-test and post-test total scores of first and second session shows that students have performed better in CBL group when compared to the traditional lecture method of teaching. In the Critical Thinking Exercise scores of session -1 and 2, CBL group was found to be higher when compared to the traditional lecture group which was statistically significant. Comparison of means of internal assessments scores of CBL and Traditional lecture groups showed that the mean internal assessments score of CBL group was higher compared to Traditional lecture group which was statistically significant. Conclusion: Incorporating case-based learning (CBL) into our medical curriculum as a regular teaching method for large group settings should be considered. The integration of didactic lectures with CBL proves to be an effective educational approach. Positive feedback from both students and faculty suggests that CBL has been successfully introduced in departments like anatomy. However, further research is needed to evaluate how well students learn, understand, and retain the course content to fully support the implementation of this method in large undergraduate classes. KEY WORDS: Case-based learning, Traditional teaching learning methods, Critical thinking.

How do children understand and respond to the EQ-5D-Y-3L? A mixed methods study in a community-based sample of 6–12-year-olds

BackgroundThe EQ-5D-Y-3L is widely used for measuring and valuing HRQoL in paediatric populations. This mixed methods study used the EQ-5D-Y-3L measure and applied a retrospective think-aloud approach to examine the self-report validity in children of varying chronological age.MethodsA mixed methods study was conducted in a community-based sample of 39 children aged 6–12 years. In a semi-structured interview, children self-completed the EQ-5D-Y-3L and then engaged in retrospective think-aloud. Conversations were audio-recorded and transcribed for analysis in NVivo using the Tourangeau four-stage response model framework to assess comprehension, judgment, recall, and response mapping issues. Fisher’s exact test was used to assess the differences between child-self reported HRQoL across subgroups. The inter-rater agreement between child-parent dyads was assessed with CCC for overall HRQoL and Gwet’s AC1 for dimension level HRQoL.ResultsOverall, response issues were detected in n = 18 (46%) children. Comprehension issues were apparent in the “having pain or discomfort” dimension where children found it challenging to understand ‘discomfort’. Recall-related issues were observed where children’s responses were influenced by their typical tendencies (e.g., being usually worried) or past incidences (e.g., feeling pain sometimes). Judgement-related issues were the most common, particularly in the “doing usual activities” dimension, where children tended to respond based on their self-perceived ability to engage in activities rather than health-related limitations. None of the participants were found to have problems with response mapping. A healthy lifestyle that included diet and exercise was a notable consideration in EQ VAS ratings.The younger age groups had a higher proportion of response issues (6–7 years: 64%, 8–10 years: 62%), compared to older children (11–12 years: 20%). Moreover, children with response issues demonstrated significantly lower EQ-5D-Y-3L scores (mean = 0.78, se = 0.04) as compared to those without (mean = 0.95, se = 0.02) (p-value < 0.001). The overall inter-rater agreement was higher for those without any response issues (CCC = 0.33) than those with (CCC = 0.14). Additionally, higher agreement was noted across all the five dimensions in the subgroup with no response issues relative to those with.ConclusionsChildren in the general community may have different perceptions of HRQoL when responding to the EQ-5D-Y-3L possibly due to their limited experience with health-related challenges. The retrospective think-aloud approach adopted highlighted the relatively higher prevalence of response issues in the younger children (ages < 11 years), indicating the need for careful interpretation of self-reported HRQoL using the current version of the EQ-5D-Y-3L in this population.

Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial

BackgroundPatients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.MethodsSixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.ResultsAt 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037).ConclusionsPatients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.Trial registrationhttps://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Effects of Myofascial Release on the Pain and Quality of Life in Patients with Fibromyalgia

Objectives: To investigate the effects of myofascial release technique on pain and quality of life (QoL) in patients with fibromyalgia (FM). Methods: A quasi-experimental study was conducted to investigate the effects of myofascial release technique on patients with FM in Shalamar Hospital Lahore, Pakistan. After initial screening, 28 patients aged 25 to 45 years of both genders meeting the predetermined inclusion criteria were selected using convenience sampling. They were divided into two groups. Group A was treated with myofascial release therapy and passive stretching, while group B was treated with passive stretching alone. The McGill pain questionnaire (MPQ) was used to assess the pain, and the revised FM impact questionnaire (FIQR) was used to evaluate QoL. Results: Out of 28 participants, 11(39.3%) were male and 17(60.7%) were females. Pre- and post-treatment mean scores of pain rating index on MPQ were 46.76±10.47 and 23.79±7.43 for the experimental group and 43.36±12.7 and 30.0±9.89 for the control group, respectively (P&gt;0.05). Mean pre- and post-treatment FIQR scores were 52.9±13.6 and 33.02±13.75 for the experimental group and 57.77±23.04 and 46.59±19.37 for the control group, respectively. The difference in the means of post-treatment scores of the two groups for FIQR was significant (P=0.042). Discussion: Compared with passive stretching alone, the myofascial release method for FM did not demonstrate significant improvement in alleviating pain among such patients. However, it is remarkable that myofascial release therapy unveiled a positive impact by improving the overall QoL for FM patients.

