Nationwide Cross-sectional Survey Research Articles

Understanding the experience of persons living with chronic abdomino-pelvic pain: A cross-sectional nationwide survey

Background: Few studies describe the healthcare expectations and experiences of persons living with chronic pelvic pain (CPP), despite its prevalence. Objectives: To describe pain symptoms, impact, interference with quality of life, treatment goals, treatments tried, and satisfaction with treatments and healthcare professionals among persons with CPP and determine whether these characteristics vary by pain duration (<6 months vs. ⩾6 months). Design: Cross-sectional population survey. Methods/Participants/Setting: Survey distributed to US persons ⩾18 years old. Results: Of 1,118 completed respondents, 69.8% ( n = 780) reported abdominal/pelvic pain and a pain level ⩾2 on a 0–10 scale. Of those, 122 respondents had pelvic pain lasting <6 months, while 658 had pain ⩾6 months (categorized as having CPP.) Compared to those with pain <6 months, persons with CPP were more likely to have severe pain that interfered with relationships ( p = 0.001), sleep ( p = 0.042), enjoyment of life ( p = 0.004), mood ( p = 0.019), and normal daily activity ( p=0.035). They were more likely to have pain that impacted sexual function ( p = 0.001) and ability to raise a family ( p = 0.035) and were more likely to report receiving conflicting information from healthcare professionals (HCPs) ( p = 0.001). In both groups, few were satisfied (very—somewhat satisfied categories combined) with care (34.9% vs. 38.6%, p = 0.332) and treatment (33.9% vs. 27.1%, p = 0.355). Limitations: Survey with close-ended questions. Conclusion: Individuals with abdomino-pelvic pain, particularly those with chronic pain, experience significant pain and disability, but many report receiving inadequate treatment or unsatisfactory care. This suggests there is still a need for improved healthcare services that address the unique needs of this population.

Skin of colour dermatology education in US primary care residency programmes: a nationwide cross-sectional survey of programme directors

Abstract Background Physicians-in-training report inadequate education in skin of colour (SOC) dermatology during residency. Although dermatology programmes have made progress in teaching SOC dermatology, the status of SOC dermatology education in primary care residency programmes remains unclear. Objectives To characterize SOC didactic and clinical training opportunities available to primary care residents, laying the groundwork for future curriculum development of SOC dermatology. Methods This cross-sectional study consisted of a nationwide 16-question survey disseminated by email between October 2022 and February 2023 to US primary care residency programmes identified using the Accreditation Council for Graduate Medical Education (ACGME) database. Results Of responding programmes (n = 49/1224, 4.0%), 29/49 offered SOC didactic training, most often through integration of content within general dermatology lectures (n = 29/49, 59.2%) and board review sessions (n = 13/49, 26.5%). Over half of programmes (n = 35/49, 71.4%) offered SOC clinical training through rotation in a general dermatology clinic (n = 33/49, 67.3%) and skin-related chief concerns in primary care clinics (n = 29/49, 59.2%). Programmes with directors indicating that they planned to incorporate SOC education into future curricula (n = 20/49, 40.8%) were more likely to already have SOC didactic and clinical training opportunities (P = 0.01 and P = 0.02, respectively). Regarding future directions, programme directors were most interested in integrating SOC topics within dermatology lectures (n = 31/49, 63.3%); identifying an expert (n = 31/49, 63.3%) and allocating lecture time (n = 10/49, 20.4%) were the most frequently cited barriers. Conclusions Some primary care programmes provide SOC dermatology didactic and clinical training opportunities, which are influenced by programme directors’ willingness to incorporate such training into curricula, and present opportunities for dermatologists to educate primary care residents.

Barriers to breast and cervical cancer screening among adolescent girls and young women in Kenya: A nationwide cross-sectional survey.

