Multicenter Cross-sectional Study Research Articles

Enlightening Nursing Care: A Protocol for a Multicenter Observational Study Measuring Nursing Work in Hospital Settings

Rising costs and demands for improved quality of care present complex challenges for existing healthcare systems. The strain on healthcare resources is exacerbated by the increasing complexity of patient conditions. The Diagnosis-Related Group (DRG) system classifies inpatients according to clinical and treatment criteria, controls healthcare expenditures, and ensures the sustainability of procedures. The cost of nursing care is included in the DRG system in the same way as other fixed costs of hospital care, but the amount of nursing care provided for the same DRG can vary widely. This study, which is based on this protocol, will aim to assess the variability of nursing costs within and across DRGs and to measure how much variability in nursing care is explained by DRGs by comparing nursing care delivery in acute care hospitals with the DRG reimbursement system in Italy. It is necessary to develop a specific protocol to ensure systematic and consistent data collection at the national level. A multicenter retrospective cross-sectional study will be conducted. A random sample of five public Italian hospitals will be enrolled. Patients included in medical or surgical DRGs, hospitalized and discharged in 2022 will be included. Data will be collected retrospectively from two sources: hospital discharge records and nursing records. Inferential statistics will be used to assess the variability of nursing time and costs across hospitals and DRGs. Nursing costs will be determined by several factors, including time spent on nursing activities and the hourly wages of nursing staff. The time needed to complete each activity will be estimated by a convenience sample of nurses from the hospitals included in this study. The annual salary of nurses will be used to calculate the nursing cost per minute, multipled by the amount of time spent per each nursing activity. The cost per patient per day of hospitalization will be calculated. The results of this study will shed light on the variation in nursing care across different DRGs. This understanding will guide recommendations for optimizing healthcare resource allocation and enhancing the efficiency of the DRG system in Italy.

Kinesiophobia and associated factors among people with musculoskeletal disorders in Ethiopia: a multicenter cross-sectional study

IntroductionKinesiophobia has a major health impact on patients with Musculoskeletal disorders (MSDs) in their functional and physical activities, which leads to poor outcomes, loss of motivation, loss of mobility, and decreased quality of life. Despite the burden of kinesiophobia among MSDs, there is limited evidence about the burden of kinesiophobia in Ethiopia. Thus, this study aimed to assess the prevalence and its associated factors of kinesiophobia among MSD patients attending physiotherapy outpatient clinics.MethodAn institutional multi-center cross-sectional study was conducted from February to April 2023 with a sample size of 424. A systematic random sampling technique and face-to-face interviews using a structured questionnaire and chart review were used. The collected data was entered into Epi-data version 4.6.0.6 and analyzed using SPSS version 25. Binary logistic regression analysis was employed to identify the potential candidates for multivariable logistic regression with a p-value less than 0.25. Finally, multivariate logistic regression analysis was employed and variables at p < 0.05 with 95% CI were considered statistically significant contributors to kinesiophobia.ResultThe overall prevalence of kinesiophobia among MSD patients was 48.3% (95% CI, 43.3–53.3). Being overweight and obese BMI value (AOR = 3.98; 95% CI, 2.17–7.29), having moderate pain level (AOR = 3.31; 95% CI, 1.51–7.26), having severe pain level (AOR = 9.29; 95% CI, 3.79–22.77), physical inactivity (AOR = 3.00; 95% CI = 1.84–4.89), anxiety (AOR = 2.57; 95% CI = 1.57–4.19), and depression (AOR = 8.21; 95% CI = 3.47–19.46) were significantly associated with kinesiophobia among musculoskeletal disorder patients.Conclusionkinesiophobia is a public health burden among patients with MSDs. Nearly half of the people with MSDs had reported kinesiophobia. Being overweight and obese BMI value, pain severity level, physical inactivity, anxiety, and depressive symptoms were significantly associated with kinesiophobia. Thus, we suggest screening for kinesiophobia, be physically active, avoiding being overweight and obese, and managing depression, anxiety and pain will help to reduce the occurrence of kinesiophobia.

