Multicenter Cross-sectional Study Research Articles

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.

Determinants of Sexual Dysfunction in Parkinson's Disease Patients: A Secondary Analysis of a Multicenter Cross-Sectional Study.

Background: Sexual dysfunction (SD) in Parkinson's Disease (PD) patients is a common and distressing concern, although it remains an underdiagnosed and undertreated condition. Indeed, the prevalence of SD in PD ranges from 42.6% to 79% in men and from 36% to 87.5% in women. PD-related SD etiology is multifactorial and includes biological, psychological, and socio-relational factors. In a previous multicenter study on 203 PD patients, we found that there was no gender difference in dysfunction severity, although men were significantly more affected by SD than women. Methods: This paper is a secondary analysis of this previous multicenter study, and aims to investigate the potential risk factors that contribute to SD. The relationship between dysfunction and the experimental factors was assessed using Generalized Linear Mixed-Effects (GLME) model. Results: The final analysis was conducted on a sample of 177 patients (76 women), after excluding individuals with incomplete data, non-compliance with inclusion criteria, or delays in assessment tool administration. The analysis, performed using the GLME model (R2 = 0.68), revealed that gender (p = 0.01), age (p = 0.02), and depression status (HAMD) (p = 0.01) were significant predictors of SD. In contrast, other factors considered in the model, such as diabetes, and autonomic symptoms, did not significantly influence SD. Conclusions: This study demonstrates that age, gender, and depression are important predictors of SD in patients with PD. Although SD is a common NMS in PD patients, it is often neglected in clinical practice and the research on this hot topic is still poor. Then, a multidisciplinary approach, including nursing and coaching, is mandatory in order to improve sexual health in this patient population.

Adherence to antihypertensive medications and associated factors in patients with hypertension, Oromia, Ethiopia: a multicenter study

Interventions designed to improve medication adherence, and blood pressure control have not been effective globally. There is limited comprehensive understanding regarding the level of drug adherence to antihypertensive medications in Ethiopia, particularly in the study area. This study aimed to assess adherence to antihypertensive medication and associated factors among patients with hypertension on follow-up at public health facilities of Adama town, Oromia, Ethiopia. A multicenter cross-sectional study was conducted among 402 patients with hypertension from January 1 to February 30, 2022. The objectives of the study were explained to participants in the local language and written informed consent was obtained. The level of adherence was measured by Morisky Medication Adherence Scale. Data were entered into Epidata and exported to Statistical Package for the Social Science for analysis. Bivariable and multivariable logistic regression analyses were conducted to determine associations between independent variables and medication adherence. Adjusted Odds ratios with 95% confidence interval were estimated to assess the strength of associations. Statistical significance was declared at a P-value < 0.05. The proportion of adherence to antihypertensive medication was 63.4% (95% CI: 59.1–66.9). Respondents under the age of 49 years ( (AOR = 2.3, 95% CI: 1.009–5.459), ages 49–59 years (AOR = 3.2, 95% CI: 1.452–7.396), and ages 60–71 years (AOR = 2.7,95% CI: 1.207–6.066), who were married (AOR = 2.1, 95% CI: 1.056–4.19), urban residents (AOR = 3.9, 95% CI: 1.486–10.949), and patients with a monthly income between 5500 and 8249 Ethiopian Birr (AOR = 4.150, CI: 1.083–15.097) were more likely to be adherent to antihypertensive medications. : The adherence to the antihypertensive drug in this study was lower compared to the expected index, 80%. Education and counseling should focus on older age, rural residents, single, and patients with higher monthly incomes.

