Preventive Approach Research Articles

Reimagining psychosis prevention: responding to the accessibility issues of At-Risk Mental State (ARMS) services through a selective public health approach.

At-Risk Mental State (ARMS) services aim to prevent the onset of first-episode psychosis (FEP) in those with specific clinical or genetic risk markers. In England, ARMS services are currently expanding, but the accessibility of this preventative approach remains questionable, especially for a subgroup of FEP patients and those from specific ethnic minority communities. This commentary outlines the key debates about why a complimentary approach to psychosis prevention is necessary, and gives details for an innovative public health strategy, drawing on existing research and health prevention theory.

Current Status of Gout Arthritis: Current Approaches to Gout Arthritis Treatment: Nanoparticles Delivery Systems Approach

The deposition of monosodium urate (MSU) crystals within joint spaces produces a painful inflammatory condition known as gout, a specific form of arthritis. The condition calls for a combined curative and preventive management model. A new development in the approach to gout is that of NLRP3-targeted biologic agents, such as monoclonal therapies, to provide more accurate treatment by blocking specific pro-inflammatory cytokines. Nanoparticle drug delivery enhances biological availability and delivery to targets, which may increase therapeutic efficacy and decrease general toxicity. The preventive approach again cannot be ignored, mainly keeping up certain modifications in diet and weight, along with pharmacological therapies to reduce uric acid (UA) levels and to decrease the frequency of acute attacks. The advancement of genetic profiling of patients and biomarker discoveries drives the trend towards building individualized medicine and care, quickly gaining ground as the most effective method of delivering treatments to individual patients, moving away from one-size-fits-all treatments. The following paper aims to provide an updated account of the management of gout with a focus on recent developments, in order to enhance these approaches, the quality of life for patients with gout, and the standard of gout treatment.

Water pollution, cholera, and the role of probiotics: a comprehensive review in relation to public health in Bangladesh

Cholera, a disease caused by Vibrio cholerae, remains a pervasive public health threat, particularly in regions with inadequate water sanitation and hygiene infrastructure, such as Bangladesh. This review explores the complex interplay between water pollution and cholera transmission in Bangladesh, highlighting how contaminated water bodies serve as reservoirs for V. cholerae. A key focus is the potential role of probiotics as a novel intervention approach for cholera prevention and management. Probiotics are promising as an adjunctive approach to existing therapies as they can enhance gut barrier function, induce competitive exclusion of pathogens, and modulate host immune responses. Recent probiotic advancements include engineering strains that disrupt V. cholerae biofilms and inhibit their virulence. Integrating probiotics with traditional cholera control measures could significantly enhance their effectiveness and provide a multifaceted approach to combating this persistent disease. This review aims to shed light on the potential of probiotics in revolutionizing cholera management and to offer insights into their application as both preventive and therapeutic tools in the fight against this enduring public health challenge.

Social issues in general practice – a survey assessing the interprofessional perspective of general practitioners and social workers regarding frequency, challenges, and needs