Prevalence and influencing factors of occupational burnout among healthcare workers in the Chinese mainland during the late 2022 Omicron COVID-19 outbreak: a multicenter cross-sectional study

Prevalence and influencing factors of occupational burnout among healthcare workers in the Chinese mainland during the late 2022 Omicron COVID-19 outbreak: a multicenter cross-sectional study

Spanish Validation of the Problem Area in Diabetes-Pediatric Version Survey and Its Weak Association with Metabolic Control Parameters in Pediatric Diabetes: A Cross-Sectional Multicenter Study

Background: Type 1 diabetes mellitus (T1DM) in pediatric patients often leads to emotional distress, impacting self-management. The PAID-Peds survey measures diabetes-related emotional burden but lacks a validated Spanish version. This study aimed to validate the Spanish PAID-Peds survey in children and adolescents with T1DM and correlate it with diabetic metabolic control parameters. Methods: A cross-sectional study was conducted from October 2022 to December 2023, recruiting 636 patients aged 8–17 years from three Spanish hospitals. Psychometric properties were assessed using Cronbach’s alpha for reliability and confirmatory factor analysis for construct validity. Associations between PAID-Peds scores and clinical measures, such as HbA1c, were examined. Results: The final sample consisted of 538 participants (84.59% response rate). The PAID-Peds survey showed high internal consistency (Cronbach’s alpha = 0.90). The confirmatory factor analysis indicated a satisfactory model fit (χ2 = 812.28, p &lt; 0.001; RMSEA = 0.08). Weak correlations were found between PAID-Peds scores and HbA1c (r = 0.14, p &lt; 0.001). Conclusions: The Spanish PAID-Peds survey is a reliable tool for assessing emotional burden in pediatric T1DM patients. Integrating it into clinical practice may improve early identification of emotional distress, aiding in better diabetes management. Further research should explore its application over time and in intervention studies.

Prevalence of cataract and its associated factors among adult diabetic patients attending at diabetic care clinics in Northwest Ethiopia, 2023

BagroundCataract is a major public health concern and the leading cause of blindness and low vision in Ethiopia. However, no studies have been conducted to assess the prevalence of cataract and associated factors among adult diabetic patients in the study area. Therefore, this study aimed to assess the prevalence of cataract and associated factors among adult diabetic patients in Northwest Ethiopia.MethodsA multicenter cross-sectional study was conducted in Northwest Ethiopia from May 8 to June 8, 2023. A systematic random sampling technique was used to select study subjects. Data were collected through an in-person interview and physical examination. The data were imported to Kobo Toolbox version 2022 4.4 and exported to Stata version 14. A binary logistic regression was carried out to identify factors associated with cataract, and the strength of association was determined by adjusted odds ratio. A variable with a P-value of < 0.05 at a 95% confidence interval was considered a significant factor for cataract.ResultsThe study included 1100 study subjects with a median age of 52 years. The prevalence of cataract was 42.2% (95%CI: 39.1-45.1%). Older age (AOR = 9.73, 95% CI: 5.53–17.13), ≥ 10 years duration of diabetic mellitus (AOR = 2.77, 95% CI: 1.96–3.90), poor glycemic control (AOR = 1.96, 95% CI: 1.40–2.74), and proliferative diabetic retinopathy (AOR = 4.14, 95% CI: 2.04–8.40), were factors significantly associated with cataract.ConclusionsThis study revealed a high prevalence of cataract among adult diabetic patients. Older age, longer duration of diabetes mellitus, poor glycemic control, diabetic retinopathy, and proliferative diabetic retinopathy had statistically significant associations with cataract. Therefore better controlling blood sugar levels will reduce the development of cataract. Regular screening of their eye will be also recommended to reduce visual impairment and blindness due cataract.