Promoting regular screening remains one of the primary preventive measures for breast and cervical cancer. The study aimed to assess the prevalence and barriers to breast and cervical cancer screening among adolescent girls and young women (AGYW) in Kenya. The study used data from the 2022 Kenya Demographic and Health Survey (KDHS), with 12,026 AGYW who were selected by multistage sampling. The outcomes of interest were breast and cervical cancer screening. Multivariable logistic regression was used to assess factors negatively associated with the outcome variables, using SPSS (version 29.0). Of the 12,026 AGYW included in this study, only 6.0% (95%CI: 5.6-6.8) and 5.1% (95%CI: 4.8-6.0) had undertaken breast and cervical cancer screening, respectively. Low education (AOR=0.08, 95%CI: 0.02-0.34 and AOR=0.48, 95%CI: 0.28-0.83), not working (AOR=0.67, 95%CI: 0.46-0.97 and AOR=0.59, 95%CI: 0.42-0.82), low wealth index (AOR=0.55, 95%CI: 0.32-0.92 and AOR=0.45, 95%CI: 0.25-0.81), no visit to a healthcare facility in the last 6 months (AOR=0.48, 95%CI: 0.33-0.69 and AOR=0.50, 95%CI: 0.35-0.71), and no birth record (AOR=0.29, 95%CI: 0.13-0.62 and AOR=0.58, 95%CI: 0.27-0.74), were the major barriers to both breast and cervical cancer screening, respectively. Moreover, having no access to newspaper (AOR=0.67, 95%CI: 0.46-0.97) was a significant barrier to breast cancer screening while having big problems with distance to a healthcare facility (AOR=0.49, 95%CI: 0.33-0.73) and not using modern contraception (AOR=0.60, 95%CI: 0.42-0.86) hindered cervical cancer screening. In conclusion, more efforts are needed from both the government and cancer stakeholders to increase accessibility of breast and cervical cancer screening services, especially to those with low social economic status. More targeted education and sensitization, improving livelihoods of AGYW through various women empowerment efforts, and improving screening capacity of low-grade healthcare facilities are among the useful strategies to improve the low screening rates.

Current practices and challenges of endoscopic-assisted breast surgery in China: A nationwide cross-sectional survey.

Endoscopy-assisted breast surgery is gaining popularity in the treatment of breast cancer owing to its minimally access nature. However, its application in Mainland China varies significantly across regions. We aimed to evaluate the current practices and challenges of endoscopy-assisted breast surgery in Mainland China using a nationwide cross-sectional survey. In 2022, we conducted a comprehensive questionnaire survey across Mainland China regarding the clinical practices of breast surgery in 215 hospitals, 198 responded fully before September 2024 and included for analysis. Data on hospital characteristics, types of EABS performed, agreements on indications and contraindications, complications, and surgeon preferences were collected and analyzed. Of 198 hospitals with complete responses in the endoscopy-assisted breast surgery section, 93 (47.0%) could perform endoscopy-assisted breast surgery, and 7 (3.5%) could perform robot-assisted breast surgeries. Hospitals performing endoscopy-assisted breast surgery had more developed breast surgery departments, higher numbers of inpatient beds, and a greater patient population. The median annual number of endoscopy-assisted breast surgery procedures per hospital was 55, with significant variability. Common procedures included endoscopy-assisted breast-conserving surgery and lumpectomy (15.5 % and 30.7 %, respectively). Breast reconstructions constituted 15.5 %. The most commonly reported complications were seroma formation and bleeding. Despite these complications, endoscopy-assisted breast surgery was considered safe and effective, with positive aesthetic and functional outcomes. To the best of our knowledge, this is the largest cross-sectional study on endoscopy-assisted breast surgery-related clinical practices in China, highlighting regional disparities and the need for standardized training and procedures.

Virtual primary care for people living with dementia in Canada: cross-sectional surveys of patients, care partners, and family physicians

BackgroundVirtual care (VC) for dementia in primary care settings is an important aspect of healthcare delivery in Canada. However, the evidence informing optimal and sustainable provision of VC for persons living with dementia (PLWD) and their care partners is scarce. The objectives of this study were to (1) describe the frequency of VC use, (2) identify characteristics of PLWD, care partners, and family physicians (FPs) that are associated with the use of VC, and (3) explore FPs’ perceptions of barriers and facilitators to provide VC for PLWD and their care partners.MethodsThe Alzheimer Society of Canada and College of Family Physicians of Canada conducted three nationwide cross-sectional surveys between October 2020 and April 2021: (1) One with PLWD, (2) one with care partners of PLWD, and (3) one with FPs. Virtual care was defined as two-way synchronous communication by telephone and/or a web camera. The prevalence of VC use among FPs, PLWD, and care partners was described. Logistic regression models were used to determine characteristics of participants (sociodemographic, urbanicity, frequency and availability of support for connecting with FPs, and FPs’ practice characteristics) associated with any VC use (phone and/or video). Inductive thematic analysis of open-ended questions explored FPs’ perceptions.Results131 PLWD, 341 care partners, and 125 FPs participated. 61.2% of PLWD, 59.5% of care partners, and 77.4% of FPs reported using VC. The models for PLWD (included age and ethnicity) and care partners (included gender/sex, urbanicity, and receiving support from a family member/friend to connect with FP) were inconclusive. FPs with > 20 years in practice were less likely to provide VC (OR = 0.23, 95%CI: 0.08–0.62, p < 0.01). FPs perceived that preferences regarding virtual vs. in-person care, office/family support, technology and family presence, and remuneration for FPs influenced VC use.ConclusionsVirtual primary dementia care uptake in Canada is substantial and mainly performed via telephone. According to FPs, physician-patient-caregiver partnerships and infrastructure for VC play key roles in using VC. Virtual care could facilitate access to primary care and minimize potential disruptions to in-person care for PLWD. Outcomes of virtual primary care for dementia need further investigation.

