Preventive Interventions Research Articles

Qualitative and optimal control analysis of a two-serotype dengue model with saturated incidence in co-infection

ABSTRACT The arboviral disease dengue is a life-threatening global public health problem due to its high prevalence rate, morbidity and mortality. Recent studies suggest that morbidity during secondary dengue infection is higher than during primary infection. To deepen our understanding, we have explored a two-serotype co-infected dengue model with bilinear incidence for primary infection and saturated incidence for secondary infection. In the model, we have also included four control measures: mosquito bite prevention control, treatment control, vaccine control and mosquito killing control. The existence and local stability of the disease free, serotype II free, serotype I free and endemic equilibrium points have been studied. The effect of inhibitory or awareness factors on disease dynamics has also been exhaustively examined. By using sensitivity analysis we have identified and quantified the most influential parameters to prevent as well as to control the dengue outbreak. To optimize our strategies, we have characterized the time-dependent optimal control to reduce dengue prevalence and the total implementation cost of the aforementioned controls. Efficiency analysis has been done to identify the best effective combination of the applied controls to reduce dengue infection. Mosquito bites with treatment control is the most effective combined strategy to control dengue infection.

Comparative analysis of the efficacy of different treatment strategies in medication overuse headache: an open-label prospective trial

Medication overuse headache (MOH) is a common form of chronic headache with a high risk of relapse after therapy. Excessive use of analgesics most frequently leads to the development of MOH in migraine patients.Objective: to analyze the short- and long-term efficacy of MOH therapy in patients with chronic migraine (CM) using different programs to discontinue the abused drug and a detoxification regimen.Material and methods. The study included 44 patients with MOH and CM who were divided into two groups. Group A comprised 18 patients who discontinued the drug that triggered MOH and were simultaneously prescribed preventive treatment for migraine without undergoing "detoxification" therapy". Group B comprised 26 patients who received a multimodal therapeutic strategy including "detoxification treatment".Results. The strategy of complex therapy with a "detoxification treatment" was significantly more effective during the 12-month observation period. In group B, a significant (p<0.01) decrease in the number of days with migraine per month was observed (before therapy – 22.6±7.4 days, after 3 months – 15.1±8.9 days, after 6 months – 12.7±9.1 days and after 12 months – 10.2±8.7 days). In the first 6 months, a similar dynamic was observed in group A, whereby the frequency of migraine increased in the 12th month of observation. Twelve months after the start of therapy, migraine occurred in episodes in the majority (84%) of patients in group B, which is significantly more than in group A (58.9%; p<0.01).Conclusion. A comprehensive approach in the treatment of patients with CM and MOH with "detoxification" therapy" showed high efficacy in terms of reducing the number of headache days per month and converting CM to episodic migraine.

Promise and Peril of a Genotype-First Approach to Mendelian Cardiovascular Disease.

Precision medicine, which among other aspects includes an individual's genomic data in diagnosis and management, has become the standard-of-care for Mendelian cardiovascular disease (CVD). However, early identification and management of asymptomatic patients with potentially lethal and manageable Mendelian CVD through screening, which is the promise of precision health, remains an unsolved challenge. The reduced costs of genomic sequencing have enabled the creation of biobanks containing in-depth genetic and health information, which have facilitated the understanding of genetic variation, penetrance, and expressivity, moving us closer to the genotype-first screening of asymptomatic individuals for Mendelian CVD. This approach could transform health care by diagnostic refinement and facilitating prevention or therapeutic interventions. Yet, potential benefits must be weighed against the potential risks, which include evolving variant pathogenicity assertion or identification of variants with low disease penetrance; costly, stressful, and inappropriate diagnostic evaluations; negative psychological impact; disqualification for employment or of competitive sports; and denial of insurance. Furthermore, the natural history of Mendelian CVD is often unpredictable, making identification of those who will benefit from preventive measures a priority. Currently, there is insufficient evidence that population-based genetic screening for Mendelian CVD can reduce adverse outcomes at a reasonable cost to an extent that outweighs the harms of true-positive and false-positive results. Besides technical, clinical, and financial burdens, ethical and legal aspects pose unprecedented challenges. This review highlights key developments in the field of genotype-first approaches to Mendelian CVD and summarizes challenges with potential solutions that can pave the way for implementing this approach for clinical care.

