Caring for the Caregiver: Caregiver Preparation and Stress Following Total Joint Arthroplasty.

Occupational Health and Safety (OHS) accountability has increasingly become a cornerstone of sustainable labor governance, particularly in developing regions where informal and part-time employment structures dominate. In Indonesia, despite an extensive regulatory framework including Law No. 1 of 1970 on Occupational Safety and Government Regulation No. 50 of 2012 on OHS Management Systems (SMK3) implementation remains inconsistent, with accountability mechanisms still weak at both institutional and behavioral levels. This study aims to formulate a strategic framework to enhance OHS accountability in Musi Banyuasin Regency, South Sumatra, as a representative industrial area facing rapid employment transformation. Using a mixed-method design, the research integrates quantitative labor market data (2020–2024) with qualitative interviews involving key government, industry, and labor stakeholders. Quantitative findings reveal persistent gender disparities in employment and a high share of part-time labor, indicating fragility in OHS compliance and risk management. Qualitative analysis identifies fragmented inter-agency coordination, limited safety literacy, and underdeveloped digital reporting mechanisms. The study proposes a collaborative governance- based model emphasizing digitalized reporting, inter-institutional data integration, and community-centered safety literacy enhancement. This model extends the theoretical discourse on accountability by bridging the gap between regulatory compliance and moral responsibility. The findings contribute to the literature on safety governance by conceptualizing accountability as a multidimensional construct that intertwines institutional transparency, behavioral commitment, and procedural enforcement. Practically, the paper provides a roadmap for strengthening OHS accountability through policy innovation and technology adoption, aligning local governance reform with the broader Sustainable Development Goals (SDG 8.8) on safe and secure working environments.

This study was conducted to analyze the factors affecting the academic performance of students at the Faculty of Economics and Management, Vietnam National University of Agriculture. Data were collected from 350 students and combined with academic records from the university’s regístrar database. The dataset was processed using STATA software through two main steps: exploratory factor analysis (EFA) and multivariate linear regression. The findings reveal that students’ academic performance was influenced by individual characteristics, family-related factors, and institutional support in learning, scientific research, and entrepreneurship. Based on these results, the study recommended that students should maintain a balance between academic study and part-time employment, while actively engage in extracurricular activities. It also suggests that the university should proactively implement student support initiatives and develop policies to attract more students to enroll in high-quality academic programs.

The use of electronic cigarettes (e-cigarettes) among young people is rising globally, including in the Middle East. This increase is largely due to widespread misconceptions that e-cigarettes are harmless alternatives to traditional smoking, despite the known health risks associated with their use. However, there is limited data on e-cigarette consumption among young adults in Iran. To address this gap, we conducted a nationwide survey to assess the prevalence of e-cigarette use, as well as the knowledge, attitudes, and factors influencing the use of these products among young adults. Study of Measurement of Knowledge and Examination of Support for tobacco control policies (SMOKES) is a nationwide multi-center cross-sectional survey, which was conducted from 2024 to 2025. A total of 2,246 university students aged 18-40 years from 15 provinces, encompassing a wide range of disciplines and ethnicities, participated in an online survey that collected data on sociodemographics, tobacco use, knowledge of e-cigarettes, attitudes toward them, and support for related policies. Descriptive statistics were utilized to summarize patterns of e-cigarette use and related misconceptions. Candidate explanatory variables were selected through a comprehensive literature review, including sociodemographic (age, sex, parental education), behavioral (concurrent tobacco use), and social (peer influence) factors. All variables showing association at p < .20 in bivariate analysis were entered into the multivariable logistic regression model examining current e-cigarette use as the dependent variable, with final models retaining significant predictors (p < .05). Ever-use of e-cigarettes was reported by 28.2% of participants, while past-month use prevalence was 5.6%. Knowledge of e-cigarette health risks was poor and misconceptions were common (34.4% believing the vapor is "just water"; 24.7% considering that e-cigarettes are less harmful than cigarettes;<40% recognizing cardiovascular or reproductive risks); on the other hand, the attitudes towards vaping was widely seen as socially acceptable (36.2% expressed e-cigarettes are more socially acceptable; 34.6% perceived that vaping is enjoyable). The ever-use of e-cigarette was significantly associated with several factors, including male sex (OR = 1.36), having divorced parents (OR = 2.37), part-time employment (OR = 1.42), concurrent use of cigarettes (OR = 6.76) or hookah (OR = 4.95), and the presence of peers or siblings who use tobacco products (OR = 1.93) (p < .05 for all). Students also reported weak enforcement of campus anti-e-cigarette policies and low access to cessation resources. The high prevalence of e-cigarette use among Iranian university students is compounded by significant knowledge gaps and permissive attitudes. This underscores an urgent need for multi-level interventions, including targeted educational campaigns, comprehensive smoke-free campus policies, and national regulations to curb access and marketing, to effectively counter this public health threat.