Orthorexia nervosa tendencies and risk of eating disorders among culinary arts students: A comparative study with dietetics students.

Students pursuing food-related academic fields such as dietetics have higher orthorexia nervosa (ON) tendencies and are at a greater risk of developing eating disorders (EDs). However, there is limited research available on ON tendencies and on the risk of EDs in the culinary arts field, which also revolves around food. The present study explored ON tendencies and the risk of EDs among culinary arts students and compared them with those of dietetics students. A cross-sectional study was conducted in France, using the eating habits questionnaire (EHQ) to measure ON tendencies, and the SCOFF as well as the eating disorders examination questionnaire (EDEQ) to evaluate the risk of EDs and ED symptoms. The study also included questions about sports practice. In total, 267 students participated in the study, including 144 culinary arts students (51 women, 92 men and one other) and 123 dietetics ones (106 women, 15 men and two others). Culinary arts students exhibited similar means of EHQ scores as dietetics ones (32.99 vs. 33.34) but higher SCOFF scores (52.8% vs.39.8%). In addition, a gender difference was evidenced: women in culinary arts showed higher EHQ, SCOFF and EDEQ scores than men in culinary arts. Linear regression models showed no effect of the type of academic field (culinary arts vs. dietetics) on the EDEQ score but revealed effects of gender, body mass index and hours of sports practice. The study emphasises the need to monitor culinary students and implement interventions to prevent EDs. It also suggests a correlation between food-related education and the risk of EDs, which requires further research.

Effect of serum antioxidants on cognitive dysfunction in first-episode and drug-naïve patients with major depressive disorder.

Cognitive dysfunction is a persistent and difficult-to-treat symptom of major depressive disorder (MDD) and is receiving increasing attention. A balanced state of oxidative stress sustained by antioxidants is essential for normal functioning of brain, including learning capacity, emotional regulation, and cognitive function. The correlation between cognition and oxidative stress may also be altered in patients with mental disorders. This study aimed to explore the relationship between serum antioxidant levels and cognitive dysfunction in patients with MDD. We collected and matched cognitive performance data using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB), serum antioxidants, and demographic and clinical characteristics of 105 first-episode drug-naïve patients with MDD and 53 healthy controls (HC) from February 2022 to October 2023, and then analyzed the differences between the two groups. HamiltonDepressionScale-17 and Young Mania Rating Scale (YMRS) were used to evaluate the clinical symptoms of the participants with MDD. Serum antioxidants, including albumin (ALB), uric acid (UA), and superoxide dismutase (SOD) were used to detect the level of oxidative stress in participants and its correlation with cognitive function. We then used a threshold for cognitive dysfunction of 1.5 standard deviations below the mean of the standard score to divide the participants with MDD into two groups to detect the relevant elements of the five different domains of cognitive dysfunction in MDD. ALB levels were significantly lower in the MDD group (p = 0.001) after adjusting for years of education. The performance in all five domains of cognitive function was significantly worse in the MDD group than in the HC group (p < 0.001). Speed of processing (SOP) in the MDD group correlated with ALB (r = 0.261, p = 0.008), and UA (r = 0.295, p = 0.002) levels. We also explored the correlation between the attention/vigilance (AV) domain and the UA (r = 0.239, p = 0.015). YMRS score was risk factor of impairment of SOP domain in patients with MDD. Yet UA was a protective factor against SOP impairment, with a 0.006-fold reduction in the risk of SOP impairment for each 1-unit increase in UA. As serum antioxidants, ALB and UA may serve as biomarkers of cognitive function in patients with MDD. Our findings contribute to the understanding of the potential ability of serum antioxidants to predict cognitive decline in patients with MDD.