Anesthetists’ Knowledge, Attitude, and related Factors on Patient Safety in Government Hospitals in Ethiopia a Multicenter Approach

In the field of healthcare, ensuring patient safety is a critical priority that has garnered global recognition as a pressing public health concern. Despite notable progress in medical treatments and diagnostic technologies, patients continue to be at risk of adverse events and harm during the perioperative period. Anesthetists hold a pivotal position in this phase of patient care and have the potential to greatly impact safety and outcomes. This research sought to assess the knowledge, attitudes, and influencing factors of anesthetists concerning patient safety in government referral hospitals situated in Addis Ababa, Ethiopia. Between January and June 2021, a multi-center cross-sectional study was conducted in 13 governmental referral hospitals located in Addis Ababa. Data were collected using a standardized and pre-tested self-administered questionnaire. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) software version 24.0. The variables and their associated factors were examined for their association with logistic regression, and significance was determined at a P-value of less than 0.05. Of the anesthesia professionals surveyed, 238 (86.86%) completed the questionnaire. The study revealed that over half of the participants had good knowledge (56.7%) and a positive attitude (68.9%). Factors significantly associated with patient safety knowledge included having patient safety information during continuing education [AOR = 4.016; 95% CI: (1.99–8.07)] and having a working experience of more than 15 years [AOR = 3.9; 95% CI: (1.23–12.29)]. Additionally, those who received patient safety training [AOR =2.0; 95% CI: (1.2–3.64)] were more likely to have a positive attitude than those who did not receive such training. The study found that a majority of Ethiopian anesthetists hold a favorable view toward patient safety, with 56.7% demonstrating good patient safety knowledge and 68.9% exhibiting a favorable attitude toward patient safety. Work experience, continuous education, patient safety training, and strong knowledge were identified as crucial factors in ensuring patient safety.Therefore, it is recommended that anesthesia professionals participate in educational programs and receive training in patient safety to address these concerns.

Assessing patient satisfaction with hemodialysis and peritoneal dialysis care and associated factors in Iran.

With the increasing demand for dialysis, there is a growing emphasis on patient-centered care. This study investigated patients' satisfaction levels with peritoneal dialysis (PD) and hemodialysis (HD) care in Iran. A cross-sectional multicenter study was conducted among 346 patients with chronic kidney disease (CKD) covered by the Iran Health Insurance Organization who received dialysis services from October to December 2022 across the country. Data were gathered using a self-made questionnaire through telephone interviews. Data analysis included descriptive statistics, t tests, ANOVA, and linear logistic regression using R software. Patients reported high satisfaction with doctors and nurses, health care facilities, and costs. PD patients had higher overall satisfaction (P < 0.001) and were more satisfied with costs (P < 0.001), while HD patients reported greater satisfaction with doctor and nurse behavior (P = 0.012). Significant factors associated with satisfaction included marital status (P = 0.012), insurance coverage duration (P = 0.027), dialysis type (P < 0.001), and time to dialysis initiation (P = 0.027). Doctor and nurse behavior had the greatest impact on satisfaction (P < 0.001). While patients were generally satisfied with the care provided, the findings revealed areas for improvement, particularly regarding the availability of medical centers and costs among dialysis patients. Focusing on patient education, communication, and supportive insurance policies has the potential to significantly enhance patient satisfaction and improve quality of life for dialysis patients.

Predictors of Mortality in Acute Kidney Injury in Elderly Patients Admitted to Geriatrics Intensive Care Unit in Egypt: A Prospective Cross-Sectional Study

Background: Acute kidney injury (AKI) is a major problem in critically ill elderly patients in intensive care units (ICUs). It increases their morbidity, mortality, and length of ICU stay. Objective: This study aims to determine the prevalence of AKI, the factors associated with increased mortality of AKI patients, and the impact of AKI on ICU outcomes. Methods: This was a multistage cross-sectional study followed by a cohort study. Included 210 patients who were admitted to the geriatric ICU. We included the elderly aged 60 and more, and we excluded patients on regular dialysis, renal transplantation, and patients who died within the first 24 hours of admission. Results: 210 elderly patients were included in the study. The prevalence of AKI was 53.8%. Overall, in-hospital mortality was 46.2%. Mortality was higher in the AKI group compared to the non-AKI group (61.9% vs. 27.8%, p=0.001). 22.1% of patients needed renal replacement therapy. Mortality for this RRT group was 84%. In multivariable analysis, chronic kidney disease (CKD), KDIGO staging III, Acute Physiology and Chronic Health Evaluation (APACHE) II, septic shock, and diabetes (DM) were independent predictors of mortality. Conclusions: AKI is common in ICU patients. Most patients were having community-acquired AKI. Chronic kidney disease (CKD), serum creatinine at AKI diagnosis, KDIGO staging III, acute physiology and chronic health evaluation (APACHE) II, septic shock, and diabetes (DM) were independent predictors of mortality.

