Multicenter Cross-sectional Study Research Articles

The multifaceted effects of migraine on Syrian society: insights from a multicenter cross-sectional study

BackgroundMigraine is the most common primary headache. It’s alone responsible for 1.3% of disability in the world. Migraine both worsen quality of life of individuals and place a significant burden on the society. Despite this, there exists a knowledge gap regarding its repercussions on the Syrian population.MethodsThis cross-sectional study enrolled 679 migraine-diagnosed patients from all over Syria through electronic questionnaires disseminated on official social media platforms. Depending on demographic characteristics, physical and mental debility assessed using the Chalder scale, the Migraine Specific Quality of Life Questionnaire (MSQ) and the Generalized Anxiety Disorder 2-item (GAD_2) scale.ResultsOur study included 679 participants (mean age: 29.49 years; BMI: 24.55). The sample was predominantly female (74.7%) and mostly single (52%). Females reported higher fatigue (mean = 21.48) than males (mean = 19.22; p < .001). However, Males had better Migraine-Specific Quality of Life (MSQ) scores (mean = 49.90) compared to females (mean = 42.27; p < .001). Females scored higher on anxiety (GAD-2: mean = 2.99 vs. mean = 2.35; p < .001). Moreover, urban residents had higher scores on the Role Preventive (RF-P) subscale of the MSQ than rural residents (mean = 49.93 vs. mean = 44.82; p = .014). Higher fatigue and anxiety levels were associated with lower quality of life scores.ConclusionsThis study aimed to elucidate the multifaceted impact of migraines on daily life, considering diverse demographic variables to enhance diagnostic accuracy, treatment efficacy, and disease management strategies.

Sociodemographic, economic, and academic factors linked with resilience in university students during covid-19 pandemic: a Brazilian cross-sectional study

BackgroundResilience is a crucial factor in students’ mental health, playing an important role in their successful adaptation to the academic environment. However, there is a lack of understanding about resilience and its associated factors in students from different undergraduate courses. This study aimed to describe the resilience profile of undergraduate students from various courses in Brazil and identify sociodemographic, economic, and academic factors associated with resilience.MethodsThis study has data from a cross-sectional multicenter study involving undergraduate students from eight Federal Institutions of Higher Education in Minas Gerais, Brazil. The dependent variable was resilience, measured using the Connor-Davidson Resilience Scale (CD-RISC) 10-item version, with sociodemographic, economic, and academic factors considered independent variables. Data was collected virtually via a self-administered questionnaire between October 2021 and February 2022 (during the covid-19 pandemic). Independent samples t-tests and ANOVAs were conducted to compare resilience scores between independent variables, and Tukey’s post-hoc test was performed when necessary. Multiple linear regression was performed to create three models.Results8,650 undergraduate students were included in this study. The average score on the resilience scale was 19.86 ± 8.15, with a normal distribution. The respondents ranged from 18 to 71 years old, averaging 23.9 ± 6.33. Being female, not having a religious belief, having low per capita family income, having had a decrease in the family income, not being heterosexual, or having the head of the family with a low education level were the main factors associated, individually, with low resilience scores in the sociodemographic and economic multiple linear regression model constructed. Being from linguistics, letters and arts courses, being enrolled in fewer subjects, or being from UFMG were the main factors associated, individually, with low resilience scores in the academic multiple linear regression model constructed.ConclusionsThe study’s findings revealed that sociodemographic, economic, and academic variables were significantly associated with resilience scores in undergraduates from Minas Gerais during the covid-19 pandemic. These findings can help universities develop target strategies to promote students’ resilience and reduce the risk of poor mental health among this population.

Poor nutrition doubles post-COVID-19 syndrome risk in cancer patients: insights from a Chinese multicentre study

BackgroundSince 2019, approximately 760 million SARS-CoV-2 cases have been reported globally, with post-COVID-19 syndrome posing significant challenges for cancer patients due to their immunosuppressed status and poor nutritional conditions. The role of nutritional status in influencing their infection risk and post-COVID-19 outcomes remains unclear, underscoring the need for targeted research and strategies.ObjectiveTo investigate the impact of baseline nutritional status on SARS-CoV-2 infection and the risk of post-COVID-19 syndrome in cancer patients.MethodsA multicenter cross-sectional study was conducted from December 2022 to June 2023 in four tertiary hospitals across China. Cancer inpatients aged 18 years and older were enrolled and classified into two groups based on their Nutritional Risk Screening (NRS) scores. The correlation between SARS-CoV-2 infection, post-COVID-19 syndrome and nutritional status were analyzed using multivariable logistic regression.ResultsAmong 834 eligible cancer patients, 10.8% were in the high nutritional risk group (NRS ≥ 3). The prevalence of SARS-CoV-2 infection was 58.8% (95% confidence interval, CI: 56.8–60.8%), and post-COVID-19 syndrome was 21.0% (95% CI: 10.4–14.4%). After adjusting for confounding factors, the high nutritional risk group had a significantly higher prevalence of post-COVID-19 syndrome compared to the low nutritional risk group (32.7% vs. 19.5%, AOR: 2.37, 95% CI: 1.23–4.54, p = 0.010). However, no significant difference in SARS-CoV-2 infection rates was found between the two groups (61.1% vs. 58.5%, AOR: 1.12, 95% CI: 0.70–1.80; p = 0.634).InterpretationPoor baseline nutritional status in cancer patients is associated with a higher prevalence of post-COVID-19 syndrome, providing preliminary information on post-COVID-19 syndrome in this population. These findings underscore the importance of adequate nutritional management in cancer patients, particularly during pandemic recurrences.

