Study Participants Research Articles

Intraindividual variability of semen quality, proteome, and sncRNA profiles in a healthy cohort of young adults.

Within-subject variability of semen parameters and molecular components of ejaculates in young men remains poorly understood. To investigate intraindividual variability (IIV) of semen parameters and molecular markers in repeated ejaculates from young men. Semen parameters were assessed in samples collected 6-8 days apart from 164 18-19-year old participants of the Russian Children's Study, a prospective cohort. Subsets of paired samples were used for label-free quantitation and targeted mass-spectrometry of proteins in seminal plasma (SP) and seminal extracellular vesicles (EVs), and for small non-coding RNA (sncRNA) profiling in EVs and spermatozoa using RNA-seq. The mean difference between two ejaculates, within-subject variation, intraclass correlation, and concordance correlation were used to assess IIV for all parameters. Low variability with high reproducibility and high reliability was considered if CVw<15% and ICC>0.90, respectively. Analytical variability was low for all investigated parameters in technical replicates. IIV was assessed for basic semen parameters and proteins in SPs and EVs: 319 and 777 proteins, respectively, using untargeted analysis; 9 and 10 proteins using targeted quantification. We also described the IIV for sncRNA, including microRNA, piwi-interacting RNA, tRNA, and tRNA-derived small RNA (tsRNA) in EVs (409 sncRNA and 78 tsRNA) and in spermatozoa (265 sncRNA and 15 tsRNA). We identified 22 and 27 non-overlapping proteins in SP and EVs, respectively, and 46 and 9 sncRNA, including 5 and 0 tsRNA in seminal EVs and spermatozoa, respectively, with low variability. The fatty acid synthase (FAS) had the lowest IIV in both media in targeted protein quantification. We identified a number of proteins and sncRNA with low variability among 111 proteins, 176 sncRNA, and 12 tsRNA which were previously suggested as biomarkers of male fertility and reproductive outcomes: lactotransferrin, cysteine-rich secretory protein 3, alpha-1-antichymotrypsin, epididymal sperm-binding protein 1, glutathione S-transferase Mu 3, alpha-1-acid glycoprotein 2, serum amyloid P-component, aminopeptidase N, neprilysin, FAS, and miR-10b-3p, miR-122-5p, miR-205-5p, miR-222-3p, miR-34c-5p, miR-509-3-5p, miR-888-5p, miR-892a, miR-363-3p, miR-941, miR-146a-5p, miR-744-5p. These molecules have low IIV and may be promising candidate biomarkers of male fertility and reproductive health.

Exploring Correlates of Resource Insecurity Among Older Black or African Americans with HIV in Ohio.

Resource insecurity is a social determinant of health that can impact people with HIV (PWH), in particular older African Americans (AA) or blacks with HIV. The purpose of this study was to identify resource insecurities among older Blacks or AA PWH specifically related to food and housing. Secondary focus was to find associations between resource insecurity and substance use history, stigma, and various forms of discrimination. Eligible participants (N = 52) of this cross-sectional study were 50years old or older, identified as Black or AA, diagnosed with HIV, and living in Ohio. Food insecurity was assessed using the Household Food Insecurity Access Scale and housing insecurity was defined as not having stable housing. Resource insecurity was categorized into food and housing secure, food or housing insecure, and food and housing insecure. Almost half (48.1%) of participants reported housing insecurity, with approximately 58.0% experiencing food insecurity, and 38.5% facing both. Current substance use, particularly opiates, showed significant association with resource insecurity (OR = 5.54; 95% CI = 1.91-17.30). Moreover, experiences of everyday (OR = 1.19; 95% CI = 1.10-1.30) or major forms (OR = 1.75; 95% CI = 1.33-2.39) of discrimination, as well as HIV stigma (OR = 1.24; 95% CI = 1.01-1.55), were also linked to increased odds of resource insecurity among participants. Findings highlight how social factors contribute to resource insecurity among older AA PWH. Understanding the factors offers insight for targeted intervention in the fight against HIV transmission.

