Observational Studies In Epidemiology Research Articles

Innovation Support Reduces Quiet Quitting and Improves Innovative Behavior and Innovation Outputs among Nurses in Greece.

Innovation is a crucial issue in healthcare services since it can affect job-related variables such as productivity, satisfaction, and burnout. The aim of our study was to examine the impact of innovation support on quiet quitting, innovative behavior, and innovation outputs among nurses. We conducted a cross-sectional study in Greece during April 2024. We employed a convenience sample of nurses. We followed the reporting of observational studies in epidemiology (STROBE). We used the following instruments: (a) the innovation support inventory (ISI) to measure innovation support; (b) the quiet quitting scale (QQS) to measure quiet quitting; (c) the innovative behavior inventory (IBI) to measure innovative behavior; and (d) the innovation outputs (IO) scale to measure innovation outputs. Our study questionnaire was anonymous, and nurses gave their informed consent to participate. The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens, approved our study protocol, while we followed the guidelines of the Declaration of Helsinki. Our study population included 328 nurses with a mean age of 42.3 years (standard deviation: 9.7). Among them, 89.9% were females. Our multivariable analysis identified a negative relationship between innovation support and quiet quitting. Moreover, we found that managerial support and cultural support improved several aspects of innovative behavior, such as idea generation, idea search, idea communication, implementation starting activities, involving others, and overcoming obstacles. Additionally, managerial support improved innovation outputs. Our findings suggested the positive impact of innovation support on quiet quitting, innovative behavior, and innovation outputs among nurses. Organizations and nurses' managers should establish an innovative working environment to improve nurses' passion, motives, and productivity.

Ambispective epidemiological observational study of varicella-zoster virus infection: An 18 year-single-center Bulgarian experience.

Varicella (chickenpox) and herpes zoster (shingles) are outcomes of varicella-zoster virus (VZV) infection, and understanding their incidence trends is vital for public health planning. To conduct an ambispective epidemiological study by analyzing the main epidemiological characteristics of VZV infection during an 18 year-period (2000-2018). We used descriptive and epidemiological methods to characterize chickenpox in Bulgaria, the city of Plovdiv and the region for a period of 18 years (2000-2018). The average incidence of varicella-zoster infection for the period 2000-2018 in the Plovdiv region was estimated at 449.58‰. The highest relative share of the infection was assessed in the month of January at 13.6%, and the lowest in the months of August and September at 2.9% (both months). The age group most affected by the infection was 1-4 years, followed by 5-9 years. This corresponds to the so-called "pro-epidemic population" - a phenomenon typical for airborne infections, confirming their mass impact on the perpetuation of VZV infection. Our findings reveal significant insights into VZV epidemiology, including age-specific incidence rates, clinical manifestations, and vaccination impact. This comprehensive analysis contributes to the broader understanding of VZV infection dynamics and may inform evidence-based preventive measures.

Bronchial cell epigenetic aging in a human experimental study of short-term diesel and ozone exposures.

Blood-based, observational, and cross-sectional epidemiological studies suggest that air pollutant exposures alter biological aging. In a single-blinded randomized crossover human experiment of 17 volunteers, we examined the effect of randomized 2-h controlled air pollution exposures on respiratory tissue epigenetic aging. Bronchial epithelial cell DNA methylation 24 h post-exposure was measured using the HumanMethylation450K BeadChip, and there was a minimum 2-week washout period between exposures. All 17 volunteers were exposed to ozone, but only 13 were exposed to diesel exhaust. Horvath DNAmAge [Pearson coefficient (r) = 0.64; median absolute error (MAE) = 2.7 years], GrimAge (r = 0.81; MAE = 13 years), and DNAm Telomere Length (DNAmTL) (r = -0.65) were strongly correlated with chronological age in this tissue. Compared to clean air, ozone exposure was associated with longer DNAmTL (median difference 0.11 kb, Fisher's exact P-value = .036). This randomized trial suggests a weak relationship of ozone exposure with DNAmTL in target respiratory cells. Still, causal relationships with long-term exposures need to be evaluated.