Prevalence of depressive symptom and its associated factors among epilepsy patients in Amhara region, Ethiopia: cross-sectional study

BackgroundDepressive symptom is the most common type of psychiatric co-morbidity among persons with epilepsy. Epilepsy patients are identified as at higher risk of suffering depressive symptom explicitly in low- and middle-income countries due to poor mental health care systems and financial burdens. The co-occurrence of depressive symptom among epilepsy patients deteriorates the prognosis of the disease and diminishes the quality of life of both the patients and their families. However, there is limited evidence on the prevalence of depressive symptom and associated factors in Ethiopia. Therefore, this study is intended to assess the prevalence of depressive symptom and associated factors among epilepsy patients attending in Amhara region, Ethiopia.MethodA multi-center institution-based cross-sectional study was done among epilepsy patients attending at Amhara region, Ethiopia. The Hospital Anxiety Depression tool was used to assess depressive symptom. To determine the factors associated with depressive symptom, a binary logistic regression model was used. Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported in the multivariable binary logistic regression analysis.ResultsAbout 406 participants were registered in the study with a response rate of 97.6%. The prevalence of depressive symptom among epilepsy patients was 53.9% [95%CI: 49.1%, 58.8%]. In the multivariable binary logistic regression analysis, taking polytherapy treatment [AOR = 1.87, 95% CI: 1.04, 3.36], perceived stigma [AOR = 5.73, 95%CI: 3.11, 10.55], poor antiepileptic medication adherence [AOR = 3.33, 95%CI: 1.30, 8.54] and having poor [AOR = 5.83, 95%CI: 2.44, 13.90] and moderate social support [AOR = 3.08, 95%CI: 1.34, 7.09] were significantly associated with depressive symptom.ConclusionsThis study revealed that the magnitude of depressive symptom among epilepsy patients in Ethiopia was relatively high and multiple factors determined the likelihood of depressive symptom. Thus, healthcare providers and concerned stakeholders should strengthen comprehensive health education to reduce the magnitude and consequences of depressive symptom among this segment of the population. Moreover, strong social support with special attention should be given to epilepsy patients.

Comprehensive Clinicopathological Analysis of Oral Reactive Hyperplastic Lesions Diagnosed in Libyan Population: Cross-Sectional Multicentric Study

Oral reactive hyperplastic lesions (ORHLs) are non-neoplastic tumor-like hyperplasia frequently developing in the oral mucosa due to chronic inflammation caused by many low-grade irritations. They are relatively common, and their clinical appearance resembles neoplastic proliferations. This study aims to determine the prevalence and distribution of ORHLs based on WHO's head and neck tumor classification (2022) in the Libyan population over the last 20 years and compare the results with previous literature. In this retrospective study, all the records of histologically diagnosed ORHLs between 2002 and 2023 collected from the Tripoli University Hospital and Saray Salam Center in Tripoli, Libya, were reviewed. Information regarding the age at diagnosis, gender, site affection, and histopathological diagnosis was extracted and analyzed using SPSS statistical software (V.26) using the Chi-square test. ORHLs constituted 14.5% of the total diagnosed cases (335/3210) in registered oral and maxillofacial biopsies. Pyogenic granuloma (PG) was the most common type of ORHL (48%) followed by irritational fibroma (IF) (30%), and peripheral giant cell granuloma (PGCG) (8%). The peak incidence of ORHLs was in the third and fourth decades (37.6% and 32.8% retrospectively), with an overall age at onset of diagnosis (Mean ± SD 36.4±7). The relationship between the age categories and ORHLs was statistically significant (P=0.03). Female predominance was found in all lesions with a ratio (2:1). Gingiva was the most prevalent anatomical location for ORHLs, accounting for 31% of cases. There have been some similarities and inconsistencies between our findings and previous studies involving various populations. We found a clear geographic difference in the relative incidence of oral reactive lesions in each Libyan governorate. The occurrence of ORHRLs in different nations can be retrospectively evaluated to improve knowledge of ORHLs, which is critical for pathologists and oral and maxillofacial surgeons.

Factors influencing antiretroviral therapy switching in people with virologically suppressed HIV-1: a cross-sectional multicenter study in France.