BackgroundHealth or illness and social issues cannot be viewed in isolation. Social problems can influence well-being and disease. General Practitioners (GPs) are requested to offer counselling opportunities to respond to the social issues of their patients adequately. Counselling on non-medical issues in general practice increases GPs’ workload. The study aimed to analyse the occurrence of social problems as well as the strengths and weaknesses of existing working agreements between social services and GPs in primary care.MethodsWe carried out a cross-sectional online survey between December 2022 and January 2023 among a sample of Swiss GPs from the Sentinella-Network, the uniham-bb-Network and social workers from the SAGES-Network.ResultsFindings come from a sample of 143 GPs (mean age 54 years, 37.8% female) and 41 social workers (mean age 43 years, 75.6% female). GPs face a median of 3 patients with social problems per week (IQR 5.2). They reported encountering patients facing “Finance” issues most frequently, with 78.8% encountering such cases between “more than 3 patients per week” and “1–3 patients per month”. “Work” (76.4%) and “Loneliness” (73.7%) were also among the most commonly encountered social problems. When suspecting the problem, GPs more often addressed the issue if it was about “Addiction” (83.2%), “Loneliness” (72.3%), or “Protection” (71.4%). More than half of GPs (56.0%) reported having contact with social workers less than once a month, while approximately half of the social workers reported having contact with GPs 1 to 3 times a month (48.7%). GPs (69.3%) and social workers (76.3%) would like more contact. The most frequently mentioned benefits of an increased collaboration from the GPs’ perspective were “improved quality of care (more time for medical issues)” (64.8%) and “improved mental health of patients” (55.6%).ConclusionsSocial problems in general practice are common, but the interprofessional cooperation between GPs and social workers is scarce. However, both parties appear to be in favour of closer interprofessional collaboration and seem to be willing to attempt to improve joint patient care in the future. The integration of social workers into general practice is promising for a comprehensive, interprofessional, and preventative patient approach to providing the best healthcare.

Similarities and Differences Between Bullying and Sexual Harassment in Schools: A Social-Ecological Review of Risk and Protective Factors

In this conceptual article, the authors provide a narrative review of literature on bullying and sexual harassment in K-12 schools framed through a comparative analysis of risk and protective factors for both forms of violence across the social-ecological spectrum. We find that a greater number of studies of both forms of violence focus on student and microsystem-level factors rather than on higher levels of the ecosystem including school boards, neighborhoods, and broader cultural norms. In addition, the research overwhelmingly identifies more risk factors than protective factors. Finally, we find more similarities than differences in risk and protective factors between the two forms of school-based violence. We identify implications of the findings for theory, research, and policy and suggest that preventing any form of harassment at school will benefit not only students but the entire school community. We argue that the causes of school-based harassment are complex and require comprehensive prevention, intervention, and response approaches that address shared risk and protective factors, particularly those at the community and mesosystem, exosystem, and macrosystem levels. Ultimately, we argue that all community stakeholders must be committed to and engaged in these endeavors for them to be successful.

Sexual Networks and Behavioral Characteristics of HIV-Positive Male Military Members, Female Sex Workers, and Male Civilians.

Military members and female sex workers (FSWs) may be more likely to acquire or transmit HIV. Mapping HIV transmission across these high-risk populations and identifying behaviors associated with sexual network clustering are needed for effective HIV prevention approaches. A cross-sectional study recruited participants newly diagnosed with HIV among militaries, civilians, and FSWs in Zambia, Senegal, and Democratic Republic of the Congo (DRC). Participants were interviewed on behaviors and provided blood samples for HIV-1 partial pol sequencing. Genetic-distance based network analyses inferred putative relationships between HIV-1 partial pol sequences. Bivariate logistic regression models identified variables associated with clustering in a sexual network. 908 participants were included (n = 313 FSWs, n = 297 military, n = 298 civilians). 311 blood samples were sequenced and had survey data, of which 93 (29.9%) were genetically linked, forming 36 transmission clusters. All but one cluster were comprised of participants from the same country, including one large cluster (n = 12; 9 FSWs and 3 civilians) from DRC. A large mixed-country cluster (n = 9) including 7 men (4 civilians, 3 military) and 2 FSWs was observed. The odds of clustering in a sexual network were elevated for DRC participants, FSWs, and those cohabitating with a sexual partner. Findings underscore the importance of identifying linkages in high-risk populations to develop tailored HIV prevention strategies. Linkages across risk groups and countries illustrate the potential role of mobile populations in HIV transmission and acquisition. Larger studies including HIV recency testing may better elucidate biological and behavioral interactions between military, civilians, and FSWs.

The current landscape of personalised preventive approaches for non-communicable diseases: A scoping review.