Nutritional risk screening by the emergency medical services: Agreement with in-hospital assessment

IntroductionEarly recognition of nutritional risk is important to prevent the adverse consequences of malnutrition. However, nutritional risk screening is often disregarded in hospitals. PurposeTo evaluate the agreement of nutritional risk screening results between screening performed by emergency medical services (EMS) and at the hospital ward. MethodsThe EMS used the Nutritional Risk Screening 2002 (NRS-2002) to screen the nutritional risk of community-dwelling patients aged ≥ 70 years transported to the emergency department of a large Finnish hospital. The NRS-2002 results from the EMS were compared to results obtained during hospitalization. ResultsThe EMS screened 472 patients and recognized nutritional risk in 81 (17 %). NRS-2002 was repeated at hospital ward in 97 of the screened. In about two-thirds of the cases (69 %), the EMS and ward personnel agreed on whether the patient had nutritional risk or not, and one-third of patients (31/97, 32 %) had the exact same score. The EMS tended to give lower scores (mean difference 0.70 ± 1.29, p < 0.001). Twenty-four patients considered not to be at nutritional risk according to the EMS were recognized as risk patients at the ward. ConclusionNutritional risk screening by the EMS could help in identifying persons requiring more detailed assessment of nutritional status.

Video media is more effective to improve balanced nutrition knowledge

Introduction: Providing appropriate nutrition information is important to increase public knowledge about balanced nutrition. One proven effective method is using video media as a means of education. Objective: Analyze the effectiveness of video media in increasing knowledge about balanced nutrition. Methods: This study uses a quasi-experimental study design without group controls. The population of this study is all students, with a sample of 52 people who meet the inclusion and exclusion criteria. The sampling technique used stratified random sampling. Result: The study showed that the use of video increased the average knowledge score (mean) by 85.96 video (p=0.003). This study shows that providing nutrition education with video media is more effective in increasing balanced nutrition knowledge. Conclusion: Video media has been proven more effective in increasing knowledge about balanced nutrition. Video media can present information more interesting, interactive, and visually, making it easier for the audience to understand and remember the material conveyed. A significant increase in knowledge in the group receiving the video media intervention showed that this method is an effective educational tool in balanced nutrition campaigns. Therefore, video media is recommended as a nutrition counseling strategy to expand the reach and impact of health education in the community.

Clinical Application of 3D-Assisted Surgery Techniques in Treatment of Intra-Articular Distal Radius Fractures: A Systematic Review in 718 Patients.

Objectives: Three-dimensional (3D) technology is increasingly applied in the surgical treatment of distal radial fractures and may optimize surgical planning, improve fracture reduction, facilitate implant and screw positioning, and thus prevent surgical complications. The main research questions of this review were as follows: (1) "How do 3D-assisted versus 2D-assisted distal radius fracture surgery compare in terms of intraoperative metrics (i.e., operation time and fluoroscopy frequency)?", and (2) "What are the effects of 3D-assisted versus 2D-assisted surgery on postoperative outcomes (patient-reported outcome measures (PROMs), range of motion (ROM), fracture reduction, complication rate, and screw placement accuracy)?" Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. In total, 873 articles were found between 1 January 2010 and 1 April 2024, of which 12 (718 patients) were suitable for inclusion. The quality of the studies, assessed using the McMaster quality assessment, ranged from moderate to excellent, although the surgical techniques and outcome measures varied widely. Articles comparing a 3D group to a 2D group (conventional imaging) and reporting on primary or secondary outcomes were included in the analysis, for which weighted means and ranges were calculated. Results: Three different concepts of 3D-assisted surgery techniques were identified: (1) 3D virtual surgical planning (VSP), (2) 3D-printed handheld models, and (3) 3D intraoperative guides. Differences between 3D-assisted and conventional 2D-assisted surgery were evaluated. Regarding intraoperative metrics, 3D-assisted surgery significantly reduced operation time by 6 min (weighted mean 66.9 versus 73.2 min) and reduced the fluoroscopy frequency by 1.1 images (5.8 versus 4.7 times). Regarding postoperative outcomes, the weighted mean of the DASH score differed between the 3D- and 2D-assisted groups (17.8 versus 23.9 points), and no differences in PRWE or VAS score were found. Furthermore, our results showed no significant differences in the ROM and fracture reduction parameters. In terms of complications, the application of 3D-assisted surgery decreased the complication rate from 10.7% to 3.6%, and the use of screws with appropriate lengths improved from 75% to 86%. Conclusions: Applications of 3D-assisted surgery in distal radial fracture surgery can slightly reduce the operation time and fluoroscopy frequency. Evidence for the improvement of fracture reduction and functional outcomes is still lacking, although it likely reduces the complication rate and improves the use of appropriate screw lengths.