Work Integrated Learning (WIL) experiences are a key component in medical imaging (MI) studies. However, these unpaid placements often result in significant financial stress, otherwise known as 'placement poverty', due to reduced income during placement and associated costs. Despite significant research in other allied health disciplines, the impact on MI students remains under-researched. A structured survey based upon the WIDE survey originally developed in New Zealand was administered by the University's Qualtrics platform. Ethics approval was granted (Ethics # 6894). The survey targeted students in their final 2 years of the four-year Honours degree, along with students within 2 years post-graduation. The survey collected both quantitative and qualitative data on financial stress during WIL placements. Of 250 eligible participants, 56 responded, with 28 complete responses included in the analysis. Findings have demonstrated MI students experience substantial financial hardship during WIL placements. Key stressors included travel, accommodation, uniforms, and increased daily living costs. Full-time placement schedules limited students' ability to maintain part-time employment, with rural placements further increasing their financial burden. Students reported impacts on mental health, academic performance, and overall wellbeing. Financial stress led some students to reduce their study load, take leave from the course or consider course withdrawal. This study highlights the significant financial challenges facing MI students during WIL placements, with implications for students' retention and workforce sustainability. Targeted financial support, flexible placement models, and policy reform are urgently needed to ensure equitable training and to address the ongoing workforce shortage.

The socioeconomic trajectories followed during early adulthood contribute to inequalities in cardiometabolic health by age 24 years.

We analysed the impact of the COVID-19 pandemic on slum dwellers in Kolkata, West Bengal, using a primary questionnaire-based survey and time use survey of the head of the household and his or her spouse from 252 households, with a total of 504 respondents. The unconditional quantile regression analysis shows that the monthly household income didn’t change significantly during the pre- and post-COVID-19 periods even though there was a slight decrease in the income of male slum dwellers in the post-pandemic period. Second, women’s full-time and part-time employment increased in the post COVID-19 period compared to the pre-COVID-19 era, because women who had not worked prior to the pandemic joined the labour force to maintain their monthly household income. We also conceptualized the “Me-Time” concept, which is the sum of time spent on leisure and sleeping. We used a 70% percent median me-time in the sample data as a threshold for the time poverty line during the post-COVID-19 period. Our findings show that me-time is 48 minutes and 88 minutes less, respectively, for fully employed or partially employed women, compared to their male counterparts. The number of children under 10 years significantly reduces an individual me-time across all employment status subgroups. We also used a time poverty threshold based on the committed time of the respondents, where the threshold is defined as 1.5 times the median committed time in the sample. We observe that 25% of fully employed women are time poor, compared to only 8.3% of fully employed men.