Domestic and external violence, parental neglect, and social sanctions among crack users: A cross-sectional study exploring the role of gender.

Substance Use Disorders are often associated with significant levels of domestic and external violence registered among abusers. This investigation aimed to evaluate the Domestic Violence Involvement (DVI) and related gender differences among Crack Cocaine Users in Brazil. For this purpose, a secondary data analysis of a multicenter cross-sectional study involving 780 Crack Cocaine Users from 6 Brazilian capitals was performed. The prevalence of DVI among abusers was not different between males and females. Crack-cocaine users with DVI versus without DVI experienced significantly more aggressions and beatings as victims throughout their life (54.7% vs. 40.5%), showed greater difficulty in controlling the impulse to assault or hurt someone throughout their life (65% vs. 36.4%), higher number of physical aggressions (25.9% vs. 11.6%), car theft (27.3% vs. 16.9%), violent crimes (12.9% vs. 6.2%). Men also reported a higher prevalence of detentions/arrests (61%) than women, while women were more frequently charged over their parental powers than men. Our findings suggested that DVI in Crack-Cocaine users may be a potential predictor of social violence in general with no significant differences between males and females. Legal punishments remain related to the cultural role assigned to each gender with men being more likely to be detained in their lives and women being reported more for parental neglect.

Current status and factors associated with sexual harassment among operating room nurses: a multi-center cross-sectional study.

The purpose of this study was to investigate the prevalence of sexual harassment among operating room nurses, and to analyze the influencing factors. Sexual harassment in the healthcare field has a high incidence and nurses are the main victims; sexual harassment not only leads to physical and mental problems, but also undermines nurses' performance and affects the quality of medical care. A multi-center cross-sectional study was conducted using an online survey to investigate the sexual harassment experiences of 483 operating room nurses. The survey included demographic information, personality traits (Ten-Item Personality Inventory), sexual harassment experiences (Workplace Sexual Harassment Questionnaire), negative consequences, coping strategies, and social support status. 63% of operating room nurses experienced sexual harassment in the past 12 months, with gender harassment predominating (56.7%), followed by unwanted sexual attention (28.6%) and sexual coercion (13.6%). Surgeons (81.20%) and married ones (66.7%) were the most common perpetrators. Most victims possess limited knowledge regarding sexual harassment laws and exhibit weak awareness of their rights protection. 47.8% remained silent after being sexually harassed; most of nurse employed passive coping strategies. Sexual harassment had the most prominent impact on the work of operating room nurses, mainly in the form of decreased work quality and efficiency (87.3%), as well as decreased work engagement (77.0%) and negative workplace pressure experience (72.2%); emotional disturbances, such as anxiety (76.6%), stigma (71.8%), and fear (71.5%); and was accompanied by sleep disorders (74.9%), headaches (56.0%) and nausea and vomiting (54.3%); as well as reduced trust in the opposite sex (83.8%) and disruption of family life (82.1%).Only 39.2% of the hospitals had sexual harassment reporting channels or methods, 30.7% had departments to deal with sexual harassment in the workplace, and 46.8% had communication discussions about psychological safety after sexual harassment. Personality traits, drinking behaviour, age, marriage, and social support were associated with sexual harassment behavior in the operating room. The high incidence of sexual harassment in the operating room affects nurses' productivity and physical and mental health. Operating room nurses had insufficient legal knowledge about sexual harassment and lacked hospital organizational support. agreeableness and openness personality traits, alcohol consumption, age, being married, and lack of social support were influential factors of sexual harassment in the operating room. Healthcare organizations should encourage reporting, care for victims, and join with the police department, judiciary, and women's federation to develop reporting procedures and training programs on sexual harassment knowledge to create a safe and comfortable professional environment.