Not So Patient-Friendly: Patient Education Materials in Rheumatology and Internal Medicine Fall Short of Nationally Recommended Readability Benchmarks in the United States.

Patient education materials (PEMs) can help promote health literacy (HL) among patients. However, their use depends on how easily patients can read and comprehend the information. Several national organizations recommend that text be written at a 6th to 8th-grade level. Herein, we assess and compare the readability and comprehension (RC) of PEMs for rheumatological and general medical conditions. We utilized six standardized RC metrics including the well-known Flesch Kincaid Readability Ease (FKRE) and Flesch Kincaid Grade Level (FKGL) to evaluate the RC of PEMs (n=175) on the American College of Rheumatology (ACR) (n=86) and the Journal of the American Medical Association (JAMA) (n=89) websites. Two-sided T-tests compared RC between the two resources. A p-value of ≤0.05 was considered significant. On all six standardized metrics used, the mean reading level of all PEMs ranged from high school to college level. For example, the mean (SD) of Simple Measure of Gobbledygook (SMOG) was 10.89 (1.88), corresponding to a 10th-grade education, and the mean (SD) of Gunning Fog Score (GFS) was 14.39 (2.49), corresponding to a 14th-grade education required to understand the text. JAMA PEMs had significantly more difficult RC levels compared to ACR PEMs based on five of the six indices used (p<0.05). PEMs available on the ACR and JAMA websites do not align with national organizations' recommendations for RC levels. To enhance patient understanding and promote HL, existing PEMs must be modified in line with these recommendations.

Comparative Assessment of the qSOFA, SII, dNLR, and OISS Infection Severity Scores in Diabetic Versus Non-Diabetic Patients with Odontogenic Infections

Background and Objectives: Odontogenic infections (OIs) can progress rapidly and may lead to severe systemic complications, especially in patients with underlying conditions like diabetes mellitus (DM). This study aims to evaluate the predictive value of inflammatory scores—quick Sequential Organ Failure Assessment (qSOFA), Systemic Immune–Inflammation Index (SII), derived Neutrophil-to-Lymphocyte Ratio (dNLR), and Odontogenic Infection Severity Score (OISS)—in assessing the severity of OIs in diabetic versus non-diabetic patients. Materials and Methods: A case–control study was conducted on 123 patients diagnosed with OIs. Patients were divided into two groups: patients with diabetes (n = 42) and patients who were non-diabetic (n = 81). Inflammatory scores were calculated at admission and correlated with clinical outcomes. Statistical analyses included t-tests, chi-square tests, and multivariate logistic regression. Results: The patients with diabetes exhibited significantly higher OISS scores (mean 6.5 ± 2.8) compared to the patients who were non-diabetic (mean 4.8 ± 2.1, p &lt; 0.001). The inflammatory markers qSOFA, SII, and dNLR were significantly elevated in the diabetic group (all p &lt; 0.01). The SII demonstrated the highest predictive accuracy for severe OIs in patients with diabetes, with an area under the curve (AUC) of 0.88 (95% CI: 0.80–0.95). Diabetes mellitus was an independent predictor of severe OIs (OR: 3.2, 95% CI: 1.5–6.8, p = 0.003). Conclusions: Inflammatory scores, particularly SII, are effective in predicting the severity of odontogenic infections in patients with diabetes. Incorporating these scores into clinical practice may enhance the early identification of high-risk patients and improve management strategies.

Perceived usefulness of a blended learning approach for skills training among medical interns: a pilot study