Personalised prevention offers a promising tool to reduce the impact of non-communicable diseases, which represent a growing health burden worldwide. However, to support the adoption of this innovation it is needed to clarify the current state of available evidence in this area. This work aims to provide an overview of recent publications on personalised prevention for chronic conditions. A scoping review of scientific literature from Medline, Scopus, Web of Science and grey literature was conducted. Eligible articles included prospective primary studies and clinical practice directives on personalised preventive approaches for chronic diseases published between January 2017 to December 2023. The review followed Arksey-O'Malley guidelines and PRISMA-ScR checklist. We identified 121 publications including 60 primary cohort studies and 61 clinical practice directives. We extracted 249 personalised preventive approaches, 27% in primary prevention, 27% in secondary prevention, and 46% in tertiary prevention. In primary prevention, 50% of the 67 approaches were from cohort studies, mainly targeting cardiovascular diseases, and 50% from directives primarily focused on cancer. Secondary prevention included 66 approaches, 73% from directives mainly concerning breast cancer. Tertiary prevention included 116 approaches, evenly distributed among the two publication types and focusing mostly on cancer and cardiovascular diseases. Lastly, tertiary prevention is the most represented level of prevention both in primary research studies and directives (54% and 41% respectively). Our study highlights a significant focus on personalised prevention in oncology in the past few years, with numerous recently issued clinical practice directives. We identified substantial original research in personalised primary prevention of cardiovascular diseases, indicating growing interest in the field. However, the distribution of primary studies and directives across the three preventive levels anticipate challenges in generating evidence of clinical utility in primary and secondary prevention, with most approaches falling under tertiary prevention.

Age of onset of cannabis use and substance use problems: A systematic review of prospective studies.

The association between the age of cannabis use (CU) onset and substance use (SU) problems has been extensively studied, yet findings remain inconsistent. This systematic review aimed to examine prospective studies on the association between age of CU onset and later SU problems, controlling for key individual, social, and SU-related risk factors. PsycINFO, Web of Science and PubMed were searched for studies published between January 2000 and December 2024. Studies were included if they: 1) were prospective; 2) measured CU onset during adolescence; 3) measured CU or SU problems after CU onset, 4) examined whole plant or phytocannabinoids. Studies were excluded if they exclusively focused on high-risk samples. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies-of Interventions tool. The review was registered with PROSPERO, number CRD42022332092. Sixteen studies met eligibility criteria. Earlier age of CU onset was associated with CU disorder (CUD) and CU negative consequences, with mixed findings for other SU problems (e.g., alcohol). CU frequency accounted for a significant portion of the risk for CU negative consequences, but the association with CUD remained independent of frequency. Only one study had low risk of bias, while seven had some concerns, and eight had a high or very high risk of bias. Findings suggest that early age of CU onset is a specific risk factor in the development of CUD, but not other SU problems. Prevention approaches should aim to delay the onset and reduce the frequency of CU among youth to reduce risk of the development of CUD.

A Systematic Review of Antibiotic Administration Incidents Involving Neuraxial Routes: Clinical Analysis, Contributing Factors and Prevention Approaches.

This review aimed to investigate the inadvertent administration of antibiotics via epidural and intrathecal routes. The secondary objective was to identify the contributing human and systemic factors. PubMed, Scopus and Google Scholardatabases were searched for the last five decades (1973-2023). The author recorded the antibiotics involved, theroute of administration, clinical details and consequences in a standardised format. The author utilized the Human Factors Analysis Classification System (HFACS) framework to identify contributing factors. Twenty publications reported neuraxial administration of antibiotics (adults, 19, paediatric, three patients). Fifteen (of 22) incidents happened in the post-surgical or post-chronic pain procedure period. Most errors (14 of 22) occurred via the epidural route. Cefazolin (six) and gentamicin (five) were the most common among 13 antibiotics involved. Intrathecal cephalosporin incidents (n = 6) were associated with devastating consequences (death, one, permanent residual neurological deficits, three). In the unsafe act category of the HFACS, the perceptual error contributing to occurrences of neuraxial antibiotics administration errors was due to IV-neuraxial device (e.g. intrathecal drain or catheter, epidural catheter) confusion (eight patients) or syringe/infusion bag swap (nine patients). Intrathecal cephalosporins and gentamicin administration are associated with devastating consequences. Prevention of neuraxial antibiotic administration requires improvements in clinical deficiencies and the implementation of supporting technological tools to prepare and administer antibiotics correctly, thereby ensuring patient safety.