Association Between Psychological Empowerment and Intent to Stay Among Military Hospital Nurses: The Mediating Effects of the Practice Environment and Burnout

ABSTRACTAimsTo explore the impact of psychological empowerment on nurses' intent to stay in military hospitals as well as the mediating effects of the practice environment and burnout in this context.DesignThis study employed a cross‐sectional survey approach and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting.MethodsA total of 1225 nurses from nine military hospitals were recruited via convenience sampling. Questionnaires were distributed and collected via the Questionnaire Star platform. The study variables, including psychological empowerment, the practice environment, burnout and intent to stay, were assessed via self‐report questionnaires. SPSS 23.0 software was used to conduct descriptive and correlation analyses. Additionally, PROCESS Model 6 was employed to examine the mediating effects.ResultsPsychological empowerment is positively associated with nurses' intent to stay. Mediation analysis revealed that the practice environment, burnout and the chain mediating effect of the practice environment and burnout accounted for 54.5%, 2.8% and 1.5% of the total effect respectively.ConclusionPsychological empowerment affects nurses' intent to stay not only directly but also indirectly via the practice environment and burnout.Implications for the ProfessionNursing managers may consider utilising psychological empowerment as a management strategy to enhance nurses' perceived practice environment, reduce burnout and ultimately increase nurses' intent to stay. This approach has the potential to lower turnover rates among nurses.Patient or Public ContributionQuestionnaires completed by nurses were used to explore the relationships among psychological empowerment, the practice environment, burnout and intent to stay in this context.

Collagen-Based Vascular Closure Device Multicenter Italian Experience in Endovascular Aortic Aneurysm Repair Compared With Suture-Mediated Closure Vascular Device.

The Manta Vascular Closure Device is a novel collagen-based vascular closure device that has been designed specifically for closure of large-bore percutaneous arterial accesses. The aim of this retrospective study is to evaluate the immediate and 30-day outcome of Manta at the completion of endovascular aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR). The hypothesis is that Manta is not inferior in obtaining hemostasis compared with the Perclose ProGlide Suture-Mediated Closure System device. We recruited all the percutaneous accesses for (T)EVAR performed from January 2021 to April 2023 by all the Italian Divisions of Vascular Surgery using Manta at the time of data collection (May 2023). The primary outcome is to evaluate the incidence of complications at the puncture site after Manta implantation and at 1 month, and compare this with ProGlide. We applied the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria for observational studies. Overall, 524 consecutive femoral accesses for (T)EVAR procedures were collected: 355 in the Manta cohort and 169 in the ProGlide cohort, respectively. The size of the sheath was 17.2±2.7 Fr for Manta, 15.7±2.3 Fr for ProGlide (p<0.001). No statistically significant differences between the groups regarding age, sex, body mass index, ultrasound-guided access, femoral calcifications, intraoperative, and 30-day complications. Successful arterial closure at groin puncture sites for (T)EVAR using Manta is 90.5% and 93.1% using ProGlide. Freedom for any reintervention for any complication is 95.5% for Manta and 96% for ProGlide. The 2 vascular closure devices have proved to be similar in terms of complications, without any statistically significant difference, although the median size of the sheaths for (T)EVAR was statistically significantly larger when Manta has been used, compared with ProGlide. Manta® is effective in the hemostasis of the access sites following the completion of (T)EVAR in this multicenter, retrospective, case-control study on 524 percutaneous femoral accesses. Compared to the more popular Proglide®, the average size of the introducers in the Manta® group was significantly larger than in the Proglide® group.

The effects of applying artificial intelligence to triage in the emergency department: A systematic review of prospective studies.