BackgroundInternship is a phase of training wherein medical graduates acquire the skills and competencies required to function independently. It has been reported that interns lack confidence in performing common procedures, as these skills are often learnt through self-learning or performing without supervision. This type of learning endangers patient safety and fails to instil the required confidence in the student. Training in skills laboratories provide opportunity to learn clinical skills in a safe environment. However, skills laboratories are resource-intensive, and there is limited information on different training approaches, such as blended learning, and how the trainees perceive their usefulness. Hence, we conducted this pilot study to assess the perceived usefulness of a blended learning approach for skills training among medical interns.MethodsThis mixed methods study was conducted in the skills laboratory of an apex medical institute in India, among 42 interns posted for the Interns Skill-based Clinical Induction Program (ISCIP). In this training, a blended learning approach was adopted, which comprised of two components - an online e-learning module, followed by a hands-on training session. The trainees were asked to complete a feedback form and grade different components of the online session, and hands-on session on a five-item Likert-based scale. The scores were expressed as the mean (SD) of a maximum possible score of 5 for each of the components. In order to gain insight of the perceived usefulness of skills training among learners, focused group discussions (FGDs) were conducted.ResultsThe mean (SD) score for perceived importance ranged from 5 (0) to 4.9 (0.2) for various skills. The proportion of interns who felt confident in performing the skill after the training was 88.1% for IV cannulation to 97.6% handwashing, and gloving and gowning. The findings of the qualitative component revealed that interns found the training to be useful and interesting. It was perceived to be more ethical, uniform, well-structured, and provided an opportunity to practice a skill repeatedly.ConclusionsThe blended learning approach was perceived to be useful among the medical interns. Further research may be conducted in other medical institutes to assess the effectiveness of skills training.Clinical trial registration numberNot applicable, as the study is not a trial.

Meta-analysis of the Effectiveness of Acupuncture Treatment in Chronic Low Back Pain

This research aimed to evaluate the effectiveness of acupuncture treatment in chronic low back pain using meta-analysis. Of the 743 acupuncture research studies assessed on academic databases, 11 studies with 12 samples were selected. Research participants' ages, female-to-male ratios, and initial and final Visual Analog Scale (VAS) pain scores were documented. In total, 388 patients, including 208 (53.61%) female and 180 (46.39%) male patients, were subjected to acupuncture due to low back pain. Mean age was 43.45 with 30.8-57.6 range. The initial VAS score mean was 5.79, and the final VAS score mean was 3.17. VAS difference mean was -2.62 with 0.47-5.26 range. Comparison with exercise and electrical acupuncture were insignificant (p&gt;0.05), whereas differences between control and acupuncture groups were significant (p&lt;0.05). Spearman’s rho correlation analysis results showed that VAS difference was only significantly correlated with VAS initial (r=-0.874; p&lt;0.01). Female frequency, male frequency and age were not significantly correlated with VAS difference (p&gt;0.05). Generalized Linear model (Logit) analysis results showed that age (OR=-0.055; p&lt;0.05) and VAS initial (OR=-0.767; p&lt;0.01) had a significant effect on VAS difference in patients having low back pain and had acupuncture treatment. Acupuncture is much more effective in the treatment of nonspecific chronic low back pain for both women and men, individuals of all age groups, but especially young people. The high level of initial pain is also one of the important factors affecting the success of low back pain treatment with acupuncture.

The association between dietary dark green vegetable intake and cognitive function in US older adults.

Dark green vegetables include dark green leafy vegetables and broccoli. They are sources of many essential nutrients, including vitamins A, B and C, folate, fibre, carotenoids and flavonoids. This study aimed to explore the association between dietary dark green vegetable intake and cognitive function in US older adults. We included 2344 older adults (≥60 years old) from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 cycles. Dark green vegetable consumption was assessed using a continuous variable (cups/day) and two categorical variables. The first categorical variable classified participants into non-consumers and consumers based on whether they consumed dark green vegetables. The second categorical variable grouped participants into four levels of dark green vegetable consumption (non-consumers, consumers with low intakes, consumers with moderate intakes and consumers with high intakes). We used five continuous variables with non-normal distribution to assess cognitive function, including a composite z-score and the standardised scores of four individual cognitive tests. The four cognitive tests included the Immediate Recall Test (IRT), the Delayed Recall Test (DRT), the Animal Mobility Test (AFT) and the Digit Symbol Substitution Test (DSST). The standardised scores of the four cognitive tests were calculated using the mean and standard deviation of each cognitive test score. The composite z-score was calculated by averaging the standardised scores of four cognitive tests to evaluate global cognition. We used multiple linear regression models to examine the association between dietary dark green vegetable intake and cognitive function. Our findings indicated that dark green vegetable intake was positively associated with global cognition (β [95% CI]: 0.17 [0.04, 0.30]; p = 0.016) and IRT (β [95% CI]: 0.26 [0.08, 0.43]; p = 0.009) and DRT (β [95% CI]: 0.21 [0.05, 0.36]; p = 0.012) standardised scores. Individuals with high intake of dark green vegetables showed notably better global cognition (β [95% CI]: 0.16 [0.05, 0.28]; p = 0.010) and showed higher IRT (β [95% CI]: 0.22 [0.07, 0.38]; p = 0.010) and DRT standardised scores (β [95% CI]: 0.21 [0.07, 0.36]; p = 0.007) compared with the non-consumers. Blood neutrophil counts mediated the cognitive benefits of dark green vegetables (Proportion: 9.5%, p = 0.006). In conclusion, our findings suggest that dark green vegetable consumption may have favourable effects on cognitive function in US older adults, especially on immediate and delayed learning abilities. The underlying mechanisms include the ability of dark green vegetables to reduce blood neutrophil levels, an indicator of decreased systemic inflammation. Increasing dietary intake of dark green vegetables may be a beneficial intervention to improve cognitive health in the older US population.

Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series

Pain, allodynia, and stiffness in complex regional pain syndrome (CRPS) greatly affects social, vocational, and community engagement. The aim of this study was to evaluate the effect of isolated median nerve releases on the outcome of CRPS 1 of the hand. In this prospective case series, people of any age diagnosed with and treated for CRPS 1 of the upper limb attending the author's practice were consecutively recruited. All were self-referrals dissatisfied with the treatment provided previously. Only patients who had been treated with nerve release to control their symptoms were included. Primary outcome measures were pain and Disabilities of the Arm, Shoulder, and Hand score. A secondary outcome was withdrawal from pain medication. Full resolution was defined as 0 pain, on a scale of 0-10, and total withdrawal from pain medication at the latest follow-up. Between January 2018 and December 2022, 82 participants with CRPS 1 of the hand for an average of 20 months were evaluated. Eighty-five nerve releases were performed. As per protocol, carpal tunnel release was performed in all, and three patients also received an endoscopic pronator release. Minor procedures unrelated to the pain were carried out concomitantly in 17 patients. Significant improvements were observed in pain score (mean 8.9 ± 1.2 at baseline vs 0.6 ± 1.8 at 35 months) and in Disabilities of the Arm, Shoulder, and Hand score (82 ± 13 vs 13 ± 20) for the same period. Five patients (6%) were considered failures. In contrast, 65 patients (79%) had full resolution of their symptoms. This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. Future research is needed to understand the pathophysiology and the failures. Therapeutic II.

Assessment of Inflammatory Scores in Severity Prediction for Elderly Patients with Odontogenic Infections.

Background and Objectives: Odontogenic infections (OIs) can lead to severe complications, especially in elderly patients due to age-related physiological changes and comorbidities. This study aims to evaluate the predictive accuracy of inflammatory scores-APACHE II, CURB-65, SOFA, and NEWS2-in determining the severity of odontogenic infections among elderly patients (>70 years) compared to younger patients (<70 years). Materials and Methods: A retrospective cohort study was conducted on patients diagnosed with an OI at the Maxillofacial Surgery Department between January 2018 and January 2024. Patients were divided into two groups: elderly patients (>70 years, n = 49) and younger patients (<70 years, n = 64). The Symptom Severity score (SS) of odontogenic infections was calculated for all patients. Inflammatory scores-APACHE II, CURB-65, SOFA, and NEWS2-were assessed at admission and correlated with infection severity. Additional subgroup analyses were performed based on comorbidities and infection sites. Results: Elderly patients exhibited significantly higher SS scores (mean 12.47 ± 2.93) compared to younger patients (mean 7.82 ± 2.17, p < 0.001). APACHE II, CURB-65, SOFA and NEWS2 scores were significantly elevated in the elderly group (all p < 0.001). The SOFA score demonstrated the highest predictive accuracy for severe OIs in elderly patients, with an area under the curve (AUC) of 0.89 (95% CI: 0.82-0.95). Subgroup analyses revealed that comorbidities such as diabetes mellitus and cardiovascular disease significantly influenced infection severity (p < 0.05). Conclusions: Inflammatory scores, particularly SOFA, are effective in predicting the severity of odontogenic infections in elderly patients. The integration of these scores into clinical practice may enhance early identification of high-risk patients and improve management strategies.