The Knowledge, Attitudes, and Practices of Emergency Department Staff to Preparedness of Disaster and Emergency in Saudi Arabia: Multicenter Cross-sectional Study

The Knowledge, Attitudes, and Practices of Emergency Department Staff to Preparedness of Disaster and Emergency in Saudi Arabia: Multicenter Cross-sectional Study

Pulmonary Progressive Fibrosis in Rheumatoid Arthritis and Primary Sjogren Syndrome: Similarities and Differences

Background: Progressive pulmonary fibrosis (PPF) has been associated with a worse prognosis, even when interstitial lung disease (ILD) is related to rheumatic diseases. Since many differences are detectable among rheumatic diseases in prevalence and features of ILD, we aimed to investigate features of PPF in different rheumatic diseases, namely rheumatoid arthritis (RA) and primary Sjogren’s syndrome (pSS). Methods: In an Italian multicentre cross-sectional study, consecutive pSS or RA patients with a diagnosis of ILD from at least two years were enrolled. For each patient, demographic, clinical, and serological data, other than chest high-resolution computed tomography and lung function tests, were recorded at the enrolment and after 2 years. Results: Among 232 patients, namely 156 RA-ILD and 76 pSS-ILD, a PPF was recorded in 38.8% of cases, without differences between the two diseases. Analysing patients with a PPF, usual interstitial pneumonia was significantly more frequent in RA than pSS (71.4% and 44.4%, respectively; p = 0.019), while ILD preceded the diagnosis of the rheumatic disease in 29.1% of RA and 89.5% of pSS (p &lt; 0.001). Finally, RA patients were significantly younger than pSS at the diagnosis of the rheumatic disease (p &lt; 0.001). Conclusions: In conclusion, although there is a similar prevalence of PPF in RA-ILD and pSS-ILD, we demonstrated for the first time that the two conditions differ in terms of radiological patterns and demographic and clinical features, suggesting that specific factors related to such diseases might influence the lung involvement over time. Prospective studies could investigate if these specificities could induce different responses to the treatment.

Women living in the region under an emergency command post are experiencing delays in reaching health facilities: a multi-center cross-sectional study

IntroductionThe time between seeking emergency care and receiving the first healthcare service is referred to as delays in reaching health facilities. Delay in reaching health facilities had three main sub-themes in different studies. These include (i). Availability of transportation and infrastructure, (ii). Distance from health facilities and (iii). Lack of finance for transportation. Although there are plenty of findings about maternal delays in reaching health facilities, studies do not address the delay situation of women in conflict zones all over the world. In Ethiopia, specifically, we saw women delayed in healthcare service due to restricted movement and closure of roads, even for ambulances, at night time. MethodsA multi-center cross-sectional study was conducted among mothers attending public health facilities in the south Gondar zone, Ethiopia from September 01/2023 to April 30/2024. The data was collected by four BSc degree-holder midwives, using structured questionnaires after training was given for a day in each hospital. A pretest using 5% of the sample size was conducted. Descriptive statistics, and multivariable logistic regression analyses were used to identify factors associated with delays in reaching health facilities. Variables having p-value ≤ 0.2 in the bi-variable analysis were fitted into multiple logistic regression models.Result The prevalence of delay in reaching health facilities among women who are living in the region of emergency command post was 54.9% CI (42.04-59.87%). Living in rural areas, non-availability of public transport during the armed conflict, labor onset at nighttime, road closures by the armed forces, and non-availability of ambulances were the factors that contributed to the delay during the emergency command post. ConclusionThe magnitude of delay in reaching health facilities among women who are living in the region of emergency command post was high.

The Association Between Mutuality and Quality of Life in Adults With Chronic Illnesses and Their Nurses: Actor-Partner Interdependence Model Analysis.