Determinants of stroke among adult hypertensive patients on follow up in Addis Ababa public hospitals, Ethiopia: A case control study.

Stroke is a non-communicable disease that causes sudden global or focal neurological disorders. It is one of the major public causes of morbidity and mortality in low- and middle-income countries, including Ethiopia. Early identification of the determinants and prompt intervention remains critical to reduce morbidity and mortality from stroke. The study aimed to identify determinants of stroke among adult hypertensive patients on follow up in Addis Ababa public hospitals, Ethiopia. Unmatched case-control study design was conducted among 326(109 cases and 217 controls) study participants in Addis Ababa public hospitals from September 1-30, 2021. The cases were adult hypertensive patients who developed a stroke and the controls were adult hypertensive patients. The study participants were selected by consecutive sampling technique. Pretested structured interviewer assisted questionnaire and checklist were used to collect data. Data were entered into Epi data version 3.1; exported and analysed by SPSS version 23. All independent variables with p-value < 0.25 in the bi-variable logistic regression analysis were entered into multivariable logistic regression analysis. Finally, variables with p-value <0.05 were considered as determinants of the stroke. In this study, current cigarette smoker(AOR = 5.55, 95% CI: 2.48, 12.43), current alcohol drinker(AOR = 4.27, 95% CI: 1.94, 9.38), medication non-compliance(AOR = 3.23, 95% CI: 1.62, 6.44), uncontrolled systolic blood pressure (AOR = 3.42, 95% CI: 1.64, 7.16), uncontrolled diastolic blood pressure(AOR = 4.29, 95% CI: 2.06, 8.93), high low density lipoprotein(AOR = 6.89, 95% CI: 3.57, 13.35) and diabetic mellitus(AOR = 3.25, 95% CI: 1.58, 6.69) were more likely to develop a stroke. Cigarette smoking, alcohol use, non-adherence to medication, uncontrolled systolic pressure, uncontrolled diastolic blood pressure, high low-density lipoprotein, and diabetic mellitus were determinants of stroke. Providing health education about lifestyle changes and the consequences of hypertension at all follow-up is very important.

Importance of Internship Programs as a Strategy to Impart Experiential Learning on Graduate

Orientation: Internship prgrma is a training programs designed to equip students and graduates with work experience and skills. Internship programs has been implemented in various fields and has proved to be effectiveal also in public administration. Research purpose: The stusy proposes using internship programs as a strategt to provide experiential learning to graduates in the Limpopo Department of Education. Motivation of the study: There is a need to understand the role internship programs plays in graduates careers, as it will inform the policy makers in the Department to influenve a planning strategy for effectoive internshop programs. Research approach/design and method: The study used a Mixed Methods Approach, which included both qualitative and quantitative methods. A convergent parallel design was used, allowing data to be collected using both methods to gain a comprehensice understanding of the phenomenon. The study's participants include officials and interns from the Limpopo Department of Education's head office in Polokwane. The sample consists of 190 respondents. Data were gathered through close-ended questonnaire and open-ended interview questions. Dara were analysed thematically and descriptive statistics. Main findings: Research results indicate that 47% of respondents believe that internship programs are crucila for the Department in facilitating experientiallearning for graduates. The styd also found that interns can gain skills and experience that will help them kand a job at the end of internship program. Practical implications: The study concludes that effecrive internships require strategic department planning, as they significantly shape futureskilled and competent employees. Contribution/add value: The study adds value to ehnace PublicADministrayion in policy making by generaring and dissemenating new knowlese and ideas about internship programs.

Burnout and resilience among physical therapy students: a cross-sectional study.