Adapting to change: an analysis of midwives' job satisfaction in the post-pandemic workplace

BackgroundMidwifery faces global workforce shortages exacerbated by the pandemic. Understanding job satisfaction drivers is vital for creating supportive work environments. This study explored the multifaceted nature of job satisfaction of midwives in the post-COVID era in order to understand the elements that contribute and the ones that don’t to midwives' sense of fulfilment and engagement at work.MethodsEmploying a quantitative descriptive methodology, a nationwide cross-sectional online survey was conducted among 169 actively practicing female midwives in Slovenia using the McCloskey-Mueller Satisfaction Scale. The survey focused on various dimensions of job satisfaction.ResultsResults revealed that midwives place high importance on praise/recognition, scheduling satisfaction, and work-life balance but exhibit a very weak non-significant negative relationship between job satisfaction and the importance they place on these factors. The study also identified a weak but statistically significant positive correlation between midwives' satisfaction with praise/recognition and the importance they attribute to it.ConclusionsThe study emphasises the need for a holistic approach in enhancing job satisfaction among midwives, fostering an environment that supports their professional development and acknowledges their contributions. It emphasizes the critical role of healthcare policymakers in developing inclusive and gender-sensitive workplace policies to improve the quality of maternal care and support the well-being and job satisfaction of midwives. Management strategies should focus on reinforcing positive work environments that facilitate professional development and work-life balance. Prioritizing these factors can improve job satisfaction, retention, and healthcare outcomes.

Weight Status and Myopia in Children and Adolescents: A Nationwide Cross-Sectional Study of China.

The prevalence of both myopia and obesity is increasing among children and adolescents around the world. We aimed to examine the association between weight status and myopia in Chinese children and adolescents. The analysis included 35,108 participants aged 6-17 from a nationwide cross-sectional survey. Our results indicated that girls with overweight and obesity had higher odds ratio (OR) of myopia and mild myopia: ages 6-8 (OR = 1.33, 95% CI: 1.01-1.76; OR = 1.71, 95% CI: 1.14-2.55) and 9-11 (OR = 1.22, 95% CI: 1.03-1.44; OR = 1.31, 95% CI: 1.06-1.62). Myopic boys had higher body fat percentages (BFP) at ages 6-8 (β = 1.18, 95% CI: 0.38-1.98), 9-11 (β = 0.58, 95% CI: 0.08-1.07), and 15-17 (β = 0.42, 95% CI: 0.03-0.80), and higher body mass index (BMI) at ages 9-11 (β = 0.30, 95% CI: 0.12-0.48) and 12-14 (β = 0.19, 95% CI: 0.02-0.38). Girls had higher BFP at ages 9-11 (β = 0.62, 95% CI: 0.19-1.05) and 12-14 (β =0.53, 95% CI: 0.19-0.88) and higher BMI at 9-11 (β = 0.53, 95% CI: 0.34-0.73). Furthermore, the dose-response curves revealed a significant gender- and age-specific association between BMI, BFP, and myopia odds ratio. the study found an association between overweight or obesity and myopia in girls aged 6-11, and indicated that high BFP and BMI are associated with myopia, varying by sex and age.

Menstrual health symptoms and literacy among young women in Aotearoa New Zealand: A nationwide cross-sectional survey.