To examine the association between mutuality and quality of life in nurse-patient dyads. A cross-sectional multi-centre study was conducted. The study was conducted in five tertiary hospitals in Italy. We enrol both inpatients and outpatients with chronic diseases and their nurses with a convenience sampling. One-hundred ninety-two dyads participated to the study. A self-assessment instrument including the Short-Form 12 Health Survey (SF-12), and the Nurse Patient Mutuality in Chronic Illness scale (NPM-CI scale), in the two versions-one for patients and one for nurses, was administered. The effects of nurse-patient mutuality on the physical and mental quality of life of nurses and patients were estimated with a series of actor-partner-interdependence models (APIM). Patients' and nurses' perceptions of their mutuality were positively correlated. For patient mental quality of life, there was a statistically significant actor effect both for patients, and for nurses. There was also a consistent statistically significant partner effect for patient mental quality of life. There were no statistically significant actor or partner effects for the nurses' and patients' physical quality of life. This construct may be influenced by additional components, further studies are needed. Mutuality between nurses and patients in chronic diseases influence both patient and nurse quality of life. Our results support the importance of taking a dyadic perspective when considering mutuality and quality of life in nurse-patient dyads. Nurse-patient mutuality is an indicator of a high-quality relationship, which allows shared goals and shared decision-making. Quality of life is one of the most important outcomes for chronic conditions patients and is an indicator of well-being. Quality of life is also an important variable in healthcare professionals' lives. Little is known about the association between mutuality and quality of life in nurse-patient dyads. Mutuality has an actor effect on patient's and nurse's quality of life and has a negative partner effect on patient's quality of life. The understanding of mutuality and interdependence within the dyad, could increase mental quality of life in nurse-patient dyads. STROBE checklist for cross-sectional studies was followed in this study. Patients were involved in the sample of the study.

Head injuries in prehospital and Emergency Department settings: a prospective multicenter cross-sectional study in France

BackgroundHead injuries are the leading cause of trauma in Emergency Departments (EDs). Recent studies have shown epidemiological changes in patients consulting ED for head injuries. The main objective of this study was to describe the profile of head injury patients consulting in the EDs in France and assess i) head injury severity across age groups; ii) the delay between the occurrence of head injury and ED arrival; iii) factors associated with traumatic intracranial hemorrhage (ICH).MethodsThis cross-sectional study collected patient data over a three-day period in March 2023. All adult patients (≥ 18 years old) admitted to the ED with a head injury (defined as a trauma to the head) were included. TBI severity was classified according to patients’ initial Glasgow Coma Scale score in the ED: severe (3–8); moderate (9 -12); mild (13–15); and simple head trauma in the absence of transient or persistent neurological symptoms.ResultsAmong the 71 participating EDs, 26,008 patients visited EDs and a total of 1070 patients (4.1%, IC 95 3.9—4.4) presented a head injury were included in the study, with a median age of 68.5 [37–85] years old. Most of the patients (66.7%) were referred to ED after a call to the Emergency Medical Dispatcher (EMD). The median time from head injury to ED visit was 2 h [1.0 – 5.5]. Ground-level falls were the leading cause of head injury (60.3%). Most of patient presented a simple head trauma (n = 715, 66.8%) followed by mild TBI (n = 337, 31.5%). CT head scans were performed for 636 patients (59.6%), of which 58 were positive. Traumatic ICH prevalence was 5.4% (95% CI: 4.1–6.9) and three patients (0.3%) required an urgent neurosurgical intervention. Neither preinjury anticoagulant (p = 0.97) nor antiplatelet (p = 0.93) use was associated with an increased risk of traumatic ICH.ConclusionsOne head injury patient out of two presenting in the ED is aged over 65 years. Patients referred by EMD were more likely to visit ED promptly. The majority of older patients underwent a head CT scan and preinjury anticoagulant use was not associated with increased risk of traumatic ICH.

Triage knowledge, perceived skills and associated factors among nurses working in adult emergency departments of selected public hospitals in Addis-Ababa, Ethiopia, 2023: Multicenter cross-sectional study

Triage knowledge, perceived skills and associated factors among nurses working in adult emergency departments of selected public hospitals in Addis-Ababa, Ethiopia, 2023: Multicenter cross-sectional study

Arterial hypertension in the era of obesity bias: the impact of obesity status on pharmacological treatment intensification in patients with diabetes