The application effect of preventive nursing intervention in patients with traumatic flail chest: A retrospective study.

This retrospective study explores the intervention effect of preventive nursing on participants with traumatic flail chest caused by multiple rib fractures. In this study, 92 patients with multiple rib fractures from a certain hospital from July 2020 to June 2022 were chosen as the research subjects. They were divided into research group and a control group according to different nursing methods. The control group received routine care. The research group received preventive care on the basis of the control group. Then, questionnaire survey was collected to evaluate the quality of life, pain degree, psychological state, complications, and lung function recovery of patients before and after nursing. In the quality of life score, before nursing, the scores of the research group and the control group were between 52 and 69, and the difference among the participants in the experiment did not possess statistical significance (P > .05). After nursing, the scores of the research group were markedly superior to the control group, and all scores possessed statistical significance (P < .05). In the pain score, the pain scores of the research group and the control group before preventive nursing were 7.87 ± 0.86 and 7.68 ± 0.75, respectively, and the difference among the participants in the experiment did not possess statistical significance (P > .05). After 6 months of nursing, the pain scores of the participants in the experiment were 2.84 ± 0.69 and 3.04 ± 0.72, respectively. The difference among the participants in the experiment possessed statistical significance (P < .05). In the Hamilton Anxiety Scale, the psychological state scores of the experimental group and the control group before intervention nursing were 52.87 ± 4.97 and 51.74 ± 4.56, respectively, and the scores after intervention nursing were 22.68 ± 4.69 and 36.87 ± 5.21, respectively. The difference among the participants in the experiment possessed statistical significance (P < .05). Preventive nursing interventions can improve long-term quality of life, significantly alleviate postoperative pain, decrease the incidence of postoperative complications, as well as enhance nursing satisfaction in patients with traumatic flail chest.

Evaluation of the information quality related to osteoporosis on TikTok

BackgroundOsteoporosis is currently considered the most common bone disease in the world and is characterized by low bone mass, deterioration of the bone tissue microstructure, and decreased bone strength. With the increasing popularity of smartphones and short videos, many patients search for various types of health information through social media, such as short videos. As one of China’s short video giants, TikTok has played a significant role in spreading health information. We found that there are many videos about osteoporosis on TikTok; however, the quality of these short videos has not yet been evaluated.ObjectiveThe purpose of this study was to evaluate the information quality of osteoporosis videos on the domestic TikTok platform.MethodsWe retrieved and screened 100 videos about osteoporosis from TikTok, extracted the basic information, encoded the video content, and recorded the source of each video. Two independent raters evaluated the information quality of each video via the DISCERN rating scale.ResultThe videos were divided into three groups according to their source: medical personnel, science communicators, and news media, with medical personnel posting the most videos. The content of the video is divided into 7 groups, namely, disease prevention, disease diagnosis, disease symptoms, disease overview, life-style, drug knowledge, and drug treatment, with the most videos related to disease overview. The average DISCERN score of the videos is 37.69 (SD = 6.78), mainly within the ‘poor’ (54/100, 54%) and ‘appropriate’ (43/100, 43%) rating ranges, with overall quality being low. Further analysis revealed a positive correlation between the number of shares, comments, likes, and favorites, and a positive correlation between the DISCERN score and the number of shares and favorites.ConclusionThe overall quality of videos concerning osteoporosis on TikTok is lower, but the quality of videos varies significantly across different sources. We should be selective and cautious when watching videos about osteoporosis on TikTok.

Heart rate variability indices for predicting cardiorenal outcomes: A lesson from the PERL and ACCORD cohorts.