To explore menstrual cycle symptoms, information sources and menstrual health literacy in young women (aged 13-25) and those who menstruate in Aotearoa New Zealand. Cross-sectional online survey in Aotearoa New Zealand. 1334 respondents (age 13-25 years, mean age 19.8), who have had at least three periods and were currently living in New Zealand. Online survey hosted by Qualtrics between October 2021, and January 2022. Information on menstrual cycle characteristics and symptoms, and menstrual health literacy. Respondents reported high rates of regular dysmenorrhoea (89%), fatigue/tiredness (78.1%) and mood changes (72.5%) associated with menstruation. A higher proportion of rangatahi (younger generation) Māori reported irregular cycles (53.5%) compared to non-Māori respondents (41.7%). Normalisation of symptoms, especially pain (80.2%), was high. Most respondents recognised the need to see a doctor for period pain which impacted their daily lives (84.7%). However, non-cyclical pelvic pain (45.7%), heavy bleeding (39%) and intermenstrual bleeding (29%) were less likely to be recognised as symptoms that require a doctor's visit. The main sources of menstrual health knowledge prior to menarche were a family member (74.2%) and health and physical education classes at school (63.7%). Many young people reported receiving little or no information about periods prior to menarche (37.9%), with very few respondents receiving information on how to manage menstrual symptoms (15.1%). Menstrual symptoms are common and the provision of culturally safe information and opportunities to learn is important for young people, whānau, schools and healthcare practitioners.

Association Between Fine Particle Waves and Sexual Function: A Nationwide Cross-Sectional Survey in China.

The effect of the long-term persistently elevated air pollutants, often referred to as air pollution waves, on sexual function has not been sufficiently addressed. This nationwide cross-sectional study involved 12,157 participants, with 5496 females and 5039 males. PM waves were characterized by daily average PM concentrations surpassing Grade II thresholds of China's ambient air quality standards (PM2.5 > 75 μg/m3, PM10 > 150 μg/m3) for three or more consecutive days (3-8 days). Male sexual function was assessed through the International Index of Erectile Function-5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT), while female sexual function was evaluated using the Female Sexual Function Index (FSFI). A multivariate linear regression model was employed to investigate the link between PM wave exposure and sexual function. Exposure to PM10 waves, defined as 3 (β = -0.0145, 95%CI = -0.0280, -0.0010), 4 (β = -0.0145, 95%CI = -0.0280, -0.0010), 5 (β = -0.0193, 95%CI = -0.0371, -0.0015), 6 (β = -0.0218, 95%CI = -0.0415, -0.0021), 7 (β = -0.0243, 95%CI = -0.0458, -0.0028), and 8 (β = -0.0243, 95%CI = -0.0458, -0.0028) consecutive days, negatively impacted IIEF-5 scores and male sexual function. Moreover, depression levels, as evaluated by the PHQ-9, played a mediating role in the connection between PM10 waves and IIEF-5 scores. The potentially vulnerable subgroups were the younger 20-30 and the low-income groups. Our results suggest for the first time that PM10 waves are associated with decreased IIEF-5 scores, which are mediated by depression score PHQ-9, informing policy formulation for public health interventions and individual safeguarding.

Prevalence of nonrestorative sleep before and during the COVID-19 pandemic: based on a nationwide cross-sectional survey among Japanese in 2019 and 2022

Japanese people sleep less compared to other countries around the world. Using a large nationally representative survey in 2019 and 2022, we investigated whether sleep duration and nonrestorative sleep (NRS) among Japanese people have improved or worsened due to the COVID-19 pandemic. Data were drawn from the Comprehensive Survey of Living Conditions, a nationwide cross-sectional sample based on self-administered questionnaires. We analyzed 426,510 people in 2019 and 375,578 people in 2022 aged ≥20 living in the community. The generalized estimating equations of the multivariable Poisson regression models were used to estimate adjusted prevalence of NRS by survey year. Potential confounders included gender, age, marital status, family size, housing tenure, equivalent household expenditures, education, employment status, illness under treatment, lifestyle behaviors (i.e., smoking, drinking, dietary, and fitness habits), mental health, and sleep duration. Among the study participants, 35.7% slept less than 6 hours and 20.9% had NRS. Regarding sleep duration, the prevalence of sleep duration of less than 6 hours was significantly lower in 2022 than in 2019 for both men and women. By gender and age, the prevalence of short sleep duration (<6 hours) significantly decreased for both men and women under the age of 49, but increased significantly for men aged ≥50 and women aged ≥75. Regarding NRS, the prevalence of NRS was significantly lower in 2022 than in 2019 regardless of gender and age: Prevalence among men was 21.4% in 2019 and 18.8% in 2022, and prevalence among women was 23.7% in 2019 and 21.2% in 2022. After adjustment for potential confounders, the difference between the 2022 NRS prevalence and the 2019 NRS prevalence was minus 1.64 percent point (pp) (95% confidence interval minus 1.82 pp to minus 1.46 pp, P < 0.001), showing a significant decrease in the 2022 NRS prevalence. A significant improvement of NRS was independent of the prevalence of short sleep duration, age, gender, and employment status. The prevalence of NRS among the general population in Japan was significantly reduced during the COVID-19 pandemic compared to before the COVID-19 pandemic. We need to monitor whether this decline continues or returns to pre-pandemic levels.