Abstract Background Obesity is recognized as a significant risk factor for several chronic conditions, such as diabetes and hypertension. Despite the growing healthcare needs of individuals with obesity, they often encounter obesity bias, potentially impacting the quality of medical care they receive. Purpose The aim of this study was to explore the impact of obesity on the appropriateness of antihypertensive treatment decisions in individuals with concurrent diabetes and hypertension. Methods In this multicenter cross-sectional study, patients with type 2 diabetes and arterial hypertension who were receiving outpatient care across four centers in Southern Brazil were enrolled. Participants were categorized into two groups based on their Body Mass Index (BMI): eutrophic (BMI &amp;lt;25.0 kg/m²) and patients with obesity (BMI ≥30.0 kg/m²). The primary outcome evaluated was the difference in pharmacological treatment decisions for hypertension between groups, considering individualized hypertension targets from American Diabetes Association (ADA), European Society of Hypertension (ESH), and European Society of Cardiology (ESC). Analysis was conducted on whether patients failed to receive necessary treatment intensification, comparing groups through multivariable logistic regression. Results The study comprised 204 individuals with type 2 diabetes and arterial hypertension, including 53 eutrophic and 151 patients with obesity. It was observed that patients with obesity more frequently fail to receive appropriate treatment intensification when compared to eutrophic individuals. This finding was statistically significant across the hypertension targets set by the ESH (adjusted Odds Ratio [OR] 2.03 [95% Confidence Interval [CI] 1.08-3.83], p = 0.022), ESC (adjusted OR 1.94 [95% CI 1.03-3.65], p = 0.035), and ADA (adjusted OR 2.01 [95% CI 1.07-3.79], p = 0.021). Conclusion The study indicates that obesity may contribute to disparities in the management of hypertension, suggesting a link between obesity status and therapeutic inertia in treating arterial hypertension among these patients.

The U-shaped association between serum direct bilirubin and incident mild cognitive impairment in hemodialysis patients: a multicenter study

BackgroundPrevious studies have suggested an association between low serum bilirubin concentrations and increased risk of cognitive impairment. This study aimed to explore the association and dose-response relationship between serum direct bilirubin (DBIL) concentrations and mild cognitive impairment (MCI) among hemodialysis patients.MethodsThis is a multicenter cross-sectional study with patients undergoing hemodialysis from 22 dialysis centers in Guizhou Province, China. The outcome was mild cognitive impairment (MCI), measured with a Mini-Mental State Examination. The association and dose-response relationship between serum DBIL and MCI incidence were examined using multivariate logistic regression analysis, restricted cubic spline, and subgroup analysis to explore the association of serum DBIL concentrations with MCI.ResultsOf the 4223 enrolled patients (mean age 55.2 ± 15.3 years, 60.4% males), 1187 (28.1%) had MCI. Serum DBIL of 0.10-1.67umol/L [multivariable-adjusted odds ratios (OR) 1.32, 95% confidence interval (CI): 1.08–1.60, P = 0.005], 2.31-3.20umol/L (OR = 1.22, 95%CI: 1.00-1.49, P = 0.047), and > 3.21umol/L (OR = 1.32, 95%CI: 1.08–1.61, P = 0.006) had increased risk of MCI compared with 1.68-2.30umol/L. The dose-response analysis between serum DBIL and MCI showed a U-shaped relationship (P for non-linearity = 0.009), and the serum DBIL concentrations with the lowest risk of MCI was 2.01umol/L. As the serum DBIL concentrations were lower than the reference, the risk of MCI decreased by 49% per standard deviation (SD) increase in serum DBIL (OR = 0.51, 95%CI: 0.29–0.89, P < 0.001); when the concentration exceeds 2.01umol/L, a rise per SD increased the risk of MCI by 9% (OR = 1.09, 95%CI:1.01–1.17, P < 0.001).ConclusionOur findings suggest a U-shaped association between serum DBIL and MCI among hemodialysis patients.

U. Parvum serovars exhibit distinct pathogenicity in Chinese women of childbearing age: a multicentre cross-sectional study

BackgroundUreaplasma spp. can be classified into different serovars. It is unknown whether distinct serovars are associated with clinical signs and symptoms.MethodsWe conducted a multicentre cross-sectional study. U. parvum serovars were identified on the basis of their multiple-banded antigen (MBA) genes. After adjusting for demographic variables and other reproductive tract infections, the odds ratio (OR) and 95% confidence interval (CI) were calculated to determine the impact of U. parvum serovars on clinical symptoms.ResultsAmong 5,277 individuals, U. parvum serovars 3 and 6 were the most prevalent serovars (17.9% and 16.0%, respectively). Potential confounders, such as age, body mass index (BMI), ethnicity, education level, contraceptive methods, number of sexual partners, gravidity, parity, and other sexually transmitted infections (STIs) that are associated with clinical symptoms (P < 0.1) were adjusted for in the univariate analysis. U. parvum serovar 14 was strongly positively associated with certain clinical symptoms, including redness and swelling of the vaginal wall (crude OR: 3.53, 95% CI: 1.92–6.49; adjusted OR: 5.21, 95% CI: 2.56–10.58), cervical bleeding and swelling (crude OR: 3.89, 95% CI: 2.38–6.36; adjusted OR: 7.37, 95% CI: 3.82–14.23), and cervical ectropion (crude OR: 2.08, 95% CI: 1.25–3.45; adjusted OR: 3.04, 95% CI: 1.60–5.74). In contrast, U. parvum serovar 3 was negatively associated with a variety of clinical symptoms, whereas no correlations were detected between U. parvum serovars 1and 6 with clinical symptoms.ConclusionsDifferent U. parvum serovars exhibit distinct correlations with clinical symptoms, suggesting that U. parvum serovars are pathogenically heterogeneous and that further differentiation of serovars may be necessary.Trial registrationThe study was registered with ClinicalTrials.gov (https://www.clinicaltrials.gov; ID: NCT04694495; Registration Date: 2021–01-05).