Part-time work is about twice as common in trade as in the general workforce in Sweden. More women than men work part time, and women and men tend to work in different trade sectors. This study first compares psychosocial work environment factors (job demands and job resources), work–non-work interference, and health-related factors between part-time and full-time employed women and men in trade in Sweden and, second, describes their sociodemographic characteristics. Data is from a subsample of trade employees in SLOSH 2022 (N = 730; 49% women; mean age 54 years; 92% permanently employed) with 20% in part-time employment. Part-time employees and women reported lower job resources (job control and skill discretion). Women reported higher emotional demands, work–life interference, and symptoms of depression. It is suggested that increased development opportunities and more varied job tasks could contribute to beneficial outcomes, especially for part-time employees and women, and more functional flexibility for organizations.

Part-time employment is an increasingly important feature of the U.S. labor market, yet little is known about how earnings determinants differ between full-time and part-time pharmacists. Few prior studies have compared earnings models across these groups, but most have relied on small or geographically limited samples. Moreover, the dynamic and rapidly evolving nature of the labor market makes this study especially timely, as most prior research on pharmacist earnings is based on older data. This study examined earnings determination separately for full-time and part-time pharmacists, estimating the influence of work input, human capital, demographic characteristics, and job-related features within each group. Data were obtained from the 2019–2022 American Community Survey (ACS), a large, continuous, nationally representative survey conducted annually by the U.S. Census Bureau. The sample included 12,064 pharmacists (4667 men and 7397 women) aged 25–64 years, practicing in the U.S. Ordinary least-squares equations were estimated separately for male and female pharmacists within each employment category, allowing comparison of the direction, magnitude, and statistical significance of covariates across groups. Results revealed notable differences in the earnings effects of several factors between full-time and part-time pharmacists, highlighting the interaction of individual choices and structural market forces in shaping compensation. These findings can inform workforce planning and guide the development of targeted job-related incentives to support retention and satisfaction across employment types.

Correction: Why Europeans (do not) leave part-time employment? A competing risks analysis

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that persists into adulthood, often impairing academic and social functioning. University students, particularly in medical fields, face substantial academic stress that may heighten vulnerability to ADHD symptoms. In Vietnam, limited evidence exists regarding ADHD prevalence among medical students. Objective: This study aimed to estimate the prevalence of ADHD risk among undergraduate students at Hanoi Medical University (HMU) in 2025 and to identify associated demographic, social, and academic factors. Methods: A cross-sectional survey was conducted among 181 students using a structured online questionnaire. ADHD risk was assessed with the Adult ADHD Self-Report Scale (ASRS v1.1). Sociodemographic and academic characteristics were analyzed using Chi-square tests and logistic regression to explore associations with ADHD risk. Results: Overall, 33.7% of participants screened positive for ADHD risk. Male students exhibited significantly higher prevalence compared to females (42.0% vs. 27.0%, p = 0.049). Academic program differences were marked, with General Medicine (63.2%) and Dentistry (69.2%) showing the highest risk, while Preventive Medicine students had the lowest (22.4%) (p = 0.0004). Logistic regression indicated female students were less likely to be at risk (OR = 0.51; 95% CI: 0.27–0.95). Other factors, including academic year, living arrangements, part-time employment, and prior mental health history, showed no significant associations. Conclusion: The prevalence of ADHD risk among HMU students was substantially higher than global estimates, underscoring an urgent need for awareness, early screening, and support services. Targeted interventions for high-risk groups, especially male students and those in clinically demanding programs, are recommended to safeguard academic performance and future professional well-being.