Prevalence of meconium-stained amniotic fluid and factors associated with emergency cesarean section: multicenter cross-sectional study in south central Ethiopia

BackgroundMeconium is thick black-green fetal intestinal content starting from the early first trimester of gestation. Unfortunately, if it is released into the amniotic cavity due to any cause, it can be associated with neonatal mortality and morbidity.ObjectiveTo identify the factors associated with meconium-stained amniotic fluid among mothers undergoing emergency cesarean section in specialized hospitals cross-sectional study in south central Ethiopia from August 1, 2022, to 30, October 2022MethodInstitution based multicenter cross-sectional study was done prospectively through meticulous chart review and interview on 875 mothers who gave birth with emergency cesarean section. Data were entered using Epi data 7 and analyzed with SPSS 26. The association between independent variables and meconium-stained amniotic fluid was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at P-value &amp;lt; 0.05ResultThe prevalence of meconium-stained amniotic fluid is 31.4%. Gravidity (AOR 3.643; 95% CI:1.215,10.921), time interval between decision to delivery (AOR 1.361; 95% CI: 0.424,4.365),eclampsia(AOR 8.022; 95% CI: 1.634,39.372), time taken from referring institution to managing institution (AOR 15.258; 95% CI: 1.591,146.328), obstructed labor (AOR 24.614; 95% CI: 6.073,99.766), cephalopelvic disproportion (AOR 2.640; 95% CI:1.002,6.950), fetal heart beat abnormality (fetal bradycardia AOR 2.068; 95%CI 0.997,4.292) (fetal tachycardia AOR 3.513; 95% CI:1.633,7.556) duration of labor(AOR 5.44; 95% CI: 1.355,9.782) and referral from health center(AOR 5.41; 95% CI: 2.053,14.272) are associated with MSAF whereas obstetric complications(AOR 6.820; 95% CI: 2.870,16.202), cesarean section scar (AOR 3.010; 95% CI: 1.344,6.740) are negatively associated.ConclusionPrevalence of meconium-stained amniotic fluid is relatively high for which intrapartum, obstetric and institution related factors are incriminated. Therefore, an improvement in the quality of antenatal and intrapartum care is strongly recommended; professional development at the health center, building the infrastructure, and strengthening the referral system is also suggested.

Mediating role of anxiety between body image distress and quality of life among women with polycystic ovary syndrome: a multicentre cross-sectional study

BackgroundPolycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Body image distress (BID) refers to psychological distress caused by deviations in the individual’s self-aesthetic ability. The objectives of this study are to investigate the prevalence of psychological distress; and to assess the role of anxiety in the relationship between body image distress and quality of life (QoL) among women with polycystic ovary syndrome using a path analysis approach.MethodA multi-center cross-sectional study design was conducted among 294 women with PCOS in 29 provinces in mainland China from July 2021 to December 2021, and the data were analyzed using path analysis. The Multidimensional Body-Self Relations Questionnaire-Appearance Scales, Modified Polycystic Ovary Syndrome Questionnaire, and Hospital Anxiety and Depression Scale were administered to women who gave informed consent to participate.ResultThe results of path analysis are indicated that anxiety significantly mediated BID and QoL in women with PCOS (p < 0.05) and the structural equation model analysis further confirmed the statistical significance of this mediating effect. The fit indices CFI = 1.00, TLI = 1.00, and RMSEA = 0.00, indicating that the model represents the data well. A good fit of the proposed model to the observed data was obtained, which revealed that BID not only directly influenced QoL, but also had a significant indirect effect on QoL via anxiety.ConclusionPsychological counseling clinics is as well needed to provide patients with individualized psychological counseling and avoid mental health problems caused by body image troubles. Anxiety mediated the relationship between BID and QoL, adding to the paucity of research for women with polycystic ovary syndrome.