In France, over 90% of people living with HIV-1 (PLWH) achieve virological suppression with effective combination of antiretroviral therapies (ART), but limited data exist on the motivation for switching ART. To describe the reasons and determinants for switching ART, with a particular focus on doravirine-based regimens, in routine clinical practice in France. This analysis of cross-sectional baseline data is part of the DoraVIH study, a French, multicenter (15 sites), two-step observational cohort study that includes prospective follow-up for a subset of participants. Eligible participants were PLWH under ART regimen, virologically suppressed for at least 6-months, doravirine-naïve and switching ART regimen. Sociodemographic and clinical data, ART history, and reasons for switching ART were assessed at baseline. Inclusions occurred between December 13, 2021 and September 21, 2022. Of the 291 PLWH included whose data were analyzed, 143 switched to doravirine-based regimen (DOR PLWH) and 148 to another combined regimen (non-DOR PLWH). Mean age was 51.6 years and 206 participants (70.8%) were men. At baseline, 35 (25.0%) DOR PLWH and 15 (10.6%) non-DOR PLWH had Body Mass Index (BMI) ≥30 kg/m2 (p = 0.007). The most common reasons for switching were treatment simplification, tolerability and drug-drug interactions, accounting for 79.7% of all reasons. Among the 68 participants with prior tolerability issues, 47 (69.1%) switched to doravirine-based regimen. Primary reasons for switch were treatment simplification and tolerability. Participants with obesity were more likely to switch to doravirine, reflecting physicians' favorable perception of doravirine potential benefits, particularly in managing weight gain.

Assessing neonatal nurses: transitioning preterm infants to oral feeding - a multicenter cross-sectional study

BackgroundIn Egypt, approximately 10% of preterm deliveries occur between 32 and fewer than 37 weeks, leading to high neonatal intensive care unit (NICU) admissions. Preterm infants often face oral feeding difficulties due to immature development, which can lead to extended hospital stays and increased health risks.AimTo assess neonatal nurses’ performance in terms of the transition to oral feeding in preterm infants, focusing on knowledge, practices, and attitudes.MethodsA descriptive, quantitative, multicenter, cross-sectional study was conducted across 16 hospitals in five governorates in Egypt from November 2023 to March 2024 involving 553 neonatal nurses. The data were collected through a self-administered questionnaire assessing knowledge and attitudes and through an observed checklist for nurses’ practices. The study used statistical methods, including binary logistic regression, to analyze the data.ResultsThe findings revealed significant knowledge gaps among nurses, particularly in terms of oro-motor function, suck-swallow-breathe patterns, and nonnutritive sucking. A total of 64.6% of the nurses had unsatisfactory knowledge, 58.6% had unsatisfactory practices, and 45% had a negative attitude toward the oral feeding transition. Key predictors of satisfactory practices included higher education levels, full-time employment, and positive attitudes.ConclusionThis study highlights critical gaps in neonatal nurses’ knowledge and practices regarding the transition to oral feeding in preterm infants. Addressing these gaps through targeted educational interventions and ongoing support is essential for improving care quality and outcomes for infants. The findings revealed that a substantial proportion of nurses lacked adequate knowledge of critical areas, such as oro-motor function, the suck-swallow-breathe pattern, and nonnutritive sucking. These knowledge deficits could hinder the ability of nurses to provide optimal care during this crucial transition.

Modifiable Health Behaviours in Children with HCM: Lessons from the Heart Health Survey.

Obesity factors into hypertrophic cardiomyopathy (HCM)-related risk as a disease modifying environmental factor. Behaviours such as diet and sleep are seldom reported upon in children with HCM. It was our aim to report on these factors in this population. A multicenter cross-sectional study recruited children and teens with HCM aged 10-19years old from 10 Canadian pediatric care sites. Patient demographics were obtained from review of medical charts. Participants completed the Healthy Hearts Survey, involving 92 questions related to family health history, personal health, smoking, nutrition, and physical or sedentary activity. A cohort of n = 56 patients with median (IQR) age of 15.5 (13.8-16.8) years were enrolled. Over half (53.6%) were classified as overweight or obese based on BMI, with 75% under activity restriction. Consumption of sugar-rich and starchy foods alongside skipping of meals (43.6%) and snacking (87.5%) were reported. A desire to lose weight was prevalent (48.2%) despite general perceptions of good health. Participants slept a median duration of 8 (7.4-9.0) hours on weekdays, however, sleep disturbances were widely reported. A majority (96.4%) reported less than 20min of exercise per day over the course of the week. Unhealthy patterns regarding diet, sleep, and physical or sedentary activities that associate with cardiovascular risk are present within children with HCM. These habits may worsen disease burden in children with HCM. It is unclear how activity restriction factors into such patterns. There are modifiable lifestyle factors in children with HCM which, if addressed, could positively impact cardiovascular risk.