This commentary highlights the role of heart rate variability (HRV) indices in predicting diabetic kidney disease (DKD) progression, based on findings from the PERL and ACCORD trials. HRV-derived measures from routine ECGs are shown to be strong predictors of rapid kidney function decline in both type 1 and type 2 diabetes, suggesting their potential utility in identifying individuals at high risk for DKD and guiding early preventive interventions.

Bidirectional associations between parenting stress and coparenting: A longitudinal actor-partner interdependence analysis.

Although parents' parenting stress has been found to be related to coparenting, existing research has mostly focused only on one parent or examined the unidirectional effects between the two factors. The present study investigated the actor and partner effects as well as the bidirectional association between parents' parenting stress and coparenting in Chinese society. The study participants were 522 Chinese father-mother dyads with elementary school-aged children who followed for two measurement occasions (half a year apart). The cross-lagged actor-partner interdependence model (APIM) was used to examine the actor effects and partner effects in the bidirectional associations between both parents' parenting stress and coparenting. The findings revealed that both fathers' and mothers' parenting stress significantly negatively predicted their spouses' coparenting (partner effects), and mothers' coparenting significantly negatively predicted their spouses' parenting stress (partner effects). However, the actor effects between parents' parenting stress and coparenting were not significant. Furthermore, there were significant bidirectional associations between fathers' parenting stress and mothers' coparenting. Findings from the present study reveal the dynamic interaction between parenting stress and coparenting. The results point to the need for providing preventive interventions to parents with high levels of parenting stress and establishing a collaborative interaction framework between parents.

Patterns of care contacts in the final year of life among opioid overdose fatalities in southern Sweden: a latent class analysis

BackgroundUnderstanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life.MethodsA retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life.ResultsThree distinct classes were identified: “Few care contacts,” with limited interaction with any services; “Social service contacts,” comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and “Numerous care contacts,” with extensive contacts with both healthcare and social services. The “few care contacts” class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support.ConclusionsUsing a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts.

Intermittent Preventive Treatment of Malaria in Pregnancy and the Impact on Neonates in African Countries as Assessed by Entropy Weight and TOPSIS Methods.

Background/Objectives: In regions of Africa with a high prevalence of malaria, pregnant women in their first or second trimester should be administered intermittent preventive treatment in pregnancy (IPTp). However, infants may contract malaria despite the IPTp therapy that their mothers have received. The objective of the present investigation was to assess the symptoms and various treatments for neonatal malaria. Methods: Entropy weight and TOPSIS were used to achieve the study goal. The TOPSIS multi-attribute decision-making system was used to assess newborn malaria symptoms and select the optimal treatment, even for mothers receiving IPTp medication during pregnancy. The entropy weight approach calculated TOPSIS attribute weights. The present research used UNICEF data for 14 African nations in 2023. Results: The results indicated that neonates whose mothers received IPTp therapy ultimately contracted malaria, with diarrhea being the primary symptom. It is important to note that health providers administer a combination of zinc and oral rehydration solution (ORS) to infants as the most effective treatment for malaria symptoms, thereby abandoning the first-line treatment for malaria, artemisinin-based combination therapy (ACT). Conclusions: The most effective treatment for neonatal malaria is a combination of zinc and ORS, although less than half of children in Africa have access to ORS. Therefore, the findings of this study may encourage African countries to prioritize co-pack therapy in their procurement and supply, healthcare provider training, and expenditures. This therapy will also help alleviate the symptoms of malaria in neonates.

Managing COVID-19 outbreaks in prisons - a brief review of literature and key lessons learnt.