The Relationship Between Nursing Work Environment and Breastfeeding Prevalence During Child Hospitalization: A Multicenter Study

Background/Objectives: Breastfeeding during pediatric hospitalization is often challenging, especially in a setting where nursing work environments can affect breastfeeding support. This study examines the relationship between nursing work environments and the prevalence of breastfeeding during child hospitalization, focusing on aspects such as nursing workload, stress levels, and quality of work life (QoWL). Methods: A cross-sectional multicenter study was conducted in Italian pediatric hospitals from October 2023 to January 2024. Each ward head nurse completed a form daily for 30 consecutive days to record the number of children breastfed. Nurses’ workload, stress, and QoWL were measured using validated self-report questionnaires. Multivariate regression was employed to examine the associations between organizational variables and breastfeeding prevalence. Results: A total of 256 nurses from low- and medium-intensity pediatric wards completed the survey (86.7% female, mean age = 39.2, SD = 9.96). Nurses reported low stress levels (M = 2.74; SD = 0.54) and a good QoWL (M = 3.03; SD = 0.50) despite high workloads (M = 3.34; SD = 0.95). The breastfeeding prevalence mean was 1.12 (SD = 1.38), which was highest in surgical units. Regression analysis revealed that higher breastfeeding prevalence was associated with nurses’ female gender (β = 0.17), clinical setting, and higher levels of nurses’ QoWL (β = 0.14) (R2 = 0.23; p &lt; 0.001). Conclusions: To enhance breastfeeding support during child hospitalizations, healthcare policies should address workload management, stress reduction, and work–life balance. Future longitudinal research should expand to other clinical settings and include detailed patient data to understand these relationships.

Deciphering the concurrent phenomenon of childhood malnutrition by using the extended composite index of anthropometric failure (ECIAF): facts from the BESLEN project.

To investigate the co-existence of single and multiple anthropometric failures among children using an extended composite index of anthropometric failure (ECIAF). This study aims to elucidate the complex interplay between child-specific and maternal factors, highlighting the multifaceted nature of childhood malnutrition. A multicentre cross-sectional study as part of the BESLEN project. Mother-Child Education Centre in the Pendik district of Istanbul, Türkiye. 1283 children (preschool children, n 822, school-aged children, n 462) and 1044 mothers. Almost 1/3 of the children included in the study had an anthropometric failure as determined by ECIAF. Weight excess was the leading cause of the total anthropometric failures, most of which were observed to be slightly higher in boys, except for stunting only and co-occurrence of stunting and underweight. Among the mother-related factors, including higher BMI and WC, low maternal age at delivery, low number of children in the household, and being a single parent may be considered predisposing factors to any phenomenon of childhood malnutrition. Among child-related factors, birth weight being ≥ 3500 grams had a higher risk for ECIAF failure, and children aged ≥ 60 months were more likely to experience stunting and underweight, while those < 60 months had a higher prevalence of weight excess. The co-existence of stunting and overweight, the occurrence of weight excess in one in three stunted children, and the high risk of central obesity are public health concerns. Also, ECIAF can better assess all aspects of childhood malnutrition than conventional measures.

Status quo and influencing factors of posttraumatic growth of nurses exposed to nurse-to-nurse horizontal violence: a cross-sectional multicenter study

BackgroundPost-Traumatic Growth (PTG) relieves physical and psychological stress symptoms in nurses who exposed to nurse-to-nurse horizontal violence (HV), has great intervention potential to reverse the negative effects of HV events. Therefore, in-depth exploration of the overall characteristics of PTG in HV-exposed nurses and its influencing factors are of great practical significance to provide them with precise psychological adaptive interventions.ObjectiveThis study aims to describe the current state of PTG of HV-exposed nurses and its influencing factors.MethodsThe staged cluster sampling method used to recruit nurses. Nurses completed the Chinese version of the nurse-to-nurse Negative Acts Questionnaire (NAQ-R), the Posttraumatic Growth Inventory-Short Form (PTGI-SF), Colquitt’s Organizational Justice Measure (OJM), Inclusive Leadership Scale (ILS), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Dysexecutive Questionnaire (DEX) and provided their sociodemographic characteristics. Data were collected between February, 2023 ~ March, 2024, and were analyzed using correlation analysis, t-test, ANOVA, and multivariate linear stepwise regression analyses.ResultsThe prevalence of HV within eight tertiary hospitals in Shandong Province amounted to 45.03%. On average, nurses scored 18.30 ± 14.33 in PTGI-SF. There were significant differences in PTGI-SF score according to departments (F = 2.589, p < 0.01), and educational background (F = 4.587, p < 0.01). The results of correlation analysis showed that there was a significant correlation between score in CD-RISC-10 (r = 0.120, p < 0.01), DEX (r=-0.069, p < 0.05), and PTGI-SF. The results of multivariate linear stepwise regression showed that resilience, dysexecutive, educational background, and type of department might be the influencing factors of PTG in HV-exposed nurses (R2 = 0.045).ConclusionsExposure to HV posed a moderate risk for nurses, while PTG levels among HV-exposed nurses were low to moderate. Overall, the current study suggests that educational background, department type, resilience, and dysexecutive were the main factors influencing PTG in HV-exposed nurses. The study found that resilience had a positive effect on PTG, while dysexecutive had a slight negative effect. Consolidation of resilience and alleviation of dysexecutive, while dialectically looking at educational background and department type, is necessary to improve PTG in HV-exposed nurses.