402 Background: Engagement with legal teams after a cancer diagnosis —medical-legal partnerships—can identify, prevent, and resolve health-harming legal needs (HHLNs), such as housing instability, employment concerns, medical debt, etc. Cancer Legal Care (CLC) is a nonprofit providing free legal services to persons affected by cancer in Minnesota. Methods: We conducted a single-arm, mixed-methods pilot study to assess the feasibility and acceptability of delivering legal support, and preliminary efficacy in addressing HHLNs to 20 adults with advanced stage colorectal cancer. CLC staff conducted an initial screening visit and provided structured as well as personalized legal support over the 6-month study period. These services encompassed a wide range of topics such as employment rights, insurance coverage or claims denial, eligibility for Social Security disability, and estate planning. We collected patient-reported outcomes (assessing comfort with health-related tasks, financial toxicity, stress, coping, and self-esteem) at baseline, 3, and 6 months and conducted end-of-study interviews to explore participant experiences. Results: Of the 20 participants enrolled, the median age was 52 years, 12 (60%) were male, 12 (60%) had full or part-time employment, and 8 (40%) had a household annual income of &lt; $25,000. Two patients were withdrawn due to death related to rapid disease progression. The study met pre-defined feasibility (90% of participants completing initial legal checkup visit, 90% remaining engaged at 3 months, 80% received at least 1 legal service) and acceptability (81% of participants recommended the intervention to others) benchmarks. For the 18 participants completing the initial visit, the visit lasted a median of 45 minutes, and 61% had self-identified HHLNs. Using a standard issue-spotting checklist, CLC attorneys identified additional HHLNs for 72% of participants, with a median of 3 total HHLNs per participant. The percentage of participants with moderate/severe financial hardship was high at baseline (70%) and decreased marginally to 63% at 6 months. Measures of stress, coping, and self-esteem remained relatively unchanged. Over the study period, participants expressed greater comfort with tasks such as addressing unexplained bills, guardianship planning, and ensuring insurance coverage. Participants endorsed high satisfaction with interpersonal relationships with CLC staff, felt empowered and supported, and suggested including their care partners in future work. Conclusions: Proactive legal care to address HHLNs through a medical-legal partnership was feasible, acceptable, and valued by patients with advanced colorectal cancer. Despite no requirement for baseline legal need, HHLNs were prevalent and addressable. This work provides essential data on the population, intervention, and outcomes to focus on in future studies assessing medical-legal partnerships. Clinical trial information: NCT06475664 .

Energy drinks, highly caffeinated beverages marketed to combat fatigue, are a global public health concern due to their association with adverse effects like insomnia and cardiovascular symptoms, particularly among young adults. Objective: To determine the prevalence, predictors, and self-reported health effects of energy drink consumption among university students in Pakistan. Methods: A cross-sectional online survey was conducted among 460 students at the University of the Punjab, Lahore. Data on consumption patterns, knowledge, and health effects were collected. First, bivariate analyses were performed to identify factors associated with frequent energy drink use. Subsequently, multivariable logistic regression was used to identify predictors of frequent energy drink use (≥3 times/week). The AOR from this test quantifies the strength of association between a predictor and the outcome, after controlling for the influence of other variables in the model. Results: The prevalence of current energy drink use was 175 (38.0%), with 22.9% of users classified as frequent consumers. Common consumption triggers were exam preparation (65.1%) and late-night studying (52.0%). Notably, 44.6% of users reported adverse effects, primarily insomnia (29.7%) and anxiety/jitters (18.2%). Knowledge about safe caffeine limits was low (28.5%). Significant predictors of frequent use included male gender (AOR=1.9; 95% CI: 1.1–3.3), residing in a university hostel (AOR=2.4; 95% CI: 1.4–4.2), and part-time employment (AOR=1.7; 95% CI: 1.0–2.9). Conclusions: The findings highlight an urgent need for targeted university-level health promotion interventions to educate students, particularly those in high-risk groups, about the potential dangers of energy drinks and to promote healthier alternatives for managing academic stress.

The Impact of Part-Time Employment on Grit and Academic Motivation of Secondary School Students in Lahore: A Qualitative Study