This study aimed to examine the prevalence of burnout, determine burnout-related factors, investigate resilience levels, and assess the relationship between burnout and resilience among physical therapy (PT) students at King Saud University (KSU) in Saudi Arabia. This cross-sectional study involved 153 PT students studying at KSU between January and March 2023. The participants completed an online questionnaire, a Maslach Burnout Inventory, and a Brief Resilience Scale. Low-to-moderate levels of Emotional Exhaustion (EE) were observed in 85% of the participants and high Depersonalization (DP) levels were reported by 34.2%. Female participants reported higher levels of EE and DP, whereas males had a greater prevalence of low Personal Achievement (PA) levels. Approximately 6.5% of the study participants reported high burnout levels (a combination of high DP, high EE, and low PA). Academic stress, followed by sleeping difficulties and changes in the academic year structure, were the most important factors contributing to higher levels of burnout (75.2%, 56.9%, and 43.8%, respectively). Most study participants around (66.0%) reported normal resilience levels. A significant correlation was detected between resilience and 2 domains of burnout (DP and PA), with the correlation being negative and weak for DP and positive and moderate for PA. Overall, low-to-moderate levels of burnout were observed among the PT students who took part. Related factors that contributed to burnout were academic stress, sleeping difficulties, and academic year structure. A normal level of resilience was found to be significantly related to DP and PA but not to EE on the burnout subscales. Higher levels of resilience can be considered to play a protective role against burnout among PT students. Med Pr Work Health Saf. 2024;75(4).

Supporting Students’ Physical Activity Self-Efficacy within High School Physical Education

Research examining physical activity (PA) is significant because of the known benefits of PA. Studying high school (HS) students is particularly important due to the consistent decline in PA as students age. One strategy to increase PA is to increase someone’s self-efficacy (confidence) to be physically active which is commonly positively associated with PA. Most of the research on how to support physical activity self-efficacy (PASE) comes from outside-of-school interventions with minimal literature on how to support students’ PASE within HS physical education (PE). This study attempted to identify and share practices that current HS PE teachers were implementing to support students’ PASE and further develop previous recommendations to support PASE. The study participants were 14 current HS PE teachers that participated in one individual semi-structured interview that lasted approximately 50-60 minutes. Interview questions were designed to ask participants about their daily in-person class routines and how they support PASE based on the four sources of self-efficacy. The results include three themes to assist in supporting HS students’ PASE which include: (a) Maximizing initial success, (b) Redefining success, and (c) Increasing PA awareness and monitoring. All themes and examples coincide with previous recommendations on how best to support PASE. PE teachers have the opportunity to design PA experiences that maximize the chances of students interpreting their experiences as successful and allow students to manage their PA participation. Implementing these types of strategies can hopefully increase students’ overall participation in PA by supporting their PASE.

The Relationship between Mindfulness Level and some Demographic Variables among Students of University

This study aimed to reveal the levels of mindfulness among the study participants and to examine the differences in the levels of mindfulness among the participants according to three demographic variables, namely gender, type of college, and academic level, and the interactions between these variables. In total, 275 university students in the Kingdom of Saudi Arabia participated in the study. Using a random sample, data were collected using a mindfulness scale. Based on the results of the study, it can be concluded that the participants had an average level of mindfulness. The findings also revealed no differences in mindfulness attributable to gender, type of college, or academic level or the interactions between all these variables. The study’s results can provide benefits by increasing young people’s awareness of the importance of alertness and presence of mind for a healthy life, in addition to generating interest in organizing training programs inside or outside universities, aimed at improving students’ levels of mindfulness and providing intensive training.

Plasma N-terminal pro-brain natriuretic peptide concentrations may help to identify patients with very low-risk acute pulmonary embolism: A preliminary study.