Accurate and rapid triage can reduce undertriage and overtriage, which may improve emergency department flow. This study aimed to identify the effects of a prospective study applying artificial intelligence-based triage in the clinical field. Systematic review of prospective studies. CINAHL, Cochrane, Embase, PubMed, ProQuest, KISS, and RISS were searched from March 9 to April 18, 2023. All the data were screened independently by three researchers. The review included prospective studies that measured outcomes related to AI-based triage. Three researchers extracted data and independently assessed the study's quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) protocol. Of 1633 studies, seven met the inclusion criteria for this review. Most studies applied machine learning to triage, and only one was based on fuzzy logic. All studies, except one, utilized a five-level triage classification system. Regarding model performance, the feed-forward neural network achieved a precision of 33% in the level 1 classification, whereas the fuzzy clip model achieved a specificity and sensitivity of 99%. The accuracy of the model's triage prediction ranged from 80.5% to 99.1%. Other outcomes included time reduction, overtriage and undertriage checks, mistriage factors, and patient care and prognosis outcomes. Triage nurses in the emergency department can use artificial intelligence as a supportive means for triage. Ultimately, we hope to be a resource that can reduce undertriage and positively affect patient health. We have registered our review in PROSPERO (registration number: CRD 42023415232).

Obesity, Metabolic Syndrome, and Sugar-Sweetened Beverages (SSBs) in America: A Novel Bioethical Argument for a Radical Public Health Proposal.

The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer's disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the "consistency argument"). This argument's radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer's disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.

Recommended Minimum Elements for Transparent Reporting of Multi-Jurisdiction Algorithm Feasibility Studies

BackgroundResearch and surveillance using routinely collected health data rely on algorithms to ascertain disease cases or health measures. Where algorithm validation studies are not possible due to lack of a reference standard, algorithm feasibility studies can be used to create and assess algorithms for use in more than one population or jurisdiction. Publication of the methods used to conduct feasibility studies is critical for transparency and reproducibility. Existing guidelines applicable to feasibility studies, including the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) and REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statements, may benefit from additional elements to capture aspects particular to multi-jurisdiction algorithm feasibility studies and ensure full reproducibility. MethodsA subcommittee of members from Health Data Research Network (HDRN) Canada’s Algorithms and Harmonized Data Working Group (AHD-WG) reviewed items within the STROBE and RECORD guidelines and compared these to published feasibility studies. Items not contained within STROBE or RECORD but recommended to ensure transparent reporting of feasibility studies were identified. The AHD-WG reviewed and approved these additional recommended elements. ResultsEleven additional recommended elements were identified: one element for the title and abstract, one in the introduction, five in the methods, and four in the results sections. Elements primarily addressed reporting jurisdictional data variabilities, data harmonization methods, and algorithm implementation. SignificanceImplementation of these recommended elements, alongside the RECORD guidelines, is intended to encourage consistent publication of methods that support reproducibility, as well as increase comparability and international collaborations.

Prognosis and risk factor assessment of patients with advanced lung cancer with low socioeconomic status: model development and validation

BackgroundLung cancer, a major global health concern, disproportionately impacts low socioeconomic status (SES) patients, who face suboptimal care and reduced survival. This study aimed to evaluate the prognostic performance of traditional Cox proportional hazards (CoxPH) regression and machine learning models, specifically Decision Tree (DT), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost), in patients with advanced lung cancer with low SES.DesignA retrospective study.MethodThe 949 patients with advanced lung cancer with low SES who entered the hospice ward of a tertiary hospital in Wuhan, China, from January 2012 to December 2021 were randomized into training and testing groups in a 3:1 ratio. CoxPH regression methods and four machine learning algorithms (DT, RF, SVM, and XGBoost) were used to construct prognostic risk prediction models.ResultsThe CoxPH regression-based nomogram demonstrated reliable predictive accuracy for survival at 60, 90, and 120 days. Among the machine learning models, XGBoost showed the best performance, whereas RF had the lowest accuracy at 60 days, DT at 90 days, and SVM at 120 days. Key predictors across all models included Karnofsky Performance Status (KPS) score, quality of life (QOL) score, and cough symptoms.ConclusionsCoxPH, DT, RF, SVM, and XGBoost models are effective in predicting mortality risk over 60–120 days in patients with advanced lung cancer with low SES. Monitoring KPS, QOL, and cough symptoms is crucial for identifying high-risk patients who may require intensified care. Clinicians should select models tailored to individual patient needs and preferences due to varying prediction accuracies.Reporting methodThis study was reported in strict compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.Patient or public contributionNo patient or public contribution.