Relationship Between Clinical Decision-Making and Moral Distress in Neonatal Intensive Care Unit Nurses: A Multicenter Cross-Sectional Correlational Descriptive Study.

In the neonatal intensive care unit (NICU), nurses care for premature and critically ill neonates, interact with parents, and make clinical decisions regarding the treatment of neonates in life-threatening conditions. The challenges of managing unstable conditions and resuscitation decisions can cause moral distress in nurses. This study aims to determine the relationship between clinical decision-making and moral distress in NICU nurses. This cross-sectional, multicenter, descriptive correlational study involved 190 nurses working in 7 NICUs across hospitals in Khorramabad and Semnan in 2023. Data were collected using demographic questionnaires, the Clinical Decision-Making Laurie Scale (2001), and the Moral Distress Scale-Revised (MDS-R). All nurses in these NICUs were female. No significant correlation was found between clinical decision-making and moral distress (r=-0.03, P =.684). The moral distress score was low. In decision-making, 57.9% of nurses exhibited intuitive analysis (understanding without a rationale). Multiple linear regression analysis revealed that age, education level, and job position were significantly related to clinical decision-making; and being married and having children were inversely correlated with moral distress. 20% of nurses exhibited interpretive intuitive clinical decision-making, which involves care complexities, cognitive understanding, and task-based decisions. Nursing managers should focus on refining these decision-making strategies for NICU nurses. Given the importance of clinical decision-making in the NICU, future research should use quantitative and qualitative methods to explore the decision-making processes and moral distress in NICU nurses.

Prevalence of delirium in German nursing homes: protocol for a cross-sectional study

IntroductionDelirium is a neuropathological syndrome that is associated with several negative outcomes. Nursing home residents are vulnerable to developing delirium. Valid prevalence data and associated factors are not yet available...

"Evaluating clinical guidelines for chronic disease management: do they enable the personalization of care?”

To described how general practitioners (GPs) personalize interventions for patients with chronic diseases and compare practice with the corresponding guidelines. Scoping review followed by a multicentre cross-sectional study in French general practices. We identified elements of personalization described in guidelines related to diabetes, hypertension, dyslipidaemia, insomnia and depression. Then, GPs completed questionnaires for pharmacological (PI) and non-pharmacological interventions (NPI) after any consultation for these diseases to collect: when, on which the variables (clinical, biological characteristics, etc.), how and by whom the interventions were personalized, and what was personalized in the interventions. Agreement between GPs' practices and guidelines was analyzed using Cohen's Kappa. We extracted 204 elements of personalization in 10 guidelines, and GPs described 1512 elements of personalization in 161 PI and 1313 elements in 131 NPI. Personalization was mainly based on patients' general characteristics (20.6% of PT; 24.8% of NPI) and treatments characteristics (14.5% of PI; 9.8% of NPI). GPs accounted for patients' preferences in 64.6% of PI and 79.4% of NPI. For PI, the agreement between GPs and guidelines was globally low (kappa=0.21[0.11; 0.31]) but moderate for treatment characteristics (kappa=0.48 [0.09; 0.87]) and high for disease characteristics (kappa=1.00[1.00; 1.00]). For NPI, agreement was globally very low (kappa=0.16[0.10; 0.25]) but moderate for treatment characteristics (kappa=0.59[0.19; 1.00]) and disease characteristics (kappa=0.48[0.12; 0.87]). Guidelines insufficiently described the tailoring variables and the subsequent modifications of the interventions. They need to be better described to promote a medicine that is both personalized to each patient and homogeneous between physicians.

Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals.

Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.