Consuming a modified Mediterranean ketogenic diet reverses the peripheral lipid signature of Alzheimer’s disease in humans

BackgroundAlzheimer’s disease (AD) is a major neurodegenerative disorder with significant environmental factors, including diet and lifestyle, influencing its onset and progression. Although previous studies have suggested that certain diets may reduce the incidence of AD, the underlying mechanisms remain unclear.MethodIn this post-hoc analysis of a randomized crossover study of 20 elderly adults, we investigated the effects of a modified Mediterranean ketogenic diet (MMKD) on the plasma lipidome in the context of AD biomarkers, analyzing 784 lipid species across 47 classes using a targeted lipidomics platform.ResultsHere we identified substantial changes in response to MMKD intervention, aside from metabolic changes associated with a ketogenic diet, we identified a a global elevation across all plasmanyl and plasmenyl ether lipid species, with many changes linked to clinical and biochemical markers of AD. We further validated our findings by leveraging our prior clinical studies into lipid related changeswith AD (n = 1912), and found that the lipidomic signature with MMKD was inversely associated with the lipidomic signature of prevalent and incident AD.ConclusionsIntervention with a MMKD was able to alter the plasma lipidome in ways that contrast with AD-associated patterns. Given its low risk and cost, MMKD could be a promising approach for prevention or early symptomatic treatment of AD.

Hypoxia-inducible factor 2 regulates alveolar regeneration after repetitive injury in three-dimensional cellular and in vivo models.

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease in which repetitive epithelial injury and incomplete alveolar repair result in accumulation of profibrotic intermediate/transitional "aberrant" epithelial cell states. The mechanisms leading to the emergence and persistence of aberrant epithelial populations in the distal lung remain incompletely understood. By interrogating single-cell RNA sequencing (scRNA-seq) data from patients with IPF and a mouse model of repeated lung epithelial injury, we identified persistent activation of hypoxia-inducible factor (HIF) signaling in these aberrant epithelial cells. Using mouse genetic lineage-tracing strategies together with scRNA-seq, we found that these disease-emergent aberrant epithelial cells predominantly arose from airway-derived (Scgb1a1-CreER-traced) progenitors and exhibited transcriptional programs of Hif2a activation. In mice treated with repetitive intratracheal bleomycin, deletion of Epas1 (Hif2a) but not Hif1a, from airway-derived progenitors, or administration of the small-molecule HIF2 inhibitor PT-2385, using both prevention and rescue approaches, attenuated experimental lung fibrosis, reduced the appearance of aberrant epithelial cells, and promoted alveolar repair. In mouse alveolar organoids, genetic or pharmacologic inhibition of Hif2 promoted alveolar differentiation of airway-derived epithelial progenitors. In addition, treatment of human distal lung organoids with PT-2385 increased colony-forming efficiency, enhanced protein and transcriptional markers of alveolar type 2 epithelial cell maturation, and prevented the emergence of aberrant epithelial cells. Together, these studies showed that HIF2 activation drives the emergence of aberrant epithelial populations after repetitive injury and that targeted HIF2 inhibition may represent an effective therapeutic strategy to promote functional alveolar repair in IPF and other interstitial lung diseases.

The associations between paternal postpartum depressive symptoms and testosterone and cortisol levels in hair over the first two years postpartum.