Transparent reporting on multi-site studies about algorithms for linked health data: A systematic review of Health Data Research Network Canada’s Algorithms Inventory

ObjectiveMulti-site studies that use routinely-collected, linked health data often rely on validated algorithms to harmonize definitions of health conditions or other population characteristics across sites. If algorithm validation is not practicable, feasibility studies that assess whether an algorithm can be consistently and accurately implemented across sites, are recommended. We investigated the transparency of reporting on multi-site algorithm feasibility studies found in Health Data Research Network (HDRN) Canada’s Algorithms Inventory. ApproachPublished, multi-site Canadian feasibility studies about chronic or infectious disease algorithms were assessed using an adaptation of the RECORD (REporting of studies Conducted using Observational Routinely collected health Data) and STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. Reviewers were trained on a subset of studies. The remainder were independently assessed by two reviewers and quality checks were conducted. Results were descriptively summarized. ResultsThirty published multi-site algorithm feasibility studies were reviewed; the majority were conducted in four or more sites, and 83% assessed chronic disease algorithms. Almost one-fifth (17%) of the studies did not justify the methods used to assess algorithm feasibility. However, the majority (&gt;95%) addressed potential sources of bias and discussed algorithm generalizability. ConclusionsWe observed accurate and complete reporting of most elements of multi-site algorithm feasibility studies conducted in Canada. These studies provided important information about availability of data elements, generalizability, and potential algorithm uses. ImplicationsTransparent reporting of algorithm feasibility studies facilitates algorithm reuse, enhances the credibility and reproducibility of study findings, and promotes collaboration within the data linkage community.

Evaluating the Capabilities of Generative AI Tools in Understanding Medical Papers: Qualitative Study.

Reading medical papers is a challenging and time-consuming task for doctors, especially when the papers are long and complex. A tool that can help doctors efficiently process and understand medical papers is needed. This study aims to critically assess and compare the comprehension capabilities of large language models (LLMs) in accurately and efficiently understanding medical research papers using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, which provides a standardized framework for evaluating key elements of observational study. The study is a methodological type of research. The study aims to evaluate the understanding capabilities of new generative artificial intelligence tools in medical papers. A novel benchmark pipeline processed 50 medical research papers from PubMed, comparing the answers of 6 LLMs (GPT-3.5-Turbo, GPT-4-0613, GPT-4-1106, PaLM 2, Claude v1, and Gemini Pro) to the benchmark established by expert medical professors. Fifteen questions, derived from the STROBE checklist, assessed LLMs' understanding of different sections of a research paper. LLMs exhibited varying performance, with GPT-3.5-Turbo achieving the highest percentage of correct answers (n=3916, 66.9%), followed by GPT-4-1106 (n=3837, 65.6%), PaLM 2 (n=3632, 62.1%), Claude v1 (n=2887, 58.3%), Gemini Pro (n=2878, 49.2%), and GPT-4-0613 (n=2580, 44.1%). Statistical analysis revealed statistically significant differences between LLMs (P<.001), with older models showing inconsistent performance compared to newer versions. LLMs showcased distinct performances for each question across different parts of a scholarly paper-with certain models like PaLM 2 and GPT-3.5 showing remarkable versatility and depth in understanding. This study is the first to evaluate the performance of different LLMs in understanding medical papers using the retrieval augmented generation method. The findings highlight the potential of LLMs to enhance medical research by improving efficiency and facilitating evidence-based decision-making. Further research is needed to address limitations such as the influence of question formats, potential biases, and the rapid evolution of LLM models.

Causal association of inflammatory bowel disease with sarcoidosis and the mediating role of primary biliary cholangitis.