Higher atherogenic index of plasma is associated with intradialytic hypotension: a multicenter cross-sectional study

Background Patients receiving maintenance hemodialysis (MHD) frequently encounter a drop in blood pressure during dialysis, known as intradialytic hypotension (IDH). The AIP is associated with diseases such as diabetes and cardiovascular events. It remains unclear whether the AIP is associated with IDH. The present study aimed to explore the association between AIP and IDH in MHD patients. Methods In this multi-center cross-sectional study, we included 1946 adult hemodialysis patients from twenty dialysis centers. Patients were divided into four groups based on the AIP quartiles. Linear regression and multiple logistic regression models were used to analyze the relationship between AIP and IDH. Subgroup analyses were further conducted to assess the robustness of the association between the AIP and IDH. Results After adjusting for potential confounding variables, each 1-unit increase in AIP was associated with a 21% increase in the odds of IDH. The odds ratios (ORs) of IDH increased gradually with higher quartiles of AIP compared with the Q1 reference group (Q2: OR, 1.41, 95% CI: 0.91-2.18; Q3: OR, 1.63, 95% CI: 1.07-2.49; Q4: OR, 1.57, 95% CI: 1.01-2.42). No interaction was observed in the subgroup analysis stratified by age, sex, history of diabetes, heart failure, and myocardial infarction. Conclusion Elevated AIP levels are associated with a heightened risk of IDH in MHD patients.

Exploring the Knowledge, Attitudes, and Practices of Critical Care Nurses in Iran towards Pressure Ulcer Prevention

Background Pressure ulcers (PUs) pose a significant health problem that can be prevented in various healthcare settings, particularly in intensive care units (ICUs). PU increases the risk of morbidity and mortality and is associated with poor prognosis in ICU patients. ICU prevalence rates for PU have been estimated to range from 21% to 39.3% worldwide (Coyer et al., 2022). According to a recent meta-analysis, the prevalence of PU in Iran's ICUs was 19.59% (Sohrabi Akhkand et al., 2020). Despite these alarming facts, PU is often preventable with adherence of healthcare providers to evidence-based PU prevention guidelines. One of the most important factors influencing PU prevention is adequate knowledge of ICU nurses to evaluate and manage risk factors and implement preventative approaches (Wu et al., 2022; Ghorbani Vajargah et al., 2023). Aims This study aimed to examine the knowledge, attitudes, and practices (KAP) of ICU nurses towards PU prevention in Iran. Methods In a multicenter cross-sectional study, after approval from institutional ethics committee (IR.MAZUMS.REC.1399.591) and written informed consent, 183 ICU nurses working in four hospitals affiliated with Mazandaran University of Medical Sciences in Sari, Iran, were evaluated. The study was carried out between July and October 2020. Data collection involved a four-part questionnaire consisting of demographic characteristics, the Pieker Pressure Ulcer Knowledge Test (PPUKT), the Attitude toward Pressure Ulcer Prevention (APUP) tool, and an assessment of nurses' practices related to PU prevention. Results The mean age of participants was 32.82 (SD = 5.93) years and the mean years of working experience was 8.26 (SD = 6.02) years. Of the nurses, 56.2% were female, 63.4% were married, 87.4% were residents in an urban area, and 76.5% had a BSN degree. The mean scores for ICU nurses' KAP regarding PU prevention were 70.57 (SD = 13.51), 52.82 (SD = 6.16), and 22.44 (SD = 5.20), respectively. As presented in Table 1, a positive correlation was observed between nurses' attitudes and their practices (r = 0.232, P = 0.002), while a negative correlation was found between their knowledge and attitudes (r = -0.156, P = 0.035) towards PU prevention. Also, the results showed a positive correlation between the years of ICU work experience among nurses and their knowledge of PU prevention (r = 0.159, P = 0.032). The same result was also observed for the overall years of working experience, although this correlation was marginally significant (r = 0.145, P = 0.051). Based on a one-way ANOVA, there was a direct relationship between knowledge and income, and knowledge were higher in high-income nurses (P = 0.017). Table 1: Means, Standard Deviations, and correlations among study variables. Descriptive statistics Correlational analysis Possible range Observed range Mean (SD) Knowledge Attitude Practice Knowledge 0-100 39.02-100 70.57 (13.51) 1 Attitude 0-100 32.69-67.31 52.82 (6.16) -0.156 1 Practice 0-44 10-37 22.44 (5.20) -0.119 0.232 1 Conclusion The findings of this study indicate that the KAP levels of Iranian ICU nurses regarding PU prevention were desirable, positive, and relatively desirable. Therefore, it is recommended that nurse managers and policy makers address the major barriers and related factors that may affect ICU nurses' practices in preventing PUs.