Patients with an acute pulmonary embolism (APE) are a heterogeneous group, and some of them may benefit from early discharge and an ambulatory care referral. We aimed to evaluate the use of N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level assessment in patients with low-risk APE based on clinical findings (0 points on the simplified Pulmonary Embolism Severity Index (sPESI)). Preliminary analysis of an ongoing prospective study including 1,151 normotensive patients with at least a segmental APE. In the final analysis, 348 patients with a 0-point sPESI were included. Blood samples were collected within the first 24 h of admission. The clinical endpoint (CE) included APE-related mortality and/or rescue thrombolysis in patients with clinical deterioration. Clinical endpoints occurred in 3 patients who had higher plasma NT-proBNP levels than study participants with a favorable clinical course (164 [64-650] pg/mL compared to 2,930 [2,285.5-13,965] pg/mL; p = 0.01). Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) for NT-proBNP for the prediction of the CEs was 0.918 (95% confidence interval [95% CI]: 0.831-1.00; p = 0.013). We defined the cutoff value of NT-proBNP at ≥1,641 pg/mL. Among subjects with 0 points on the sPESI, those with concentrations of NT-proBNP exceeding 1,641 pg/mL might require closer attention; remaining patients could be considered candidates for outpatient treatment. However, these findings warrant further investigation in a large, prospective group of patients.

Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies.

Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user.

How do high-achieving students learn languages online?

The impact of language learning strategy use on achievement has been extensively researched in the traditional foreign language classroom. However, little is known about this topic in the context of online learning. In addition, previous research has focused primarily on English as a foreign or second language. This study fills these gaps by investigating the use of language learning strategies by students taking a beginner-level online course in a foreign language other than English at a Swedish university. The study examined the extent to which students used language learning strategies, whether age was related to the use of language learning strategies, and whether language learning strategy use increased the likelihood of foreign language achievement, operationalised as receiving the highest final course grade. Participants (n= 108), aged 19–76 years (M = 37.6), completed the Strategy Inventory for Language Learning (Oxford, 1990). Three main findings emerged from the study. First, the students used metacognitive strategies most frequently, which could be explained by the fact that the online format requires great learner autonomy. Second, age was negatively but weakly related to the use of memory and affective strategies. Third, the use of cognitive strategies significantly increased the likelihood of foreign language achievement almost tenfold. Thus, this category of strategies appeared to be a strong predictor of achievement among the study participants.

Effect of Oral Nutritional Supplementation on Health-Related Outcomes and Nutritional Biomarkers in Children and Adolescents with Undernutrition: A Systematic Review and Meta-Analysis

This systematic review aims to synthesize scientific evidence on the effects of oral nutritional supplementation (ONS) on health-related outcomes and nutritional biomarkers among children and adolescents with undernutrition. The review protocol was reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive keyword and reference search was conducted in seven electronic bibliographic databases: PubMed, Academic Search Complete, Academic Search Premier, CINAHL, Global Health, Web of Science, and Scopus. We identified 14 peer-reviewed articles reporting results from 13 unique studies (eight randomized controlled trials, four pre-post studies, and one observational study). Study participants were recruited from 14 countries/regions, with ages ranging from 1 to 14 years. Outcomes of interest include health-related outcomes (acute diseases and infections) and nutritional biomarkers (e.g., serum iron and zinc). Six of the eight studies examining acute diseases/infections and five of the seven examining nutritional biomarkers reported statistically significant improvement in some, but not all, outcomes. A meta-analysis of three studies found that ONS interventions reduce the incidence of upper respiratory tract infection (URTI) by 39% (95% CI, 0.42–0.91) in children at nutritional risk when compared to dietary counseling (DC) alone. This systematic review suggests that ONS interventions can improve certain health-related outcomes and nutritional biomarkers in undernourished children and adolescents. Specifically, the use of ONS significantly reduces the risk of URTI, highlighting its potential to enhance immune function and break the cycle of undernutrition and infection.