Blood pressure control and cardiovascular risk assessment in patients with hypertension: a pooled analysis of 6 countries in Eastern and Southern Europe (SNAPSHOT study)

Abstract Background Recent guidelines of the European Society of Cardiology (ESC) introduced stricter recommendations regarding blood pressure (BP) control, based on recommended levels following an assessment of cardiovascular (CV) risk. However, data are lacking on perception and actual BP control, and CV risk assessment. Purpose To assess BP control and CV risk assessment in patients with hypertension. Methods This is a cross-sectional multicentre study (SNAPSHOT) including pooled data from 6 countries in Europe. 9466 patients with hypertension were included from 513 participating investigators (69.6% general practitioners [GPs], 17.4% cardiologists, 6.2% endocrinologists). BP control and CV risk were assessed by investigators and compared to the re-assessment based on current ESC guidelines (SCORE1 and SCORE2&amp;2-OP). Results 9443 patients with complete data (65.6±10.7 years, 57.0% female) were analysed from Bulgaria (35.6%), Romania (26.8%), Croatia (13.8%), Serbia (12.5%), Georgia (6.4%), and Spain (4.9%). Most patients had additional risk factors, such as overweight/obesity (81.6%), dyslipidaemia (80.8%), type 2 diabetes (32.8%) or current/former smoking (29.5%). Two or more risk factors (male gender, age ≥65 years, obesity, smoking) were more frequent in patients with very high calculated CV risk (60.9% by SCORE1, 57.7% by SCORE2&amp;2-OP). Systolic and diastolic BPs were 139.3±17.3 mmHg and 82.3±10.9 mmHg, respectively. Almost all patients (98.5%) had their hypertension treated, 54.5% taking a single-pill combination (SPC). The most used drug classes were diuretics (59.6%), angiotensin-converting enzyme inhibitors (59.4%), and beta-blockers (57.0%). Combination therapy of 2 or 3 drug classes (SPC or not) was used in 33.2% and 34.4% of patients, respectively. According to investigators, BP was considered controlled in 75.0% of patients, whereas 48.0% of patients had BP &amp;lt;140/90 mmHg, and only 24.4% of patients were controlled at BP target according to guidelines (Figure 1). CV risk was estimated by investigators as low, moderate, high or very high for 10.1%, 34.9%, 32.0% and 23.0% of patients, respectively, whereas calculated CV risk was very high in most patients (59.1% by SCORE1, 86.8% by SCORE2&amp;2-OP). CV risk estimated by investigators varied by country and by speciality, being high (29.4%, 35.0% and 32.0%) and very high (32.4%, 49.8% and 18.6%) for cardiologists, endocrinologists and GPs, respectively. Compared to calculated CV risk, CV risk estimated by investigators was frequently underestimated (54.4% by SCORE1, 67.6% by SCORE2&amp;2-OP), varying between 30.8% in Spain and 68.2% in Bulgaria for SCORE1, and between 42.1% in Spain and 84.8% in Serbia for SCORE2&amp;2-OP (Figure 2). Conclusion Physicians across 6 European countries tended to overestimate control of BP and underestimate CV risk in patients with hypertension. Our findings highlight the need for better assessment and management of patients according to the latest ESC guidelines.

Knowledge, behaviours, practices, and expectations on climate change among French health workers