Adherence to Wearing Therapeutic Footwear Among People at High-Risk of Diabetes-Related Foot Ulcers in Jordan.

This study aimed to investigate the levels of adherence to wearing therapeutic footwear, and the factors associated, among people at high-risk of diabetes-related foot ulcers (DFUs) in Jordan. This was a secondary analysis of data from a multi-centre cross-sectional study of participants at high-risk of DFU in Jordan who had therapeutic footwear. Participants had socio-demographic, health, limb, and psychosocial variables collected, plus self-reported their proportion of adherence time wearing therapeutic footwear on an average day (excluding sleeping time) using a visual analogue scale. Participants were categorized into high (≥60%) or low (<60%) adherence levels, plus users (1%-100% adherence) or non-users (0% adherence) of therapeutic footwear. Of 104 included participants (mean age 58 ± 13 years, 68% males), 65 (62.5%) self-reported low adherence levels and 44 (42.3%) as non-users. No variables were independently associated with low adherence levels (P > .05). Whereas participants with lower self-reported foot care outcome expectation scores were independently associated with non-use of therapeutic footwear (P = .05). Most people at high-risk of DFUs in Jordan self-reported low adherence or total non-use of their therapeutic footwear. Perceived low footcare outcome expectations was the only factor found associated with non-use of therapeutic footwear and further research is needed to explore other potential factors.

Prevalence and associated factors of mental health distress among hospitalized patients in general hospitals: a multi-center cross-sectional study in Iran

BackgroundUnderstanding the prevalence of mental distress in hospitalized patients and identifying associated factors can help reduce the burden of mental disorders on their medical management and improve their quality of life. This study aimed to examine the prevalence of mental distress among hospitalized patients in general hospitals and assess its associated factors.MethodsIn this cross-sectional study, we evaluated the mental health status of inpatients in seven cities in Iran, using the General Health Questionnaire-12 (GHQ-12), with a total GHQ-12 score ≥ 4 or higher categorized as “mentally distressed.” Statistical analyses were conducted using independent t-tests, one-way analysis of variance, and cross-tabulations.ResultsA total of 524 patients (347 females) were assessed, with 208 (38.7%) being classified as mentally distressed. The prevalence of mental distress was significantly higher among males (52.0%) compared to females (34.0%) (p = 0.002). There were no significant differences in GHQ-12 scores among different age groups (p > 0.05). Significant differences were observed in mental health status based on job status, with retired (64.7%) and laborer (22.8%) patients showing the highest and lowest rates of mental distress, respectively (p < 0.001). Additionally, mental distress prevalence varied significantly across hospital wards, with internal medicine (47.6%) and obstetrics and gynecology (28.3%) having the highest and lowest prevalence, respectively (p = 0.004).ConclusionsA considerable proportion of patients hospitalized for medical reasons also experience mental distress. Various demographic factors are associated with their mental health status. This highlights the need for integrated mental health assessments alongside medical treatment to alleviate the burden of mental disorders.