Healthy eating in globalized food environments: market access and consumer behavior in the Galápagos Islands of Ecuador

Abstract Food environments are the interface between food systems and consumers. Although market access contributes to diet intake, consumer behavior determines food acquisition practices yet is often neglected in food environment research. Implementing sustainable food system transformations in climate-vulnerable, trade-dependent settings requires effective integration of both geographic and experienced-based measures of access. This study in the Galápagos Islands (i) develops measures for geographic and experience-based food environments (EFEs) and (ii) links diet outcomes to these food environment measures independently and when interacted. Cross-sectional household data including diet recalls come from 388 participants in the Healthy Family Study from San Cristóbal Island, Galápagos in 2018. Geocoded market inventory and price data were obtained in 2018 using the Nutritional Environment Measurement Survey for Stores (n = 60). Geographic food environments were created from market scores and distribution. EFEs were based on factor analyzed consumer behavior strategies. Diet quality was defined using the global dietary recommendations score. Adjusted linear regressions tested the relationships between diet and food environment measures and included sociodemographic covariates. Interactions between geographic and EFEs were tested. This study showed that higher prioritization of convenience when food shopping was associated with lower healthy food intake. However, the relationship between food environment measures and diet is strongly modified by consumer behavior. For convenience-prioritizing households, the nearest market proved most associated with healthy diet outcomes. For households with a food-driven purchasing strategy, the preferred market was most associated with healthy diet outcomes. These findings show that market inventory can be healthful or deleterious to diets, depending on how individuals navigate their food environments. Empirical measures of food access that neglect to consider consumer behavior may fail to capture realistic representations of food environment and diet relationships. These findings underscore the importance of tailoring food system changes to incorporate context-specific consumer behavior.

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study.

The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched. To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives. Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction. Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

History of infertility and anti-Müllerian hormone levels among participants in the Nurses' Health Study II.

To better understand whether history of infertility is associated with anti-Müllerian hormone (AMH) levels later in life, outside of reproduction. Among 1,758 premenopausal women in the Nurses' Health Study II with measured AMH, we used multivariable generalized linear models to compare log-transformed plasma AMH for women with a history of infertility compared with fertile women. We investigated AMH levels by cause of infertility and effect modification by menstrual cycle regularity. Lastly, we investigated AMH levels by history of primary and secondary infertility and age at reported infertility. Mean age at blood collection was 40 years. We observed no association between overall history of infertility and AMH levels (% difference AMH: -8.1% [CI, -19.4 to 4.8]). The association between overall infertility and AMH was strongest among women who first reported infertility at >30 years (-17.7% [CI, -32.1 to -0.3]). Overall, we observed no association between the history of infertility and AMH levels later in life. However, specific subgroups of women with a history of infertility may have lower AMH levels throughout life compared with fertile women. This association was observed among subgroups, such as those who first experienced infertility at >30 years. These findings have implications for mechanisms through which infertility may be associated with premature menopause and chronic disease risk.

The longitudinal study of the relationship between social participation pattern and depression symptoms in frail older adults

BackgroundMental health challenges are encountered by frail older adults as the population ages. The extant literature is scant regarding the correlation between depressive symptoms and social participation among frail older adults.MethodsThis study is based on an analysis of data from China Health and Retirement Longitudinal Study (CHARLS) participants aged 60 and older who are frail. A frailty index (FI) was developed for the purpose of assessing the frailty level of the participants. Additionally, latent class analysis (LCA) was employed to classify the participants’ social engagement patterns in 2015 and 2018. The study used ordered logistic regression to examine the relationship between social participation type and depressive symptoms. We also used Latent Transition Analysis (LTA) methods to explore the impact of changes in social activity types on depressive symptoms after three years of follow-up in 2018. In addition, the response surface analysis (RSM) investigation explored the relationship among FI, depression, and social participation.ResultsA total of 4,384 participants completed the baseline survey; three years later, 3,483 were included in the follow-up cohort. The baseline survey indicates that female older adults in rural areas who are single, have lower incomes, shorter sleep durations, and lighter weights exhibited more severe depressive symptoms. Social participation patterns were categorized into five subgroups by LCA. The findings indicate that individuals classified as “board game enthusiasts” (OR, 0.62; 95% CI, 0.47-0.82) and those as “extensive social interaction” (OR,0.67; 95% CI, 0.49-0.90) have a significantly lower likelihood of developing depressive symptoms compared to the “socially isolated” group. We also discovered that “socially isolated” baseline participants who transitioned to the “helpful individual” group after three years had significantly greater depressed symptoms (OR, 1.56; 95% CI, 1.00-2.44). More social activity types and less FI are linked to lower depression in our study.ConclusionThe results of the study emphasize the importance of social participation patterns and the number of social participation types in relation to the severity of depression among frail older adults individuals. This study’s findings may provide important insights for addressing depressive symptoms in frail older adults person.