Abstract Introduction Hospitals face a dual challenge with climate change (CC): reducing emissions and preparing for its impacts. The main objective of this study was to evaluate the knowledge, behaviours, and practices (KBP) of health workers (HWs) in French hospitals regarding CC and environmental sustainability (ES). The secondary objectives were to understand their expectations and identify associated factors with the KBP of HWs. Methods A multicenter cross-sectional KBP study was carried out among HWs of six French hospitals from June 2021 to December 2022. A structured questionnaire was designed and consisted of five parts: i) participant characteristics, ii) CC knowledge and perceptions, iii) behaviours, iv) practices concerning ES actions, and v) expectations. A multilevel logistic regression model assessed associations between HWs’ KBP and both individual and hospital characteristics. Results Out of 57034 HWs, 4552 (8.0%) participated in the study. Only 15.4% identified the activities with the greatest environmental impact. On a scale of 1 (Not a priority) to 10 (High priority), the average median rating attributed to commitment to ecological transformation in their hospitals was 5.0/10. Among the participants, 1079 (23.7%) had already initiated at least one ES action. To implement ES-related projects, main barriers were reported including lack of dedicated time (40.4%), hierarchical support (32.5%), methodological support (28.9%), and training access (23.7%). The presence of a sustainable development steering committee, especially active for over 5 years, positively correlated with better information for HWs (ORa=1.78 [1.29-2.45]), better knowledge (ORa=1.83 [1.32-2.53]), and more ES actions initiated (ORa=1.74 [1.33-2.29]). Conclusions French HWs demonstrate a commitment to making their hospitals more environmentally sustainable. Some drivers and barriers were identified to further support these essential transformations. Key messages • First national study on knowledge, behaviours, practices, and expectations on climate change and environmental sustainability among French health workers. • Among the drivers to strengthen dynamics within hospitals, the need for training among French health workers and institutional support has been identified.

Machine learning approach for detection of valvular heart disease through digital cardiac auscultation: results from multi-center prospective cross-sectional study

Abstract Background Cardiac auscultation, an essential bedside diagnostic tool, often identifies significant valvular heart disease through murmurs. However, its accuracy is contingent upon the clinician's expertise, leading to a growing dependence on expensive imaging techniques. This study aimed to develop and validate a machine learning model for detecting valvular heart disease from cardiac auscultation. Methods The digital cardiac auscultation and associated echocardiograms were prospectively collected from three sites between May 1, 2022, and Dec 31, 2022. We trained, validated, and externally tested a machine learning based model to classify aortic stenosis, mitral stenosis, aortic regurgitation, mitral regurgitation, tricuspid regurgitation, oveall valvular heart disease from cardiac auscultation, age, sex, and comorbidity. We condcted training, and internal testing using datasets for eXtreme Gradient Boosting (XGBoost) machine learning model from hospital one and hospital two. The dataset from hospital three was employed for external testing. We evaluated the area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), accuracy, sensitivity, specificity. Result We selected the cardiac auscultation and echocardiograms of a total of 4,321 patients, excluding those without valvular heart disease information, congenital heart disease, a history of valvular operation, and cardiac auscultation could not be interpreted. The diagnostic performance of heart murmurs for valvular heart disease across the three datasets generally demonstrated high sensitivity and PPV. Specifically, the sensitivity for aortic stenosis was 89.1%, mitral stenosis 88.8%, aortic regurgitation 88.5%, mitral regurgitation 89.8%, tricuspid regurgitation 90.1%, and for any valvular heart disease, it was 95.0%. However, the NPV was consistently lower, with values of 16.4%, 14.2%, 12.2%, 23.1%, 26.2%, and 65.3% for the respective conditions. In XGBoost machine learning model, the AUROC values for internal testing (N=1,403), along with their 95% confidence intervals, were as follows: aortic stenosis (0.93, 0.88–0.97), mitral stenosis (0.91, 0.81–0.97), aortic regurgitation (0.84, 0.79–0.90), mitral regurgitation (0.94, 0.90–0.98), tricuspid regurgitation (0.81, 0.75–0.87), and overall valvular heart disease (0.86, 0.82–0.89). For external testing (N=814), the AUROC values were: aortic stenosis (0.90, 0.83–0.96), mitral stenosis (0.88, 0.79–0.95), aortic regurgitation (0.94, 0.93–0.96), mitral regurgitation (0.93, 0.92–0.95), tricuspid regurgitation (0.89, 0.87–0.91), and overall valvular heart disease (0.92, 0.90–0.94). Conclusion The machine learning based model can accurately classify valvular heart diseases using information from digital cardiac auscultation.Figure 1.Study FlowFigure 2.AUC curve

Empowering Educators: Italian Nurses’ Knowledge, Attitudes, Practices, and Vaccine Hesitancy