Previous observational epidemiological studies have identified a potential association between inflammatory bowel disease (IBD) and sarcoidosis. Nonetheless, the precise biological mechanisms underlying this association remain unclear. Therefore, we adopted a Mendelian randomization (MR) approach to investigate the causal relationship between IBD with genetic susceptibility to sarcoidosis, as well as to explore the potential mediating role. The genetic associations were obtained from publicly available genome-wide association studies (GWASs) of European ancestry. The IBD dataset has 31,665 cases and 33,977 controls, consisting of 13,768 individuals with ulcerative colitis (UC) and 17,897 individuals with Crohn's disease (CD). The genetic associations of sarcoidosis with 4,854 cases and 446,523 controls. A bidirectional causality between IBD and sarcoidosis was implemented to be determined by a two-sample MR approach. The inverse variance weighted (IVW) method was utilized as the main statistical method, and a series of sensitivity analyses were performed to detect heterogeneity and horizontal pleiotropy. A two-step MR approach was used to investigate whether the mediating pathway from IBD to sarcoidosis was mediated by PBC. The forward MR analysis indicated that genetic predisposition to IBD was significantly linked to an increased risk of sarcoidosis (OR = 1.088, 95% CI: 1.023-1.158, pIBD-sar = 7.498e-03). Similar causal associations were observed in CD (OR = 1.082, 95% CI: 1.028-1.138, pCD-sar = 2.397e-03) and UC (OR = 1.079, 95% CI: 1.006-1.158, pUC-sar = 0.034). Reverse MR analysis revealed that genetic susceptibility to sarcoidosis was correlated with an augmented risk of CD (OR = 1.306, 95% CI: 1.110-1.537, psar-CD = 1.290e-03) but not IBD or UC. The mediation analysis via two-step MR showed that the causal influence of IBD and CD on sarcoidosis effects was partly mediated by PBC, and the mediating effect was 0.018 (95% CI: 0.005-0.031, p = 7.596e-03) with a mediated proportion of 21.397% in IBD, and 0.014 (95% CI: 0.004-0.024, p = 7.800e-03) with a mediated proportion of 17.737% in CD. The MR analysis provided evidence substantiating the causal effect of IBD (CD and UC) on an increased risk of sarcoidosis, with PBC playing a mediating role in IBD and CD. However, sarcoidosis only enhances the risk of developing CD, but not IBD or UC. These findings illuminate the etiology of sarcoidosis and contribute to the management of IBD patients.

Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey

BackgroundImproving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya.MethodsA cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05.ResultsOf the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10–74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47–6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34–5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19–5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68–133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99–6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43–350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88–14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77–3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35–21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively).ConclusionIn conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.

How grit mediates depressive symptoms with life and job satisfaction in full-time employed adults with congenital heart disease

BackgroundTechnological advancements have extended the lifespan of individuals with congenital heart disease (CHD), but physical and mental health issues can affect their life and job satisfaction. AimsThis study examined whether grit can protect full-time employed adults with CHD from depression by exploring its mediating role between depressive symptoms and life or job satisfaction. MethodsA cross-sectional design involved 181 adults with CHD assessed using the Patient Health Questionnaire, Grit-10, Satisfaction with Life Scale, and Basic Psychological Need Satisfaction at Work Scale. Data analysis was conducted with SPSS and Smart PLS software for partial least squares structural equation modeling, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. ResultsIndicated that depressive symptoms were negatively correlated with grit, life satisfaction, and job satisfaction, while grit was positively correlated with both satisfaction measures. Grit partially mediated the relationship between depressive symptoms and life/job satisfaction, accounting for 30.70 % and 29.11 % of the variance, respectively. ConclusionsGrit significantly mitigates the negative impact of depressive symptoms on life and job satisfaction in full-time employed adults with CHD. Nurses should identify signs of depression in adults with CHD and evaluate their grit levels. Interventions to increase grit and reduce depressive symptoms could enhance life and job satisfaction.

Physiotherapists' attitudes and beliefs in the management of low back pain: Protocol for a systematic review.

Low back pain (LBP) poses a significant global health burden where a biopsychosocial model of care has been recommended. Physiotherapists (PTs) play a crucial role in LBP management; however, their attitudes and beliefs towards LBP were not reviewed in detail. This systematic review aims to summarise the attitudes and beliefs of PTs towards LBP and the factors influencing them. The review protocol and methods adhere to the PRISMA-P and Meta Analyses and Systematic Reviews for Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search of PubMed, Scopus, CINAHL, Web of Science, PEDro and Ovid databases will be conducted to search for cross-sectional studies evaluating PTs' attitudes and beliefs towards LBP. Two reviewers will independently screen the articles, conduct data extraction and assess methodological quality using the Joanna Briggs Institute's critical appraisal tool for prevalence studies. Data synthesis will involve a narrative synthesis of study characteristics, attitudes, beliefs, and methodological quality. If feasible, a meta-analysis will be performed to quantify the pooled effects. Despite the emphasis on biopsychosocial approaches for managing LBP, the adoption of such approaches in physiotherapy practice is still suboptimal, with attitudes and beliefs of PTs being considered an important factor influencing treatment practices. Our review will summarise the literature on attitudes and beliefs of PTs towards LBP. Such knowledge would inform the need for development of additional interventions addressing the attitudes and beliefs that would eventually enhance the update of the biopsychosocial model of care in physiotherapy management of LBP.