Dietary nutrient intake and nutritional status in maintenance hemodialysis patients: a multicenter cross-sectional survey

Purpose To investigate the dietary nutrient intake of Maintenance hemodialysis (MHD) patients, identify influencing factors, and explore the correlation between dietary nutrient intake and nutritional and disease control indicators. Methods This was a multicenter cross-sectional study. A dietary survey was conducted using a three-day dietary record method, and a self-designed diet management software was utilized to calculate the daily intake of dietary nutrients. The nutritional status and disease control indicators were assessed using subjective global assessment, handgrip strength, blood test indexes, and dialysis adequacy. Results A total of 382 MHD patients were included in this study. Among them, 225 (58.9%) and 233 (61.0%) patients’ protein and energy intake did not meet the recommendations outlined in the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Nutrition in Chronic Kidney Disease (2020 update). The average protein and energy intake for these patients were 0.99 ± 0.32 g/kg/d and 29.06 ± 7.79 kcal/kg/d, respectively. Multiple linear regression analysis showed that comorbidity-diabetes had a negative influence on normalized daily energy intake (nDEI = DEI / ideal body weight) (B = −2.880, p = 0.001) and normalized daily protein intake (nDPI = DPI / ideal body weight) (B = −0.109, p = 0.001). Pearson correlation analysis revealed that dietary DPI (r = −0.109, p < 0.05), DEI (r = −0.226, p < 0.05) and phosphorus (r = −0.195, p < 0.001) intake were statistically correlated to Kt/V; dietary nDPI (r = 0.101, p < 0.05) and sodium (r = −0.144, p < 0.001) intake were statistically correlated to serum urea nitrogen; dietary DPI (r = 0.200, p < 0.001), DEI (r = 0.241, p < 0.001), potassium (r = 0.129, p < 0.05), phosphorus (r = 0.199, p < 0.001), and fiber (r = 0.157, p < 0.001) intake were statistically correlated to serum creatinine; dietary phosphorus (r = 0.117, p < 0.05) and fiber (r = 0.142, p < 0.001) intake were statistically correlated to serum phosphorus; dietary nDPI (r = 0.125, p < 0.05), DPI (r = 0.135, p < 0.05), nDEI (r = 0.116, p < 0.05), DEI (r = 0.125, p < 0.05), potassium (r = 0.148, p < 0.001), and phosphorus (r = 0.156, p < 0.001) intake were statistically correlated to subjective global assessment scores; dietary nDPI (r = 0.215, p < 0.001), DPI (r = 0.341, p < 0.001), nDEI (r = 0.142, p < 0.05), DEI (r = 0.241, p < 0.001), potassium (r = 0.166, p < 0.05), phosphorus (r = 0.258, p < 0.001), and fiber (r = 0.252, p < 0.001) intake were statistically correlated to handgrip strength in males; dietary fiber (r = 0.190, p < 0.05) intake was statistically correlated to handgrip strength in females. Conclusions The dietary nutrient intake of MHD patients need improvement. Inadequate dietary nutrient intake among MHD patients could have a detrimental effect on their blood test indexes and overall nutritional status. It is crucial to address and optimize the dietary intake of nutrients in this patient population to enhance their health outcomes and well-being.

Prevalence and associated factors of adolescent psychological abuse, neglect in Western China a multi-center cross-sectional study

ABSTRACT Background: The western region of China has a dense population, relatively underdeveloped economy, and a significant number of left-behind children. Currently, the prevalence of adolescent psychological abuse, neglect, and the factors associated with these issues in the region remain unclear. This study aims to evaluate the current status of adolescent psychological abuse and neglect and its associated factors in this region. Methods: Data were collected from 50 schools in western China through cluster sampling to target adolescents aged 12 to 18. A comprehensive survey form was used to collect socio-demographic characteristics of adolescents. The Child Psychological Abuse and Neglect Scale was employed to assess the current psychological abuse and neglect of adolescents. Independent samples t-tests were used for inter-group comparisons. A Directed Acyclic Graph was constructed for controlling confounding variables. Subsequently, binary logistic regression analysis was performed, and a nomogram risk factors model was developed using R Studio. Results: This study included 12,743 teenagers, with an average age of 15.53(±1.39) years. Among them, 4,965 individuals, accounting for 39.0%, reported experiences of psychological abuse, while 4,167 individuals, accounting for 32.7%, reported experiences of neglect. The rates of psychological abuse and neglect in adolescents are influenced by gender, grade, left-behind experience, parental marital status, and living on campus (P < .05). Conclusion: Adolescents in western China exhibit higher rates of psychological abuse and neglect compared to those in the eastern and northern regions of China. Gender, grade, left-behind experience, and family factors significantly influence the psychological abuse and neglect of adolescents.