Abstract Background Vaccine hesitancy (VH) among healthcare workers is a prevalent global phenomenon and a public health concern. The study aims were i) identifying knowledge, attitudes, and practices (KAP); ii) estimating the prevalence of VH regarding recommended vaccines for healthcare workers (HWs). Methods Multicenter cross-sectional study of an Italian sample of nurses and nursing students. Following a systematic review (PROSPERO ID:CRD42020212252), a validated questionnaire was used (Cronbach’s alpha=0.82). Two multivariable logistic regression model were built to identify predictors of (1) VH to the recommended vaccine for HWs; (2) acceptance of the fourth COVID-19 vaccine dose. Results 226 participants were enrolled (169 nurses; 57 students). Regarding KAP: only four nurses (1.8%) had adequate knowledge among vaccine recommended for HWs, whereas 30% (N = 66) reported never having recommended vaccinations during clinical practice. 106 (46%) nurses/students reported VH for at least one of the vaccines recommended for HWs - high levels of VH were recorded for influenza vaccination (N = 88,38.9%) and fourth COVID-19 vaccine dose (N = 100,44.3%). At the multivariable analysis, (1) significant associations with highest levels of VH were found for nurses who reported having at least one child (OR:5.42, 95%CI: 1.64-17.89) and who had not received any dose of influenza vaccination in the last 5 years (OR:13.25, 95%CI: 5.29-33.16). Lowest odds of VH was found for nurses employed in Primary Health Care (OR:0.17, 95%CI: 0.03-0.98); (2) routinely recommending vaccinations during practice (OR:0.38, 95% CI: 0.15-0.95) was associated with acceptance of fourth COVID-19 vaccine dose. Conversely, reliance on social media as the primary information source seemed to be a predictor of COVID-19 vaccine refusal (OR:2.05 95% CI: 1.31-3.20). Conclusions Preliminary results identified predictors of VH among nurses, offering insights for organizations to effectively tailor public health interventions. Key messages • High levels of vaccine hesitancy among nurses towards recommended vaccines for healthcare workers pose a threat to patient safety. • Empowering ‘educators’ through focused public health interventions is essential to address factors contributing to vaccine hesitancy among healthcare workers.

Anemia in patients with chronic kidney disease and its association with cardiac abnormalities

Abstract Introduction Chronic kidney disease (CKD) is a pathology characterized by multisystemic comorbidities, predominantly associated with cardiovascular disease and anemia. However, the precise association between the degree of anemia and the development of cardiac abnormalities in patients with CKD undergoing hemodialysis remains unclear. Purpose To determine the association between the degree of anemia and cardiac abnormalities in patients with CKD receiving hemodialysis treatment. Methods A cross-sectional multicenter study that included individuals with CKD undergoing hemodialysis was conducted. Electronic medical records containing information regarding medical conditions and pertinent laboratory parameters was collected, and cardiac function was determined using echocardiography. A Spearman rank correlation analysis was conducted to evaluate the associated between the degree of anemia and echocardiographic parameters, with significant set at p &amp;lt;0.05. Results Ninety-nine individuals were included, with a median age of 48 years. The population was categorized based on hemoglobin (Hb) levels into non/mild anemia (Hb &amp;gt;10 mg/dL) and moderate/severe anemia (Hb &amp;lt;9.9 mg/dL) groups (table). Significant differences were observed in left ventricle (LV) posterior wall thickness (10mm in non/mild vs. 11mm in moderate/severe, p&amp;lt;0.015), left atrial (LA) volume (34 mL/m2 in non/mild vs. 39 mL/m2 in moderate/severe, p&amp;lt;0.007) and left ventricular ejection fraction (LVEF) (59% in non/mild vs. 55% in moderate/severe, p&amp;lt;0.025). Negative correlations (figure) were observed between Hb levels and LV mass index (r= -0.21, p= 0.03) and pulmonary artery systolic pressure (PASP)(r= -0.27, p= 0.006). Conclusion The degree of anemia demonstrated an association with cardiac abnormalities, as evidenced by alterations in echocardiographic parameters such as LVEF, LA volume and PSAP. This study underscores the importance of further prospective investigations to enhance early identification and stratification of anemia in patients with CKD aiming to mitigate further cardiac complications.Clinical demographics tableScatter plots with correlation graphs

A critical appraisal of the International Classification of Headache Disorders migraine diagnostic criteria based on a retrospective multicenter cross-sectional headache registry study in youth.