Multiple sclerosis (MS) is a chronic neurological condition that affects approximately 150 000 people in the UK and presents a significant healthcare burden, including the high costs of disease-modifying treatments (DMTs). DMTs have substantially reduced the risk of relapse and moderately reduced disability progression. Patients exhibit a wide range of responses to available DMTs. The Predicting Optimal INdividualised Treatment response in MS (POINT-MS) cohort was established to predict the individual treatment response by integrating comprehensive clinical phenotyping with imaging, serum and genetic biomarkers of disease activity and progression. Here, we present the baseline characteristics of the cohort and provide an overview of the study design, laying the groundwork for future analyses. POINT-MS is a prospective, observational research cohort and biobank of 781 adult participants with a diagnosis of MS who consented to study enrolment on initiation of a DMT at the Queen Square MS Centre (National Hospital of Neurology and Neurosurgery, University College London Hospital NHS Trust, London) between 01/07/2019 and 31/07/2024. All patients were invited for clinical assessments, including the expanded disability status scale (EDSS) score, brief international cognitive assessment for MS and various patient-reported outcome measures (PROMs). They additionally underwent MRI at 3T, optical coherence tomography and blood tests (for genotyping and serum biomarkers quantification), at baseline (i.e., within 3 months from commencing a DMT), and between 6-12 (re-baseline), 18-24, 30-36, 42-48 and 54-60 months after DMT initiation. 748 participants provided baseline data. They were mostly female (68%) and White (75%) participants, with relapsing-remitting MS (94.3%), and with an average age of 40.8 (±10.9) years and a mean disease duration of 7.9 (±7.4) years since symptom onset. Despite low disability (median EDSS 2.0), cognitive impairment was observed in 40% of participants. Most patients (98.4%) had at least one comorbidity. At study entry, 59.2% were treatment naïve, and 83.2% initiated a high-efficacy DMT. Most patients (76.4%) were in either full- or part-time employment. PROMs indicated heterogeneous impairments in physical and mental health, with a greater psychological than physical impact and with low levels of fatigue. When baseline MRI scans were compared with previous scans (available in 668 (89%) patients; mean time since last scan 9±8 months), 26% and 8.5% of patients had at least one new brain or spinal cord lesion at study entry, respectively. Patients showed a median volume of brain lesions of 6.14 cm3, with significant variability among patients (CI 1.1 to 34.1). When brain tissue volumes z-scores were obtained using healthy subjects (N=113, (mean age 42.3 (± 11.8) years, 61.9% female)) from a local MRI database, patients showed a slight reduction in the volumes of the whole grey matter (-0.16 (-0.22 to -0.09)), driven by the deep grey matter (-0.47 (-0.55 to -0.40)), and of the whole white matter (-0.18 (-0.28 to -0.09)), but normal cortical grey matter volumes (0.10 (0.05 to 0.15)). The mean upper cervical spinal cord cross-sectional area (CSA), as measured from volumetric brain scans, was 62.3 (SD 7.5) mm2. When CSA z-scores were obtained from the same healthy subjects used for brain measures, patients showed a slight reduction in CSA (-0.15 (-0.24 to -0.10)). Modelling with both standard statistics and machine learning approaches is currently planned to predict individualised treatment response by integrating all the demographic, socioeconomic, clinical data with imaging, genetic and serum biomarkers. The long-term output of this research is a stratification tool that will guide the selection of DMTs in clinical practice on the basis of the individual prognostic profile. We will complete long-term follow-up data in 4 years (January 2029). The biobank and MRI repository will be used for collaborative research on the mechanisms of disability in MS.

Summary: The escalating cost of medical education in the UK, set against austerity and financial crises, poses significant challenges for medical students. This paper examines financial pressures, increased living costs, and inadequate support schemes. It highlights the impact on students' mental well-being, academic performance, and the necessity of part-time employment, whilst critiquing widening participation schemes and financial uncertainties during clinical placements. Relevance: Understanding the financial pressures on medical students is crucial for policymakers, educational institutions, and support organisations. This commentary offers insights into these challenges, examining the inadequacies of support schemes and their impact on students' wellbeing and performance. It underscores the need for effective support systems and financial strategies to support students throughout their education. Take-home message: A more transparent and supportive financial structure is needed to ensure medical students can succeed in their education.