During the COVID-19 pandemic, prisons faced a unique challenge of preventing and managing outbreaks with minimal adverse impact. This study aims to describe the epidemiology of COVID-19 in prisons, identify lessons learnt and make recommendations. The authors used the PubMed advanced search function using MeSH terms; (coronavirus, sars) AND (prisons) AND (disease outbreaks). The authors included original research reporting COVID-19 outbreaks in prisons. All other types and non-English publications were excluded. The authors used a structured data abstraction template to extract data systematically, and a second author independently abstracted data from 10% of the papers for quality assurance. The search yielded 96 hits. The authors included 15 studies meeting the inclusion criteria. These studies were from four countries. Seven studies reported individual outbreaks. The mean and median number of inmates and staff were 1,765, 1,126 and 575, 510. The mean and median number of cases among inmates and staff were 584, 464, and 72, 77. The number of reported deaths varied from 0 to 11. The authors present the prison-specific hazards grouped under human factors, healthcare factors and environmental factors. The authors also summarise interventions deployed as either primary prevention interventions, such as vaccinations, or secondary prevention interventions, including screening and contact tracing. This narrative review summarises the prison-specific hazards, which include movement of people in and out of the person, moving in new prisoners from other prisons, mixing of prisoners when transporting to courts, limited medical and isolation resources, crowded dormitories, shared lavatories, small communal facilities, poor ventilation and overcrowding. The interventions included limiting non-medical transfers into and out of the persons, assigning staff members to specific areas, encouraging face coverings among prisoners and staff and social isolation measures within the constraints of the prison setting. The interventions were adopted by prison authorities to contain and manage the outbreaks. Public Health and prison authorities need to be aware of the risk of further outbreaks of COVID-19 and other infectious diseases in these settings and implement key measures identified in this review to minimise adverse outcomes.

The prevalence, course, and risk factors of suicidal ideation and suicide attempts among students in vocational education

BackgroundWorldwide, suicide is one of the leading causes of death among adolescents and young adults. Given that suicide in this age group is common within vocational students, this study aims to provide insights into the prevalence, course, and risk factors of suicidal ideation (SI) and suicide attempts (SA) among students in vocational education over the past 10 years.MethodsThis study has a repeated cross-sectional design, utilizing data from 2013 to 2023 provided by the ‘Testjeleefstijl’ foundation in the Netherlands (‘Test Your Lifestyle’). In total, 101,182 students in vocational education completed a web-based standardized questionnaire. Univariate logistic regression was used to test the predictive value of risk factors separately (anxiety and depression, gender, age and school year) on SI and SA. In addition, a machine learning model (Berkelmans et al., 2023) ​was used for high-risk identification of combined risk factors (multivariate models).ResultsWithin vocational students, 12-month SI and SA prevalence increased from respectively 17.7% and 2.3% in schoolyear 2013–2014 to 23% and 3.2% in 2022–2023. Although female gender significantly predicted SI and SA in the univariate analyses, the multivariate models revealed that female gender decreased the likelihood of both SI (OR 0.9) and SA (OR 0.7). A high risk for anxiety and depression was the strongest predictor in the multivariate models for SI (OR 42.8) and SA (OR 19.0).ConclusionOver the past decade, the prevalence of SI and SA increased in students in vocational education, with the risk of anxiety and depression being the strongest contributing factor. While females had a higher prevalence of anxiety and depression, the results suggest these conditions tend to lead to SI and SA more quickly among male students. Early intervention in suicide prevention is crucial, highlighting the need to identify and address anxiety and depression. Vocational education schools have a critical role in this, emphasizing early screening and intervention, with specific attention to gender-specific factors.

Sharing the motherload: A review and development of the CO-Parent conceptual model for early childhood obesity prevention.

Fathers remain under-represented in early childhood obesity prevention research and interventions, despite growing evidence that paternal biopsychosocial factors and behaviors from pre- and post-conception can influence lifelong offspring health. Informed by a literature review of high-quality evidence, "CO-Parent" (childhood obesity-Parent) is a new conceptual model underpinned by couple interdependence theory and a socioecological framework. Literature was searched for the concepts parental AND weight-related behaviors AND child weight or weight-related behaviors, in databases including MEDLINE, PsycINFO, Global Health, Scopus, and SocINDEX. Prior evidence syntheses were prioritized as source data to inform model development. "CO-Parent" illustrates the interdependent and independent effects of maternal and paternal weight, weight-related behaviors, and well-being, across preconception, pregnancy, postpartum, and the early years on child weight-related behaviors and weight up to age five. The influences of public policy, social, environmental, economic, community, and other complex modifiable mediating factors are included in the model. The "CO-Parent" conceptual model paves the way for a paradigm shift by recognizing fathers as key figures in early childhood obesity prevention initiatives, encouraging them to "share the motherload." It highlights both the independent and interdependent roles fathers play in the epidemiology of obesity starting from preconception. CO-Parent also provides the foundations necessary to guide future theory and research to be more inclusive of fathers to further understanding of the independent and interdependent influences of parents in early childhood obesity prevention.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis

BackgroundPreventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity.MethodsA systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design.ResultsA total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05.ConclusionsPooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

Guardians under pressure, a spotlight on hypertension among healthcare workers in Kinshasa, Democratic Republic of Congo: a cross-sectional study

BackgroundHypertension is one of the main risk factors for cardiovascular disease impacting over a billion people worldwide. Work environment factors could adversely affect workers’ cardiovascular health, including contributing to hypertension. Healthcare workers who treat patients are also affected. In the Democratic Republic of Congo, limited studies explored the work environment factors associated with hypertension. This study aimed to examine hypertension prevalence and determine the associated risk factors among healthcare workers in Kinshasa.MethodsA cross-sectional study was conducted in Kinshasa’s healthcare facilities from December 2023 to January 2024 among healthcare workers selected by multistage stratified random sampling. Data was collected through a structured questionnaire using a modified WHO STEPwise approach and Karasek questionnaire. Anthropometric parameters, blood pressure, and fasting blood sugar were measured. The prevalence of hypertension was assessed. All sociodemographic, occupational, and lifestyle variables associated with hypertension were included in multivariable logistic regression analysis at the 5% significance level.ResultsThe study encompassed 614 participants, comprising 55.2% females and 44.8% males. The mean age of participants was 38.8 ± 10.4 years, ranging from 20 to 78 years. The prevalence of hypertension was 22.6% and over half of those with hypertension (56.1%) were unaware of their condition. Of the known hypertensive participants before the study, 60.7% had uncontrolled blood pressure. In the multivariable analysis, identified risk factors for hypertension were age ≥ 40 years (aOR = 2.75, 95% CI: 1.64–4.61), seniority ≥ 10 years (aOR = 2.65, 95% CI: 1.54–4.58), multiple job holding (aOR = 3.11, 95% CI: 1.81–5.34), job stress (aOR = 1.84, 95% CI: 1.17–2.89), physical inactivity (aOR = 1.67, 95% CI: 1.03–2.68), overweight (aOR = 1.75, 95% CI: 1.06–2.90) and obesity (aOR = 3.75, 95% CI: 2.10–6.70).ConclusionOur results underline an important prevalence of hypertension among healthcare workers in Kinshasa, despite their medical knowledge of the causes and the risks. A healthy lifestyle among healthcare workers is fundamental for ensuring the efficiency and productivity of the healthcare system. Regulating multiple job holding and implementing a hypertension prevention intervention encompassing their holistic support is crucial for reducing job stress and promoting well-being.

Efficacy of Sustained-Release Formulation of Moxidectin (Guardian SR) in Preventing Heartworm Infection over 18 Months in Dogs Living in a Hyperendemic Area.

This study investigates the efficacy of a sustained-release (SR) moxidectin microsphere formulation in preventing canine heartworm infection over 18 months in Canary Hound dogs, a hunting breed common in the Canary Islands, which is a hyperendemic region. These dogs typically do not receive preventive treatments and act as reservoirs for the disease. This field study was conducted across 11 hunting kennels with 109 dogs living outdoors, none of whom were receiving heartworm prophylaxis, with Dirofilaria immitis prevalence ranging from 11.1% to 57.1% (average 36.7%). Among these, 20 clinically healthy, heartworm-negative dogs were randomly selected to receive a single subcutaneous injection of moxidectin SR (0.17 mg/kg body weight). Antigen and Knott's tests were performed at 6, 12, 18, and 24 months. All dogs completed the study without adverse reactions and remained heartworm-negative throughout. By the end of the study, kennel heartworm prevalence ranged from 14.3% to 46.7% (average 35.4%). A single subcutaneous dose of moxidectin SR at the recommended dosage may prevent patent heartworm infection in dogs for up to 18 months in hyperendemic regions. Further studies are required to confirm these findings. Extending the efficacy period of moxidectin could improve owner compliance, particularly among those with lower animal health awareness.