After the birth of a child, also fathers may develop postpartum depression. Altered steroid hormone concentrations are discussed as a possible underlying mechanism, as these have been associated with depressive symptoms in previous studies outside the postpartum period. While higher paternal testosterone levels have been found to protect against paternal postpartum depressive symptoms (PPDS), an association between higher cortisol levels and PPDS has been seen in postpartum mothers, with no comparable studies available on fathers. This study aimed to investigate cross-sectional and longitudinal associations between testosterone and cortisol levels in hair and PPDS over a period of 2 years postpartum. Data from N = 226 fathers, who took part in the endocrine sub-study DREAMHAIR of the longitudinal prospective cohort study DREAM, were used. PPDS were assessed 8 weeks, 14 months, and 24 months after birth using the Edinburgh Postnatal Depression Scale. At the same time, fathers provided 2 cm scalp-near hair samples in which testosterone (HairT) and cortisol (HairF) levels were determined. Cross-sectional and longitudinal associations between HairT, HairF and paternal PPDS were investigated. Correlation analyses showed a negative cross-sectional association between HairF levels and paternal PPDS 14 months after birth. A random intercept cross-lagged panel model revealed prospective relationships between paternal PPDS 8 weeks postpartum and HairF 14 months postpartum, and additionally between 14 months and 2 years postpartum in an exploratory model with similarly good model fit. No further significant associations of HairF with paternal PPDS emerged, and none of the analyses with HairT became significant. The overall pattern of results was confirmed when controlling for the influence of batch and storage time on HairT and HairF levels. No consistent relationships between HairT or HairF and paternal PPDS emerged in this relatively healthy cohort. In HairF analyses with significant results, lower HairF was associated with more severe PPDS. Longitudinal results imply that altered cortisol secretion may rather follow than precede changes in paternal PPDS. Further research on hormonal changes in PPDS in fathers should consider possible covariates and examine fathers with higher depressive burden, which may help to identify fathers at risk and inform future preventive and interventive approaches.

Comparaison of incisional and endoscopic percutaneous gastropexy techniques in dogs: a preventive approach to gastric dilatation-volvulus syndrome

Comparaison of incisional and endoscopic percutaneous gastropexy techniques in dogs: a preventive approach to gastric dilatation-volvulus syndrome

Association of endothelial nitric oxide synthase (NOS3) rs2070744 variant with advanced retinopathy of prematurity: a case–control study and meta-analysis

Despite advances in neonatal and ophthalmological care, retinopathy of prematurity (ROP) continues to be a leading cause of childhood blindness worldwide. Investigating gene variants associated with vascular responses in ROP may provide valuable insights into its pathogenesis and identify risk or protective factors. Nitric oxide (NO) and endothelin-1 (ET-1) play roles in vascular regulation, influencing processes relevant to ROP development. Functional variants of genes encoding endothelial NO sythetase (NOS3 rs1799983, rs2070744), endothelin-1 (EDN1 rs5370), and endothelin receptor A (EDNRA rs5335) may influence ROP development or progression. The results of our study support the role of the rs2070744 variant in ROP. We identified the protective effect of the rs2070744C allele against the development of ROP requiring treatment, also after adjusting for covariates. Meta-analysis including 298 patients and 397 controls confirmed this protective role. The rs2070744CC homozygous genotype exhibited an odds ratio (OR) of 0.42 (adjusted P = 0.036). Additional meta-analysis results for NOS3 rs1799983 are presented, suggesting potential risk in a recessive model. No associations were found between EDN1, EDNRA variants, and ROP. Exploring genetic predispositions in ROP, including vascular regulation genes, can lead to personalized prevention and treatment approaches. Our results need to be replicated in a larger sample of premature infants.

Safety of 1 mcg/mL as the starting dose in cluster protocol for hymenoptera immunotherapy.