Effect analysis of trimethylamine N-oxide and its precursors on susceptibility to pancreatic diseases

To investigate the causal relationship between trimethylamine N-oxide (TMAO) and its precursors (betaine, carnitine, and choline) and pancreatic diseases based on the Mendelian randomization (MR) method. Genome-wide association study data of TMAO, betaine, carnitine, choline, acute pancreatitis (AP), chronic pancreatitis (CP), pancreatic cancer (PC), and circulating immune cell characteristics (white blood cell, lymphocyte, monocyte, neutrophil, eosinophil and basophil) were collected. According to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-MR reporting guidelines, the available genetic variants [single nucleotide polymorphism (SNP)] were strictly screened. The causal relationship between exposure (TMAO and its precursors) and outcomes (pancreatic diseases and circulating immune cell characteristics) was evaluated using inverse variance weighting (IVW), MR-Egger regression and weighted median. The reliability of the results was evaluated by sensitivity analysis based on MR-Egger regression, MR-PRESSO, Cochrane's Q test and leave-one-out method. A total of 36 SNP associated with TMAO and its precursors were included. Five of these were associated with TMAO, 13 with betaine, 12 with carnitine, and 6 with choline. (1) MR analysis showed that TMAO may increase the risk of AP [odds ratio (OR) = 1.100, 95% confidence interval (95%CI) was 1.008-1.200, P = 0.032], and choline may reduce the risk of alcoholic acute pancreatitis (AAP; OR = 0.743, 95%CI was 0.585-0.944, P = 0.015). The analysis results of MR-Egger regression and weighted median were consistent with the IVW results. There is no evidence to support a causal relationship between TMAO and its precursors and the risk of CP and PC. Sensitivity analysis indicated that SNP analyzed by MR showed no heterogeneity and low pleiotropy. The leave-one-out method analysis determined that after excluding any SNP, the effect intervals of the remaining SNP on the results were similar to the overall effect intervals, which suggested the robustness of MR results. (2) There was a positive causal relationship between plasma TMAO level and circulating monocyte count (OR = 1.017, 95%CI was 1.000*-1.034, P = 0.048, * represented that the data was obtained by correcting to 3 decimal places from 1.000 1). The causal effect obtained by MR-Egger regression and weighted median analysis was consistent with the results of IVW. Sensitivity analysis illustrated SNP analyzed by MR showed no heterogeneity and pleiotropy. The leave-one-out method analysis determined that after excluding any SNP, the effect intervals of the remaining SNP on the results were similar to the overall effect intervals, which suggested the robustness of MR results. TMAO and choline may change the risk of AP, and TMAO may contribute to the increase of circulating monocyte count in AP.

Perceptions Regarding the Use of E-cigarettes Among Smokers in Saudi Arabia.

Background Adults and young people selectelectronic cigarettes (ECs) due to their perceived lower risk compared to traditional combustible cigarettes. Objective This study aimed to measure the perceptions of the use of electronic cigarettes as a smoking cessation tool among the population of Saudi Arabia. Methods Between October 2023 and November 2023, we conducted a cross-sectional study of Saudi Arabia's general population over prominent social media platforms. We strictly adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to reportour results. Results Of the 376 total participants, the majority (89.6%) were male, with a median age of 35 years, and 96.3% were of Saudi nationality. Nearly half (47.3%) held Bachelor's degrees. Approximately 55.6% reported having previously attempted to quit smoking on multiple occasions. The predominant method for quitting was the use of ECs, which was reported by 88.7% of the participants. Nearly two-thirds (70%) perceived ECs as an effective cessation tool. Among those who had used EC to quit smoking, 62.5% had succeeded, while one-third (37.5%) were unsuccessful. The most frequently reported side effects were sore throat, changes in appetite, and headache, each of which affected ~50% of the participants. Conclusion This study highlights the complex relationship between ECuse and smoking cessation among Saudi Arabian smokers. Although many users perceive ECs as effective cessation tools, their actual success rates in terms of long-term abstinence from smoking are questionable.