Associations of lifestyle behaviors with mental health in a nationwide cross-sectional survey of 152,860 Brazilian students.

To evaluate the association between modifiable lifestyle behaviors and mental health indicators in Brazilian adolescents. This cross-sectional study used data from the 2019 National Survey of School Health including 152,860 students. The lifestyle behaviors and mental health indicators were obtained from a self-reported questionnaire. Logistic regression analyses were used to examine the association between lifestyle behaviors and mental health indicators. Infrequent healthy eating (OR 1.22; 95%CI 1.14-1.31), being inactive (OR 1.82; 95%CI 1.65-2.01), smoking (OR 1.24; 95%CI 1.10-1.40), and irregular school attendance (OR 1.31; 95%CI 1.22-1.40) were associated with not having close friends. Additionally, not having close friends was also associated with unhealthy eating (OR 0.86; 95%CI 0.81-0.92) and alcohol consumption (OR 0.81; 95%CI 0.75-0.87). Infrequent healthy eating (OR 1.29; 95%CI 1.24-1.33), frequent unhealthy eating (OR 1.39; 95%CI 1.35-1.43), being inactive (OR 1.12; 95%CI 1.07-1.18), excessive screen time and sitting (OR 1.10; 95%CI 1.07-1.14 and OR 1.68; 95%CI 1.63-1.73, respectively), smoking (OR 1.26; 95%CI 1.19-1.34), alcohol (OR 1.33; 95%CI 1.28-1.37), drugs (OR 1.13; 95%CI 1.05-1.22), and irregular school attendance (OR 1.53; 95%CI 1.48-1.59) were associated with worse self-rated mental health. Various lifestyle behaviors are associated with different indicators of mental health.

Cardiologists' knowledge and implementation of lifestyle counselling for cardiovascular disease prevention: A national survey

Cardiovascular disease remains a leading global cause of morbidity and mortality, with lifestyle modification playing a critical role in prevention. This nationwide cross-sectional survey of 100 cardiologists assessed attitudes, practices, and knowledge regarding lifestyle counseling for CVD prevention. While most cardiologists recognized the importance of lifestyle counseling, gaps were evident in its consistent implementation, particularly in areas like dietary guidance and physical activity promotion. Key barriers included time and resource constraints and concerns about patient compliance. These findings highlight the need for targeted interventions and training to enhance the integration of lifestyle counseling into clinical practice, fostering a more comprehensive approach to CVD prevention.

Public support for new tobacco control measures in Poland: A cross-sectional survey 2024.

This study assessed public support for new tobacco control measures in Poland, including a smoking ban on private balconies, regular tobacco tax increases, and a total ban on tobacco sales. A nationwide cross-sectional survey was conducted in 2024 using a computer-assisted web interview (CAWI). The 1080 adults (aged 18-82 years) were interviewed, of which 53% were females. A self-prepared questionnaire included questions on support for various tobacco control measures. The primary outcomes were levels of support for each proposed measure. Attitudes were measured using a 5-point Likert scale, and independent variables included sociodemographic factors and smoking status. The smoking ban on private balconies was supported by 44.1% of respondents, with higher support among older adults, non-smokers, and those with higher education. Support for annual tobacco tax increases was 47.1%, particularly among younger and middle-aged adults, the educated, and non-smokers. A total of 41.8% of respondents declared support for the total ban on tobacco sales. Higher education, non-smoking status, and voluntary smoke-free home rules were significantly associated (p<0.05) with higher support for all three tobacco control measures. There was no significant impact (p>0.05) of the gender, financial status, household size, and location of the place of residence on public support of analyzed tobacco control measures. This study revealed that less than half of adults in Poland declare support for extensive tobacco regulations such as a smoking ban on private balconies, taxation increases, and a ban on tobacco sales. Educational level and smoking status are significantly associated with public attitudes toward tobacco control measures.