A Case of Anthracyclines Therapy-induced Cardiotoxicity

Established Anthracyclines including Doxorubicin cardiomyopathy is a lethal disease. When congestive heart failure develops, mortality is approximately 50%. Extensive research has been done to understand the mechanism and pathophysiology of doxorubicin cardiomyopathy, and considerable knowledge and experience has been gained. Unfortunately, no effective treatment for established doxorubicin cardiomyopathy is presently available. However an effective and clinically applicable preventive treatment is yet to be discovered. Here we reported a 56-year-old female diagnosed stage IVB CD20 positive large B-cell Non-Hodgkin lymphoma developed doxorubicin cardiomyopathy after chemotherapy with a regimen of 5 drugs known as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) given for 5 cycles and intrathecal chemotherapy with 4 doses hydrocortison.

Occupational burnout of health care workers in a specialised COVID hospital setting

The aim is to evaluate the peculiarities of the development of professional burnout (PB) among physicians of therapeutic and surgical specialties, as well as middle medical workers, specialised red zones, as well as its prediction and prevention in this category of workers. Material and methods. The following groups of medical workers were examined: the 1st group consisted of doctors of therapeutic specialities (GPs) working in the red zone (n=111); the 2nd group consisted of doctors of surgical specialities (MDs) working in the ‘red zone’ (n=61); the 3rd group consisted of nurses working in the red zone (n=29); the 4th group – the control group included workers of engineering, technical and economic specialities not related to work in medical organisations (n=190). Professional burnout syndrome was assessed using the Maslach Burnout questionnaire and V.V. Boyko’s technique of diagnosing the level of burnout [4, 5]. The data were processed using Statistica statistical package by StatSoft (USA). Results. It was found that the work of therapeutic and surgical doctors, as well as middle medical workers of specialised red zones, is connected with the exposure of medical workers to a number of specific risk factors related to the provision of medical care to infected patients, as well as with significant changes in the work regarding aspects related to organisation, safety, which contribute to the increase in the level of stress and the increase in the level of SP. Conclusions. The work of physicians of therapeutic and surgical specialities, as well as middle medical workers of specialised red zones, is associated with an increase in the level of professional stress and the level of SP. It is necessary to continue the research of emotional state of medical doctors and average medical workers working in conditions of extreme epidemic situations with the purpose of timely preventive treatment for preservation of health of medical workers.

COVID-19-related morbidity and mortality in people with multiple long-term conditions: a systematic review and meta-analysis of over 4 million people.

To describe the direct impact of coronavirus disease 2019 (COVID-19) infection on morbidity and mortality in people with multiple long-term conditions (MLTCs). A systematic review and meta-analysis including observational studies. Studies conducted between 1 January 2020 and 4 May 2023 across 51 countries were identified from five databases. A total of 4,084,469 patients with confirmed COVID-19 infection. Pooled risk ratios (RRs) for mortality, hospitalisation, severe disease, intensive care unit (ICU) admission and mechanical ventilation were estimated with random effect meta-analysis models. A total of 38,356 studies were identified and 111 included. In most (74%) of the studies, MLTCs referred to having two or more long-term conditions. Others described MLTCs by high weighted indices: the Charlson Comorbidity Index in 11% and the Clinical Frailty Score in 7%. Using the National Institutes of Health quality assessment tool for observational studies, the risk of bias was judged as low and moderate in 86 and 25 studies, respectively. Having MLTCs was associated with increased mortality (RR: 2.61 [95% CI: 2.27 to 3.0]); hospitalisation (2.4 [1.92 to 2.99]); severe disease (2.61 [1.92 to 3.54]); ICU admission (1.22 [1.07 to 1.39]) and mechanical ventilation (1.83 [1.18 to 2.84]) compared with those with no MLTCs. Pooled RRs for adverse outcomes were higher in children and young people compared with all age groups. In meta-regression analyses, men were more likely to need ICU admission (p = 0.013) and mechanical ventilation (p = 0.002). Public health policies, clinical and preventative interventions should prioritise people with MLTCs to minimise direct adverse outcomes from COVID-19 disease.