Knowledge, attitudes, and practices toward the treatment of endodontic-periodontal lesions among oral health care providers: a multi-center cross-sectional study

BackgroundThis study aimed to evaluate the knowledge, attitudes, and practices (KAP) of oral healthcare providers concerning the treatment of endodontic-periodontal lesions (EPLs) and investigate the relationships among the KAP dimensions using correlation analysis and structural equation modeling (SEM).MethodsThis cross-sectional study enrolled dental healthcare professionals between February 2024 and June 2024, with questionnaire data collected in Hangzhou and Shaoxing, China. Data were collected using a self-administered questionnaire that gathered demographic information and KAP scores.ResultsA total of 281 valid questionnaires were analyzed. Among the participants, 185 (70.08%) were doctors, and 58 (59.85%) had attended relevant academic conferences or training sessions. The mean scores for knowledge, attitude, and practice were 10.06 ± 3.31 (possible range: 0–18), 25.58 ± 2.29 (possible range: 7–35), and 15.70 ± 3.23 (possible range: 5–25), respectively. The SEM revealed that education (β = 0.013, P = 0.013), professional title (β = 0.64, P < 0.001), participation in related research projects (β = -1.84, P < 0.001), and number of patients treated (β = 1.41, P < 0.001) directly influenced knowledge. Knowledge (β = 0.24, P < 0.001) and research participation (β = -0.79, P = 0.026) directly affected attitude. Both knowledge (β = 0.26, P < 0.001) and attitude (β = 0.19, P = 0.023) directly impacted practice. Additionally, education (β = 0.23, P = 0.021), professional title (β = 0.15, P = 0.001), research participation (β = -0.44, P = 0.001), and number of patients treated (β = 0.34, P < 0.001) indirectly influenced attitude, while indirect effects on practice were noted for knowledge (β = 0.04, P = 0.034), education (β = 0.30, P = 0.023), professional title (β = 0.20, P = 0.001), research participation (β = -0.73, P < 0.001), and number of patients treated (β = 0.44, P < 0.001).ConclusionsOral healthcare providers demonstrated limited knowledge, generally positive attitudes, and relatively inactive practices in the treatment of EPLs. To enhance clinical outcomes, targeted educational initiatives and hands-on training should be prioritized to address knowledge gaps and facilitate the translation of positive attitudes into more active and effective clinical practices.

Prevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study.

Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence. To evaluate utilisation of HF pharmacotherapy and prevalence of polypharmacy, adverse drug events (ADEs), falls, delirium, renal impairment and duration of hospitalisation in older inpatients, according to frailty. A retrospective cross-sectional study of the TO HOME cohort of 2000 inpatients ≥75 years admitted for ≥48 h to rehabilitation, geriatricor general medicine from 1 July 2016 to 30 June 2017 across six hospitals in Sydney, Australia. Data were collected from electronic medical records. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification identified HF diagnosis, ADEs and frailty using hospital frailty risk score. Outcomes included utilisation of HF pharmacotherapy; polypharmacy; ADEs, falls, delirium, renal and impairment; and duration of hospitalisation. Among 439 (22.0% of TO HOME cohort) patients with undifferentiated HF, 284 (69.5%) had intermediate or high risk of frailty, and 412 (94%) took ≥1 HF pharmacotherapy, with 357 (81.3%) patients on loop diuretics. Patients with high frailty risk frequently continued beta-blockers (70%) and discontinued renin-angiotensin system inhibitors (57%). Most patients experienced polypharmacy (n = 426, 97.0%). Renal impairment prevalence was 67%-76% across frailty groups. Increasing frailty risk (low, intermediate and high) was associated with increasing prevalence of ADEs (31%, 56% and 84%), falls (12%, 25% and 46%) and delirium (8%, 27% and 49%) and longer hospitalisation. Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.

Are ultrasound salivary parenchymal lesions more severe in primary Sjögren patients with a longer disease duration? A cross-sectional study.