Cutoffs on severity metrics for minimal manifestations or better status in patients with generalized myasthenia gravis

International consensus guidance and Japanese clinical guidelines for myasthenia gravis (MG) recommend achieving minimal manifestations or better status (MM-or-better) as the severity component of the treatment goal. However, the subjective nature of determining MM can result in ambiguity regarding this category in clinical practice and clinical trials. This study analyzed severity metrics in a large number of MG patients to propose criteria for MM-or-better. We utilized data obtained from 3800 MG patients who participated in nationwide cross-sectional surveys in Japan. Among these, 2784 patients with generalized MG were divided into two groups based on MG Foundation of America postintervention status: MM-or-better status (n = 1432); and improved-or-worse (I-or-worse) status (n = 1352). We compared severity metrics (MG-activities of daily living scale [MG-ADL], quantitative MG score [QMG], and MG composite scale [MGC]) between groups and calculated cutoff values to separate the two groups. Using these cutoffs, patients subjectively assigned as MM-or-better were classified into strict MM-or-better (below a cutoff) or optimistic MM-or-better (above a cutoff) groups, and clinical characteristics were then compared. Cutoff values for strict MM-or-better were MG-ADL ≤2, QMG ≤7, and MGC ≤4 (sensitivity 82.0%, 88.7%, and 87.4%; specificity 85.0%, 70.0%, and 77.9%; and accuracy 91.2%, 88.7%, and 90.7%, respectively). Mean values of the revised 15-item MG quality of life scale were significantly lower in the strict MM-or-better group than in the optimistic MM-or-better group. Quantitative criteria for MM-or-better appear likely to be useful in the context of rigorous clinical trials and also as reference information in clinical settings.

Identify unmet needs in diabetes care in Shandong, China: a secondary analysis of a cross-sectional study using cascade of care framework

BackgroundThe continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.MethodsWe conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.ResultsThis secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.ConclusionsA significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.

Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany.

Wearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context. This study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator. A cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use. Overall, 24% (223/932) of participants (52% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1-2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18-40: 36%; 41-64: 26%; 65+:14%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95% CI: 0.94 to 1.07 in age group 18-40; OR = 1.07, 95% CI: 1.03 to 1.12 in age group 41-64; OR = 1.11, 95% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95% CI: -0.0244 to -0.00791, p <.001). This study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.

Health Professionals' Approaches to Spirituality and Religiosity in Brazil: A Study Based on Item Response Theory.

This study aimed to estimate the proportion of Brazilian nurses, doctors, and psychologists who approach spirituality and religiosity (S/R) issues in professional practice. The study also explored these health professionals' willingness to interact with patients on issues related to S/R in their clinical practice using item response theory (IRT). From a nationwide cross-sectional web survey, demographic data and the opinions of doctors, nurses, and psychologists were collected regarding aspects related to S/R. For this study, the willingness of physicians to interact with patients regarding the S/R issues scale, developed by the Network for Research Spirituality and Health and translated into Brazilian Portuguese, was used. Information was adjusted according to the IRT. Of the 1095 participants, 335 (30.6%) were nurses, 433 (39.5%), doctors, and 327 (29.9%) were psychologists. The areas of activity with the most significant representation were primary healthcare (n = 292, 26.7%) and mental health (n = 296, 27.0%). A total of 76 (22.7%) nurses, 152 (35.1%) doctors, and 112 (34.3%) psychologists often or always asked about S/R in professional practice. There was a significant difference in the frequency of approach by nurses compared to doctors (p < 0.001) and psychologists (p = 0.001). Doctors were more willing to approach S/R, with a statistically significant difference between nurses (DM -0.72, 95% CI BCa [-1.38 to -0.11]) and psychologists (DM 1.44, 95% CI BCa (0.76-2.11)]. This study should encourage a morecomprehensive approach to human beings, contributing to more profound research in Brazil and worldwide.