Prevalence and associated factors of glomerular hyperfiltration among adult stable sickle cells in Kinshasa, DR Congo

Introduction Glomerular hyperfiltration is highly frequent, theoretically dependent on cardiac output, low systemic vascular resistance and hemolysis markers. In sickle cell disease (SCD), hyperfiltration is an extremely common phenomenon and occurred in young and early adult patients. Despite the fact that the glomerular hyperfiltration is known as the early manifestations of sickle cell nephropathy, its burden among adult sickle cell disease in sub-Saharan is poor studied. This study aimed to determine the prevalence and associated factors of hyperfiltration Methods This was an analytical multicentric cross-sectional study involving stable adult sickle cell patients in Kinshasa, recruited between March and October 2023. Parameters of interest encompasses demographic, clinical, biological, echocardiographic and pulse wave measurement data. Hyperfiltration was defined using the CDK-EPI equation based on cystatin C; eGFR >130 for women and >140 ml/min/1.73m2 for men. We used multivariate logistic regression analysis to search determinants of glomerular hyperfiltration. Results Two hundred and fourty six (246) patients with SCD were enrolled. The prevalence of hyperfiltration was 20.7%. In multiple logistic regression analysis, hyperfiltration status was independently associated with age (< 25 years) [3.57 (1.78-7.49); p = 0.027)], female sex [4.36 (2.55-5.62); p = 0.031), CRP (< 6 mg/l) [0.77 (0.61-0.97); p = 0.028)], central systolic pressure (< 100 mmHg) and central diastolic pressure (< 60 mmHg) [0.86(0.74-0.98), p = 0.028)], [(0.83 (0.71-0.98); p = 0.032)]. Conclusion One out of five SS adults exhibits hyperfiltration, which is associated with young age and female sex, whereas low CRP and blood pressure were negative risk factors.

The association Malnutrition-Inflammation Score with chronic kidney disease-associated pruritus and quality of life in hemodialysis patients: a multicenter cross-sectional study

Malnutrition is prevalent among hemodialysis patients, negatively impacting their quality of life (QoL) and chronic kidney disease-associated pruritus (CKD-aP). This study investigates the association between the Malnutrition-Inflammation Score (MIS) and CKD-aP, as well as QoL, in hemodialysis patients. This cross-sectional study was conducted on 479 HD patients (279 males and 200 females) referred to eight dialysis centers. A food frequency questionnaire (FFQ), Kidney Disease Quality of Life Short Form (KDQOL-SF™), and Yosipovitch Itch Questionnaire (YIQ) were used to assess nutritional status, QoL, and CKD-aP, respectively. Anthropometric indices, body mass index (BMI), biochemical parameters, and adequacy of dialysis (Kt/V) were also measured in all patients. Significant differences were observed across MIS quartiles in terms of age, dialysis vintage, dialysis time, and urine volume (p < 0.05 for all). QoL scores showed significant differences, with the physical component score and symptoms/problems score being lower in higher MIS quartiles (p < 0.05 for all). Multivariate analyses revealed that higher MIS quartiles were significantly associated with worse QoL scores, including symptoms/problems and physical component scores, even after adjusting for confounders (p < 0.05 for all). Moreover, the pruritus VAS score, as well as the burden of kidney disease and mental component, had a significant negative association with MIS after adjusting for confounders (p < 0.05 for all). This study demonstrates that higher MIS, indicating poorer nutritional status, is associated with impaired QoL, particularly in the symptoms/problems, physical, and mental components among hemodialysis patients. However, no significant association was found between MIS and CKD-aP.