Unveiling the menstrual mind: Exploring proprioceptive proficiency, reaction responsiveness, and motor mastery in premenstrual syndrome versus Non-PMS cohorts: A two-arm parallel non-blinded cross-sectional study

IntroductionPremenstrual syndrome (PMS) is characterized by cyclical physical and mood disturbances during the luteal phase. Symptoms gradually intensify during this phase and typically subside a few days after menstruation begins. PMS encompasses neuromuscular and psychological symptoms that can significantly affect the quality of life of affected females. This study aims to compare proprioception, reaction time, and coordination between females with PMS and those with non-PMS. Material and methodsA cross-sectional study, conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, recruited 998 females with PMS and without PMS, aged 18–40 years based on premenstrual dysphoric disorder criteria. Participants underwent assessments of proprioception and reaction time using the Sensbalance Miniboard. Coordination was assessed using Lower Extremity Motor Coordination Test. Data analysis utilized the Kolmogorov-Smirnov test to determine the normality of the data while Mann Whitney-U test was used to compare the between group differences of the variables. ResultsSignificant differences were observed with p-value <0.05 for all the variables, proprioception (front, back, right and left), reaction time (front, back, right and left), coordination (right and left) between the PMS and non-PMS groups. ConclusionsFemales with PMS were associated with great variation in proprioception, reaction time and coordination when compared with females without PMS.

Mendelian randomization analysis of maternal coffee consumption during pregnancy on offspring neurodevelopmental difficulties in the Norwegian Mother, Father and Child Cohort Study (MoBa).

Previous observational epidemiological studies have suggested that coffee consumption during pregnancy may affect fetal neurodevelopment. However, results are inconsistent and may represent correlational rather than causal relationships. The present study investigated whether maternal coffee consumption was observationally associated and causally related to offspring childhood neurodevelopmental difficulties (NDs) in the Norwegian Mother, Father and Child Cohort Study. The observational relationships between maternal/paternal coffee consumption (before and during pregnancy) and offspring NDs were assessed using linear regression analyses (N = 58694 mother-child duos; N = 22 576 father-child duos). To investigate potential causal relationships, individual-level (N = 46 245 mother-child duos) and two-sample Mendelian randomization (MR) analyses were conducted using genetic variants previously associated with coffee consumption as instrumental variables. We observed positive associations between maternal coffee consumption and offspring difficulties with social-communication/behavioral flexibility, and inattention/hyperactive-impulsive behavior (multiple testing corrected p < 0.005). Paternal coffee consumption (negative control) was not observationally associated with the outcomes. After adjusting for potential confounders (smoking, alcohol, education and income), the maternal associations attenuated to the null. MR analyses suggested that increased maternal coffee consumption was causally associated with social-communication difficulties (individual-level: beta = 0.128, se = 0.043, p = 0.003; two-sample: beta = 0.348, se = 0.141, p = 0.010). However, individual-level MR analyses that modelled potential pleiotropic pathways found the effect diminished (beta = 0.088, se = 0.049, p = 0.071). Individual-level MR analyses yielded similar estimates (heterogeneity p = 0.619) for the causal effect of coffee consumption on social communication difficulties in maternal coffee consumers (beta = 0.153, se = 0.071, p = 0.032) and non-consumers (beta = 0.107, se = 0.134, p = 0.424). Together, our results provide little evidence for a causal effect of maternal coffee consumption on offspring NDs.

P20-02 Developing the SciRAPepi tool for assessment of reliability and relevance of observational epidemiological studies

P20-02 Developing the SciRAPepi tool for assessment of reliability and relevance of observational epidemiological studies