Public Awareness and Willingness to Vaccinate Against Herpes Zoster: A Nationwide Cross-Sectional Study in Poland.

Herpes zoster (HZ), caused by varicella zoster virus reactivation, affects a significant portion of the population, leading to substantial morbidity. Vaccination is highly effective in preventing HZ, yet awareness and uptake remain low. This study assessed awareness and willingness to vaccinate against HZ in Poland following the introduction of a reimbursement policy. A nationwide cross-sectional survey (September 2024) using a computer-assisted web interview (CAWI) method collected data from 1137 adults. Factors associated with HZ vaccine awareness and willingness were analyzed using logistic regression models. Only 47% of respondents reported awareness of the HZ vaccine. Television was the primary information source (52%). Factors associated with awareness included chronic disease status (aOR = 1.35, 1.02-1.80, p = 0.04). Willingness to vaccinate was reported by 63.7% of eligible participants, with factors such as the absence of children (aOR = 1.30, 1.01-1.69, p = 0.04) and moderate financial status (aOR = 1.51, 1.04-2.18, p = 0.03) being associated with higher willingness. Significant gaps exist in public awareness and willingness to vaccinate against HZ in Poland. Multifaceted strategies, including targeted media campaigns, enhanced physician engagement and improved access, are needed to increase vaccination rates.

Factors affecting turnover intention of nurses in Japanese nursing homes for older adults-A cross-sectional study.

This study aimed to clarify factors that affect turnover intention of nurses in Japanese nursing homes (NHs). Cross-sectional nationwide self-administered anonymous questionnaire survey was conducted among 2000 nurses and 1000 directors from 1000 NHs. Data were collected between December 2019 and January 2020. The questionnaire contained NH nurses' turnover intention，organizational factors such as work conditions, and so on; individual factors such as self-evaluation of nursing practice and so on. Responses were obtained from 267 nurses and 163 directors (response rates: 13.4% and 16.3%, respectively). This analysis included 196 responses from both nurses and directors from NHs. Univariate analysis and logistic regression analyses were performed to examine factors affecting nurses' turnover intentions. Regarding the NH nurses' turnover intention, 49.5% responded "no intention to leave," 50.5% responded "intention to leave." Of these "intention to leave," 41.4% responded "I wanted to work in a medical facility." A stronger burden of on-call shift (OR [odds ratio] = 1.54, 95% CI [confidence interval]: 1.10-2.16) and a lower affective organizational commitment (OR = 0.71, 95% CI: 0.62-0.80) indicated a higher turnover intention of NH nurses. Retention of NH nurses may be increased by reducing the burden of on-call shifts and enhancing affective organizational commitment.

Concurrent Experience of Self-Reported Mental Health Symptoms and Problematic Substance Use During the First Two Years of the COVID-19 Pandemic Among Canadian Adults: Evidence from a Repeated Nationwide Cross-Sectional Survey.

This study was aimed at identifying the prevalence of concurrent experience, poor mental health and problematic substance use, and its associated factors, among Canadian adults during the COVID-19 pandemic. A nationwide repeated cross-sectional sample of 14,897 Canadian adults (quota-sampled, weighted) were recruited on ten occasions between October 2020 and March 2022 using online panels. Concurrent experience was defined as mild to severe symptoms of depression (Patient Health Questionnaire-9) and/or anxiety (Generalized Anxiety Disorder-7) AND meeting screening criteria for problematic cannabis (Cannabis Use Disorder Identification Test-Revised) and/or problematic alcohol use (Alcohol Use Disorder Identification Test). Multivariable binary logistic regression models were fitted to identify the associated factors of concurrent experience using Stata v14.2 SE software. The pooled prevalence of concurrent experience was 17.12%, and 45.54% of the participants reported at least one experience (mental health symptoms or problematic substance use). The highest prevalence of concurrent experience per province was reported in Saskatchewan (19.4%) and the lowest in Quebec (13.6%). Younger adults, male respondents, those identifying as 2SLGBTQ+, self-reporting ethnocultural minority status, diagnostic history of mental health and substance use disorder, suicidal ideation, and lower ability to handle unexpected/difficult situations were significantly associated with concurrent experience during the COVID-19 pandemic in Canada. This analysis showed that the COVID-19 pandemic significantly impacted mental health and substance use in interrelated ways. Data-driven province-specific interventions might be helpful toward a client-centered and integrated mental health and substance use care system in Canada.