Breakfast consumption and associated factors and barriers among school-aged children

BackgroundBreakfast provides the energy and nutrition we need to function at best, both mentally and physically. It is also plausible to propose that children’s general development is impacted when they skip breakfast.ObjectiveTo assess the prevalence of breakfast consumption and associated factors and predictors among public primary school children in Debremarkos Town, Northwestern Ethiopia, 2020.MethodsA community-based cross-sectional study was conducted among school-aged children in Debremarkos, Northwest Ethiopia. A multistage random sampling technique was used to select 609 study participants. The children’s parents were interviewed using a pretested, structured questionnaire. For the rest of the analysis, SPSS version 20 was used. Logistic regression analysis was performed to assess the factors associated with breakfast consumption. Statistical significance was determined at a p value &amp;lt;0.05.ResultsOut of the sampled children, 600 respondents participated in the study, for a response rate of 98.5%. The prevalence of regular breakfast consumption among school-aged children was 67.5%. Higher odds of regular breakfast consumption were found among respondents who were females (AOR = 1.72, 95% CI = 0.118–1.773), those who lived in high-income families (AOR = 7.33, 95% CI = 1.036–8.110), and those who had an educated family (AOR = 13.05, 95% CI = 0.019–13.1). However, lower odds of regular breakfast intake were found among respondents aged 9–12 years (AOR = 0.54, 95% CI = 0.369–0.79).ConclusionBreakfast is a major health concern for school-aged children in Debremarkos city. Breakfast eating is associated with several factors; the most notable factor is being female, having a high income, and having an uneducated family. Therefore, to prevent children from skipping breakfast, stakeholders must move swiftly.

“Transgenders are not dinosaurs!” Stigma faced by transgender women in their daily lives in India: implications for research and policy

Background Transgender women face stigma that adversely impacts their mental wellbeing. The stigma can be self-directed (internal), discrimination, violence and hatred directed towards them by others, mostly cis-gender persons (interpersonal stigma) and discrimination faced at the level of institutional arrangements (structural stigma). Methods This was an exploratory study that used qualitative methods of data collection (focused group discussions and in-depth interviews) to gather data from consenting adult trans women who lived in the city of Kolkata situated in the eastern state of West Bengal in India. Results The findings showed that trans women faced the trauma of non-acceptance and even rejection by their families when they began to express their chosen gender. Their gender non-conforming behaviour made them the butt of ridicule and harassment in school, resulting in many of them not finishing school. This made finding employment difficult. The trans women study participants also faced harassment at the hands of the police and from hospital staff, making them reluctant to approach the police for help and seek treatment from health providers for their physical as well as mental health concerns. Conclusions It is important for researchers to be cognizant of the challenges faced by trans women/transgender people while designing and conducting research. It is also important for policymakers to make gender affirming policies to mitigate and eliminate the stigma that transgender people are subject to thereby promoting their wellbeing.

Vitamin D status and intermediate vascular and bone outcomes in chronic kidney disease: a secondary post hoc analysis of IMPROVE-CKD.

Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD) and has been associated with abnormalities of mineral metabolism and vascular calcification. Vitamin D influences parathyroid hormone values and calcium and phosphate metabolism, and may play a role in vascular function and bone health. We aimed to test our hypothesis that vitamin D deficiency is associated with arterial stiffness, aortic calcification and lower bone mineral density (BMD) in patients with CKD. A cross-sectional analysis was performed using baseline data from the IMpact of Phosphate Reduction On Vascular Endpoints in CKD (IMPROVE-CKD) study cohort. Clinical and laboratory parameters were compared between those with and without vitamin D deficiency, defined as 25-hydroxyvitamin D (25(OH)D) <50 nmol/L. Univariable and multivariable linear regression analyses were performed to assess associations between serum 25(OH)D levels and pulse wave velocity (PWV), augmentation index (AIx), abdominal aortic calcification (measured by the Agatston score) and lumbar spine BMD. Baseline 25(OHD) values were available in 208 out of 278 IMPROVE-CKD study participants, with a mean value of 70.1 ± 30.7 nmol/L. Of these, 57 (27%) patients had vitamin D deficiency. Those with 25(OH)D deficiency were more likely to have diabetes (56% vs 38%), cardiovascular disease (54% vs 36%) and lower serum calcium (2.29 ± 0.13 vs 2.34 ± 0.13 mmol/L). On univariable and multivariable regression analyses, baseline 25(OH)D values were not associated with PWV, the AIx, Agatston score or BMD. Baseline 25(OH)D levels were not associated with intermediate markers of vascular function and BMD in patients with CKD stages 3b and 4.

Metabolic dysfunction and incidence of heart failure subtypes among Black individuals: The Jackson Heart Study.

The extent to which metabolic syndrome (MetS) severity influences subclinical myocardial remodelling, heart failure (HF) incidence and subtypes, remains unclear. We assessed the association of MetS with incident HF (including ejection fraction subtypes) among Black individuals. We included 4069 Jackson Heart Study participants (mean age 54.4 years, 63.8% women, 37.2% with MetS) without HF. We categorized participants based on MetS status and MetS severity scores (based on waist circumference [MetS-Z-WC] and body mass index [MetS-Z-BMI]). We assessed the associations of MetS indices with echocardiographic parameters, biomarkers of myocardial damage (high-sensitivity cardiac troponin I [hs-cTnI] and B-type natriuretic peptide [BNP]) and incident HF hospitalizations including HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). MetS severity was associated with subclinical cardiac remodelling (assessed by echocardiographic measures and biomarkers of myocardial damage). Over a median of 12 years, 319 participants developed HF (157 HFpEF, 149 HFrEF and 13 HF of unknown type). MetS was associated with a twofold greater risk of HF (hazard ratio [HR] 2.07, 95% confidence interval [CI] 1.64-2.61). Compared to the lowest quartile (Q1) of MetS-Z-WC, the highest quartile (Q4) conferred a higher risk of HF (HR 2.35, 95% CI 1.67-3.30), with a stronger association for HFpEF (Q4 vs. Q1: HR 4.94, 95% CI 2.67-9.14) vs. HFrEF (HR 1.69, 95% CI 1.06-2.70). Metabolic syndrome severity was associated with both HF subtypes among Black individuals, highlighting the importance of optimal metabolic health for preventing HF.

"I felt so small": A qualitative study of migrant nursing assistants' experiences in Norway.

In the wake of an increasingly ageing population, Norway has a growing need for healthcare workers, especially in nursing homes. This study explored the employment experiences of migrant nursing assistants working in elderly care in Norway. A qualitative interview-based study was carried out between March and August 2020. In-depth, semi-structured interviews were performed with 13 purposively selected immigrant nursing assistants working in a nursing home within Western Norway. Data were thematically analysed. Migrant nursing assistants working in Norwegian elderly care faced mixed experiences. On the one hand, study participants experienced several barriers in their workplace, resulting from insufficient command of the Norwegian language, heavy workload and mistreatment and discrimination by both patients and colleagues. On the other hand, participants cited the financial compensation from work, the meaningfulness derived from helping others and the flexible day-off requests as workplace facilitators. Participants also made continuous efforts to learn the Norwegian language and to build good relations with their co-workers. There is a need to enhance migrant nursing assistants' positive experiences in the Norwegian eldercare sector by making targeted workplace reforms and fostering a supportive and inclusive environment.