School management activities in a digital age – An international comparison based on ICILS 2018

Principals have an important role to play in the implementation of digitalization in schools. They can be seen as role models for teachers with regard to ICT usage. Furthermore, there is nowadays a solid research linking educational leadership and management indirectly to stu-dent achievement. However, there is a lack of studies on the specific ICT usage of principals and the relationship with students' ICT skills. Against this background, our research aimed to find out whether different clusters of principals in Chile, Denmark, Germany, the Republic of Korea, and the United States can be identified on the basis of their leadership and manage-ment activities using ICT and whether there are differences in the distribution of the identi-fied clusters across the countries. A latent class analysis was conducted using ICILS 2018 school questionnaire data. Across the five countries, three different clusters were identified based on principals’ activities using ICT. Proportions of principals’ distribution across the clus-ters varied significantly between the countries. In addition, it was investigated whether the clusters are related to students' competence in CIL using the means of student's scores in the computer based CIL test. No significant relation was found either when the five countries were considered together or individually.

Examining the Relationships between Career Development, Daily Life Decision Making and Social Emotional Learning Skills of Middle School Students

This presented research has three purposes: The first purpose of this study is to examine the power of middle school students' social emotional learning and daily life decision-making skills together as a predictor of their career development. The second purpose is to examine the career development of middle school students according to gender. Third purpose is to examine the career development of middle school students according to targeted high school type. The research group consisted of 263 middle school students (141 female, 116 male, 6 unknown). These students were studying in 3 middle schools in the center of a large city in the northwestern part of Turkey and their ages ranged between 10-15 (X̄=12.31; sd=1.07). The research data were collected by applying the Chilhood Career Development Scale, Social Emotional Learning Scale for Adolescents, Daily Life Decision Making Scale and Personal Information Form. The research data were analysed using multiple linear regression analysis, t test, and one-way ANOVA. The research results showed that middle school students' social emotional learning and daily life decision-making skills scores together accounted for a significant proportion of the variance 0.19% of the career development scores of middle school students. The results showed that the career development score mean of students targeted Anatolian high school were higher than those aiming for science high school and vocational and technical high school. There was not significantly differences in career development scores of the students according to gender. The research results were discussed based on the relevant literature, provided important implications for the theoretical and practical literature on career development, social emotional learning and daily life decision-making skills and suggestions were presented for future theoretical and practical research.

Validation study of synthetic models for esophageal atresia with tracheoesophageal fistula (EA/TEF): A simulation-based training in pediatric surgery

BackgroundPediatric surgery is a highly specialised field, with minimally invasive surgery (MIS) posing greater technical challenges than conventional open surgery. Proficiency requires both in and out-of-operating-room training, with simulation playing a crucial role. The purpose of this study was to explore MIS perceptions, training experiences, and preferences regarding laparoscopic simulation training. Furthermore, we aimed to validate two synthetic EA/TEF models. MethodA questionnaire focused on the degree of adoption of MIS among paediatric surgeons was proposed online to participants at the 68th Czech and Slovak Pediatric Surgery Congress in Slovakia in 2024. All participants also had scheduled sessions to practice advanced laparoscopic skills on two synthetic EA/TEF models. The purpose of this study was to analyse experiences with paediatric MIS, the implementation of simulation training, and personal stances on integrating simulation training into training curricula. EA/TEF models were validated with a 5-point Likert scale. ResultsThirty-three paediatric surgeons from 14 centres in two countries completed the questionnaire. Six (18 %) were novices, 12 (36 %) intermediate trainees, and 15 (45 %) specialists with over 11 years of practice. Eight participants (18 %) declared weekly access to simulation training, while 49 % had none. Additionally, 15 individuals (45.5 %) strongly agree and 48.5 % agree that regular training on simulators enhances surgical skills in MIS procedures in the operating room. Twenty-six respondents (76 %) believe that simulator training should be part of the requirements for pediatric surgical trainees, with no significant difference according to the surgeons' experience (p = 0.290). Thirty surgeons validated the EA/TEF models. Highest ratings were for overall impression and tool usefulness in experienced surgeons' training (mean scores: 4.5 and 4.6). The working space received the lowest score (mean: 3.6 ± 0.8), with experienced surgeons rating it significantly lower (3.4) than the inexperienced group (4.1, p = 0.030). No significant differences were observed between models in Likert scale parameters. ConclusionSimulation training is essential for teaching MIS in paediatric surgery, improving skills, and should be part of specialisation preparation. Synthetic EA/TEF models received high ratings as effective training tools for thoracoscopic EA/TEF training. Further studies are needed to prove construct validity.