Hymenoptera venom allergy is a potentially severe allergic reaction in the general population. The only preventative approach in these cases is venom immunotherapy (VIT), which follows different protocols. The recommended initial dose is 0.001-0.1 mcg of venom extract. However, few reports have declared the safety of 1 mcg venom as the starting dose. The study was conducted on Iranian patients with a history of anaphylaxis to venom. Skin tests confirmed hypersensitivity to honeybee, yellow jacket, and/or paper wasp from subfamily Polistes using Apis melifera, Vespula spp, and Polistes spp venom extracts, respectively. Subsequently, the patients were treated with the cluster protocol. Twenty-two patients (17 males and 5 females, aged 28.3±11.8 years) were enrolled in the study. Skin prick tests and intradermal tests showed positive results for yellow jacket in 17 (77.3%) and 21 (95.4%) patients, honeybee in 14 (63.6%) and 17 (77.3%) patients, and wasp in 14 (63.6%) and 17 (77.3%) patients, respectively. Upon administering the initial dose of 1 mcg/mL, 40.9% (9 cases) of patients presented mild local reactions, including 7 with yellow jacket allergy, 5 with honeybee allergy, and 3 with wasp allergy. One patient with yellow jacket allergy had a mild systemic reaction. Patients with a positive skin test for wasp had significantly lower rate of reactions after the first dose of venom (p=0.026). Throughout the entire build-up phase, more than 90% (20 of 22) of patients experienced mild local reactions, followed by large local reactions (3 cases, 13.6%), mild systemic reactions (1 case at 1 mcg/mL dose), and moderate-to-severe systemic reactions (3 cases, 13.6%). Large local and moderate-to-severe systemic reactions were detected after injecting 50 mcg (each one case) and 100 mcg (each 2 cases) of venom extracts. This study recommends 1 mcg/mL of the venom extract as a safe starting dose for VIT. This accelerated protocol could successfully reduce the time and costs of therapy for patients undergoing out-patient cluster VIT.

Nanomaterial-based synergistic strategies for combating dental caries: progress and perspectives.

Dental caries, as the predominant global oral disease, remains a critical public health issue worldwide, particularly in socioeconomically disadvantaged communities. However, common caries prevention approaches (e.g., oral health education, mechanical plaque removal, and delivery of fluoride agents) are still insufficient for optimal caries management, and therefore, alternative regimens that can supplement existing strategies are highly warranted. Nanomaterials exhibit considerable potential in combating cariogenic pathogens and biofilms owing to their promising antimicrobial capacity, improved penetration into biofilms, targeted precision delivery, and versatile physicochemical properties. As unifunctional materials are limited in caries management, this review underscores the latest advancement in multifunctional anti-caries nanomaterials/nanomedicines. It highlights the cutting-edge materials developed or engineered to (i)incorporate diagnostic capabilities to prevent caries at an early stage, thus enhancing treatment efficiency, (ii) integrate mechanical "brushing" with anti-caries approaches to mechanochemically eradicate biofilms, (iii) exert antimicrobial/antibiofilm effects while preserving dental hard tissue. The current work also outlines future directions for optimizing nanosystems in the management of dental caries while emphasizing the need for innovative solutions to improve preventive and therapeutic efficacies.

INVESTIGATING MEDIATORS OF SYSTEMIC MITOCHONDRIAL BIOENERGETICS IN COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE

Abstract We previously showed peripheral blood mononuclear cell (PBMC) and platelet mitochondrial bioenergetic capacities are lower in older adults with Alzheimer’s disease (AD), with notable changes in fatty acid oxidation (FAO)-mediated respiration. The metabolic pathways underlying mitochondrial functional differences remain un-identified. This study investigated lipid metabolites that are differently expressed across different stages of cognitive impairment (CI). Targeted lipidomics analyzed 51 fatty acids (FAs) in PBMCs and platelets of older adults with normal cognition (NC), mild cognitive impairment (MCI), and AD dementia (DEM). 10 FAs were selected in each cell type based on significant concentration differences between different cognitive groups. In PBMCs, 9 FAs exhibited higher concentrations in MCIs than NC and DEM, with significantly lower concentration in DEM than MCI, while 1 FA exhibited progressively declining concentrations from NC to MCI to DEM. Significant positive correlations were observed between FA concentrations and FAO and maximal mitochondrial respiration (Max). In platelets, 7 FAs showed progressively declining concentrations from NC to MCI to DEM, and significant positive correlations with FAO and Max, while 3 FAs showed progressively increasing concentrations with cognitive impairment, and significant negative correlations with FAO and Max. Significant negative correlations were also observed with mPACC5 cognitive assessment scores and hippocampal volumes. Pathway analyses identified FA biosynthesis, alpha-linolenic acid, and alpha-linoleic acid metabolism as involved pathways differently impacted across cognitive groups. These findings emphasize the importance of FAs and related metabolic pathways in systemic bioenergetic decline in CI, and may facilitate development of preventative, diagnostic, and therapeutic approaches in AD.