The present study investigates the multifaceted impact of part-time employment on the academic performance, well-being, and career readiness of college students. Drawing upon responses from 120 students, the research explores how variables such as job type, gender, working hours, and income levels influence students’ experiences. Findings reveal that while part-time jobs provide crucial financial support, foster independence, and enhance transferable skills such as communication, teamwork, and time management, excessive working hours negatively affect academic focus, health, and overall well-being. Temporary jobs are associated with greater skill acquisition and financial benefits compared to permanent roles, though they also impose heavier time and health burdens. Gender-based differences emerged, with female students reporting both higher benefits and greater challenges than their male peers. Similarly, higher-income students enjoyed greater financial and skill-related rewards but faced increased time pressure and health concerns. The study concludes that part-time employment is neither wholly advantageous nor detrimental; its effects depend on balance, job nature, and institutional support.

The number and scope of work of rheumatology specialists are crucial for the care of patients with inflammatory rheumatic diseases. We report on current developments in numbers of rheumatologists up to 2024. The number of internal medicine specialists in rheumatology is reported by age group, gender, field of activity, and scope of activity based on medical statistics from the German Medical Association (BÄK), the Federal Register of Physicians of the National Association of Statutory Health Insurance Physicians (KBV), basic data from hospitals, and extrapolated to the population figures of the Federal Statistical Office. As of 31 December 2024, there were 1161 practicing rheumatology specialists, of whom 531 (46%) were female and 386 (33%) were aged60 or older. The number and proportion of rheumatologists under the age of60 fell from 806 (73%) in 2020 to 775 (67%) in 2024. A total of 725rheumatologists were accredited to work in outpatientpractices for national health insurance patients. Of these, 301 (42%) were employed, an increase compared with 2020 (148 [30%]). In contrast, the number of licensed rheumatologists fell from 392 (57%) to 365 (50%). For every 100,000 adults in Germany, there were 1.7practicing rheumatologists, 1.0of whom was accredited to outpatientcontracted care, with regional variations ranging from0.8 in Saarland to1.6 in Brandenburg and Hamburg (persons, not full-time employees). Since 2018, the number of rheumatologists in hospitals has risen from 360 to 386 in 2023; part-time employment increased from 25% to 39%. The annual average number of full-time inpatient staff has fallen from 340 to 312. Between 2020 and 2024, atotal of 303 new rheumatology specialists were recognized, corresponding to an average of61 specialists per year. The decline in the number of younger rheumatology specialists, coupled with an increase in part-time work, is leading to adecrease in rheumatology capacity in Germany. The current rate of further training is not sufficient to compensate for the age-related retirement of rheumatologists, let alone the loss of full-time positions.

RPGR-Related Retinal Dystrophy in Latin America-A Collaborative Study.

The retention of front-line staff in retail has proven challenging. Simultaneously, there are high demands for performance, in a working environment that is often characterized as being detrimental to personal wellbeing. In this paper, we test hindering job demands and job resources as predictors of individual well-being and work-related attitudes and behavior. Retail employees may need to manage their own emotions (emotional dissonance) and can even be exposed to threats and harassment in face-to-face interactions with customers. As a sector with high levels of part-time employment, insecurity around working hours may be an important demand within retail that has not received much attention in previous research. We also consider the role of job resources, namely job control, social support from the supervisor, and possibilities for development. We investigate outcomes related to employees’ well-being (exhaustion), thoughts about leaving the job (turnover intention) and job performance through moderated hierarchical regression analyses with interaction terms. Data was collected cross-sectionally by electronic survey using established measures, in collaboration with a large union that operates in the Swedish retail sector. Emotional dissonance predicted all outcome variables, threats and harassment predicted exhaustion, and worktime insecurity predicted exhaustion and turnover intention. All job resources were significantly and directly related to the outcome variables, but job control showed the strongest negative relation with exhaustion, possibilities for development the strongest negative relation with turnover intention, and supervisory support was a strong positive predictor of job performance. The findings mainly confirm that job demands themselves need to be managed actively, and that job resources have to be present to directly protect wellbeing and performance, and prevent turnover intention. However, evidence for moderating effects of job resources in this sample was weak.