Evaluation of caries risk assessment practices among dental practitioners in Guangzhou, China: a cross-sectional study.

This cross-sectional study aimed to investigate dental practitioners' knowledge and practices regarding Caries risk assessment (CRA) in routine clinical practice in Guangzhou, China. An online questionnaire was disseminated to dental practitioners to gather socio-demographic information, factors associated with CRA, the implementation of preventive treatment, and the level of awareness regarding personalized preventive treatment in relation to CRA. Statistical analyses included descriptive statistics, Chi-square tests, ANOVA, MANCOVA, linear regression, and scatter plots. Out of the 695 dental practitioners who were contacted, 206 dentists participated in the online survey. However, out of the total number of dentists, 198 were successfully recruited, while the remaining 8 dentists had incomplete data in their questionnaires. 92.4% of dentists provided in-office fluoride treatments, and 73.2% held a strong belief in the correlation between current oral hygiene and tooth cavities. 23.7% of dentists evaluated caries risk on an individual basis, and a significant 41.9% never utilized a particular type of CRA. 53.5% of dentists recommended non-prescription fluoride rinses, whereas 51% advocated prescription fluoride treatments. Significant statistical relationships were found between the use of in-office fluoride and the effectiveness of restorative treatment (P < 0.05). Additionally, a significant association was discovered between the use of a specific form for CRA and the kind of dental school (P < 0.05). The study suggests that a significant number of dental practitioners in Guangzhou, China, do not utilize dedicated assessment forms for CRA in their routine professional activities. These findings highlight the im-portance of encouraging dentists to utilize CRA systems to effectively identify patients who are at risk of acquiring dental caries.

Intervention Development for Tailored Education for Aging and Cognitive Health (TEACH) for Dementia Prevention in Midlife Adults: Protocol for a Randomized Controlled Trial.

A total of 12 modifiable risk factors account for 40% of dementia cases globally, yet population adherence to health behaviors associated with these factors is low. Midlife is a critical window for dementia prevention, as brain pathology often begins to accumulate years or decades before the onset of symptoms. Although multidomain behavioral interventions have been efficacious in reducing the risk of cognitive decline, adherence is low. Intrapersonal factors, such as health beliefs, are known mediators of the relationship between knowledge and health behavior. In keeping with stage I of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, this study will use mixed methods to (1) develop an enhanced health education intervention, including an explanatory method for communicating information about dementia risk and personal health beliefs, and (2) conduct a pilot randomized controlled trial (n=20 per intervention arm) over 8 weeks to assess the feasibility of delivering the enhanced intervention versus basic health education alone. Phase 1 will involve focus groups and individual qualitative interviews. Focus groups will be analyzed using (1) a descriptive framework matrix analysis and (2) interpretive data review by the research team. Individual qualitative interviews will be coded using applied thematic analysis using a phenomenographic approach. Phase 2 will involve a pilot randomized controlled trial. Proximal outcomes (measured at baseline, 4 weeks, and 8 weeks) include the perceived threat of Alzheimer disease, dementia awareness, and self-efficacy. This project was funded in August 2022. Data collection began in 2023 and is projected to be completed in 2025. Study findings will reveal the feasibility of delivering an 8-week multidomain health education intervention for primary prevention of dementia in midlife and will provide preliminary evidence of mechanisms of change. ClinicalTrials.gov NCT05599425; https://clinicaltrials.gov/study/NCT05599425. DERR1-10.2196/60395.