We used Cluster Analysis of Migraine-associated Symptoms (CAMS) to critically evaluate current International Classification of Headache Disorders-Third Edition (ICHD-3) migraine-associated symptoms criteria. Diagnostic criteria play a central role in guiding clinical trial inclusion, and therefore available treatments. Migraine and tension-type headaches (TTH) are differentiated in ICHD-3 by many headache characteristics, including associated symptoms. A diagnosis of probable migraine indicates some but not all features of migraine are met. Photophobia and phonophobia, or nausea and/or vomiting, are required to meet a diagnosis of migraine; however, CAMS-a model that describes associated symptoms across youth with headache-indicates that a broader range of symptoms contain information about migraine burden. In this multisite retrospective cross-sectional study, we evaluated ICHD-3 migraine criteria. Youth aged 6-17 years with migraine (including probable migraine) or TTH were included in the analysis. We used CAMS to evaluate the migraine-associated symptom criterion. With CAMS as a guide, we evaluated how changes to the migraine-associated symptom criterion altered who met the diagnosis of migraine. Of the 9017 participants included in this study, 66.7% were female and had a median (interquartile range) age of 13 (10-15) years. Most participants had migraine or probable migraine (99.0%), and the remainder had TTH (1.0%). A sizable percentage (10.1%) of youth under the umbrella diagnosis of migraine were diagnosed with probable migraine because they did not meet migraine-associated symptom criterion D; however, many in this group reported several non-ICHD migraine-associated symptoms. We explored alterations to criterion D based on CAMS. Allowing for photophobia or phonophobia re-categorized 55.6% of youth as having migraine, though some only had one symptom. Including lightheadedness or lightheadedness and spinning re-categorized 19.7% and 25.8% of youth with migraine, respectively, but all of those who were re-categorized had at least two migraine-associated symptoms. The ICHD-3 captures the most prevalent migraine-associated symptoms; however, many youths with probable migraine who do not meet full criteria due to insufficient associated symptoms nonetheless experience multiple non-ICHD migraine-associated symptoms. Changes to criterion D should be considered for the ICHD-4.

The Effect of Perceptions of Evidence-Based Practice on Endotracheal Cuff Pressure Management in Critical Care Nurses: A Correlational Cross-Sectional Multicentre Study.

This correlational cross-sectional multicentre study aims to achieve two objectives. Firstly, to assess nurses' knowledge and practice of endotracheal cuff pressure management. Secondly, to examine the relationship between endotracheal cuff pressure management knowledge and evidence-based practice leadership and work environment. A correlational cross-sectional multicentre study design. This study was conducted among 144 intensive care nurses in Turkey. Data collection included descriptive characteristics and cuff pressure management of nurses, the Evidence-Based Practice Leadership Scale and Evidence-Based Practice Work Environment Scale. Descriptive statistics, chi-square test, Pearson correlation and receiver operating characteristics analysis were conducted. A STROBE checklist was the reporting guide for this study. The success status of nurses in terms of knowledge related to cuff pressure was found significantly different according to the type of intensive care unit working in and the status of receiving training on evidence-based practice. A positive, strong relationship was found between nurses' mean scores on the Evidence-Based Practice Leadership Scale and the Work Environment Scale. There was a very weak positive correlation between the mean scores of the Evidence-Based Practice Leadership Scale and the cuff pressure management. Adherence by nurses to current evidence-based practice for cuff pressure monitoring is essential for safe patient care and improved quality of care. It is recommended to provide both a supportive working environment and training programmes for intensive care nurses to perform cuff pressure management in line with evidence-based practice. Providing educational programs, an appropriate clinical environment, support from health managers and access to appropriate tools are important considerations in increasing the knowledge and skills of intensive care nurses to effectively monitor and manage cuff pressure. Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies. No patient or public contribution.

Cluster Analysis of Migraine-associated Symptoms (CAMS) in youth: A retrospective cross-sectional multicenter study.

To conduct a retrospective cross-sectional multicenter study to validate the relationships between migraine-associated symptoms. Symptoms associated with headache-photophobia and phonophobia, nausea, and/or vomiting-are required criteria for migraine diagnosis based on the International Classification of Headache Disorders-Third Edition (ICHD-3). However, individuals with migraine report high rates of other symptoms (e.g., lightheadedness, difficulty thinking). We recently completed a single-center study assessing the relationships between an expanded set of migraine-associated symptoms. A pre-registered cross-sectional multicenter retrospective analysis was conducted on standardized questionnaire data of youth ages 6-17 years from two headache registries at pediatric tertiary care centers. Cluster Analysis of Migraine-associated Symptoms (CAMS) was implemented to assess associations between 11 migraine-associated symptoms. We explored differences between the two centers, and how CAMS was associated with demographics, including sex and age, and headache burden. There were 10,721 participants who were 66.5% female and had a median (interquartile range) age of 13 (10-15) years. The first three CAMS dimensions accounted for 46.5% of the variance and were consistent across sites. The first dimension indicated those reporting any migraine-associated symptoms were likely to report multiple. The second dimension separated symptoms into those included in ICHD-3 migraine diagnostic criteria and non-ICHD symptoms (e.g., lightheadedness, difficulty thinking). The third dimension separated sensory hypersensitivity and vestibular symptoms. An abundance of migraine-associated symptoms correlated with greater headache severity (Spearman's ρ = 0.18, 95% confidence interval [CI] 0.17-0.20; small effect size) and disability (ρ = 0.26, 95% CI 0.25-0.28; small effect size). We also observed differences in associated symptoms across age and sex. Associations between an expanded set of migraine-associated symptoms are informative for headache burden and reveal intriguing changes across child development and sex. We were able to replicate findings across two centers, indicating that these symptom clusters are inherent to migraine.