Salivary gland ultrasound (SGUS) has an interest in primary Sjögren's disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset. In this cross-sectional international multicentre study, patients with pSD according to the 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities were classified according to the semiquantitative score as defined by OMERACT. Patients were separated into 4 groups (Group A: < 5 years, Group B: 5-9 years, Group C: 10-20 years, and Group D: > 20 years from the onset of buccal dryness). The association between disease duration groups and SGUS lesions was quantified in terms of odds ratios and 95% confidence intervals. A total of 247 patients were consecutively included between May 2019 and February 2022. Eighty-nine percent of patients had a focus score ≥1/4 mm2, and 85% had positive anti-Ro/SSA. pSD duration was associated with a pathological OMERACT score (score 2 or 3): OR for 5-year duration: 1.23 [95% CI 1.04; 1.47], p= 0.0383). Considering each US item, the only statistical association with pSD duration was found regarding the presence of hyperechoic bands (25% or more): OR for five-year duration 1.18 [95% CI 1.03; 1.36], p= 0.038), independent of an older age. pSD duration was associated with the presence of hyperechoic bands, but not with hypoechoic areas, suggesting a progressive fibro-adipose evolution.

Self-Reported Time-at-Bedside and Its Association with In-Training Examination Scores of Residents in Japan.

Time-at-bedside plays a central role in clinical medicine. However, the amount of time Japanese clinical residents spend at patients' bedsides remains unexplored. To quantify time-at-bedside and examine its association with in-training examination scores during clinical residency in Japan. Nationwide multicenter cross-sectional study. First- and second-year postgraduate residents who took the General Medicine In-Training Examination at the end of the 2022 academic year. Time-at-bedside was defined as the average time per day the residents spend providing care at patients' bedsides during their residency. Time-at-bedside was classified into six categories: C1 (10-20min per day), C2 (30-50min per day), C3 (60-80min per day), C4 (90-110min per day), C5 (120-140min per day), and C6 (150min or more per day). Data on time-at-bedside were collected through an electronic survey conducted immediately after the General Medicine In-Training Examination. The primary outcome was the General Medicine In-Training Examination score. A multi-level analysis examined the association between self-reported time-at-bedside and the General Medicine In-Training Examination score. A total of 5344 residents were included in this study. Of these, 2760 were first-year residents, and 2584 were second-year residents. Of the 5334 residents, 66.9% reported spending less than 60min at a patient's bedside. Compared to the C1, C2 (adjusted score difference [aSD] = 1.1, 95% confidence interval [95% CI] 0.48 to 1.79), C3 (aSD = 1.5, 95% CI 0.75 to 2.20), and C5 (aSD = 2.0, 95 CI 0.62 to 3.38) were positively associated with the General Medicine In-Training Examination score. However, C4 (aSD = 1.1, 95% CI - 0.15 to 2.26) and C6 (aSD = 0, 95% CI - 1.79 to 1.87) were not associated with the General Medicine In-Training Examination score. Self-reported time-at-bedside positively correlates with in-training examination scores among Japanese resident physicians.

Educational needs for nursing manager competency in Korean hospitals: multi-center cross-sectional study

BackgroundNursing managers have a critical responsibility for high-quality care, nursing staff support, and business operations for hospital outcomes. As the healthcare environment has changed, the role of nursing managers and the competencies required have evolved. This study aims to assess the educational needs for nursing management competency among 155 nursing managers in one tertiary and six general hospitals in South Korea.MethodsData were collected from April 1 to May 20, 2023, using self-reported questionnaires. The Borich needs assessment and locus for focus model were used to analyze educational needs.ResultsThe results revealed that key components in the administrative manager (ensuring a safe working environment) and leader (fostering a positive workplace atmosphere) domains were most important. The lowest-scored item for performance was “Completing education to enhance competency as a manager and participating in external activities” in the educator domain. The most difficult item was “Allocation of appropriate nursing staff based on nursing requirements and adjustment of tasks” in the administrative manager domain. The top-priority items in administrative manager competencies were “Allocation of appropriate nursing staff based on nursing requirements, and adjustment of tasks” and “Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks.”ConclusionsThese findings underscore the necessity for nursing organizations to provide specialized training modules that address the identified needs, especially focusing on human resource management skills, the allocation of nursing staff, and resource acquisition and management for nursing managers. Furthermore, nursing organizations should support ongoing education and professional development activities through recognition, financial support, or career progression opportunities.