Social Media and Violence: Research on Experiences of Cyberbullying among Youth in America

In contemporary society, nearly all people, from children to the elderly, own mobile phones. While the widespread use of social media greatly benefits people, it also has numerous negative effects. Teenagers often engage with social media; they can learn more and connect with others through these platforms. At the same time, many of them also experience bullying on social media platforms. This paper will explore the significance of social media in the daily lives of US teenagers, as well as the detrimental effects it can have on them, including mental health issues, social relationship problems, and poor academic performance. Next, the paper will discuss the factors such as the role of social media, the lack of organizations, and the behavior patterns of teenagers that contribute to these negative impacts. Moreover, in order to address and reduce the occurrence of cyberbullying, social media companies, government organizations, families, and schools must collaborate to develop and implement practical solutions. In-depth research on these topics provides insights, facilitates discussion, and proposes potential directions for more effective prevention and intervention approaches.

Appraising annual post-maintenance functional performance of asphalt roadway based on causal inference approach

ABSTRACT To maintain good functional pavement performance and extend the service life of asphalt pavements, the long-term performance of pavements under maintenance policies needs to be evaluated and favourable options need to be chosen based on the condition of the pavement. A major challenge in evaluating maintenance policies is to produce valid treatments for the outcome assessment under the control of uncertainty of vehicle loads and the disturbance of freeze-thaw cycles in the climatic environment. In this study, a novel causal inference approach, combining a classical causal structural model and a potential outcome model framework, is proposed to appraise the annual post-maintenance performance of four preventive preservation treatments of pavements for longitudinal cracking over a 5-year period of upkeep. Three fundamental issues were brought to our attention: detection of causal relationships prior to variables under environmental loading (identification of causal structure); obtaining direct causal effects of treatment on outcomes excluding covariates (identification of causal effects) and sensitivity analysis of causal relationships. The results show that the method can accurately evaluate the effect of preventive maintenance treatments, assess the maintenance time to cater well for the functional performance of different preventive maintenance approaches and develop appropriate maintenance strategies for pavements.

Exploring the Knowledge, Attitudes, and Practices of Critical Care Nurses in Iran towards Pressure Ulcer Prevention

Background Pressure ulcers (PUs) pose a significant health problem that can be prevented in various healthcare settings, particularly in intensive care units (ICUs). PU increases the risk of morbidity and mortality and is associated with poor prognosis in ICU patients. ICU prevalence rates for PU have been estimated to range from 21% to 39.3% worldwide (Coyer et al., 2022). According to a recent meta-analysis, the prevalence of PU in Iran's ICUs was 19.59% (Sohrabi Akhkand et al., 2020). Despite these alarming facts, PU is often preventable with adherence of healthcare providers to evidence-based PU prevention guidelines. One of the most important factors influencing PU prevention is adequate knowledge of ICU nurses to evaluate and manage risk factors and implement preventative approaches (Wu et al., 2022; Ghorbani Vajargah et al., 2023). Aims This study aimed to examine the knowledge, attitudes, and practices (KAP) of ICU nurses towards PU prevention in Iran. Methods In a multicenter cross-sectional study, after approval from institutional ethics committee (IR.MAZUMS.REC.1399.591) and written informed consent, 183 ICU nurses working in four hospitals affiliated with Mazandaran University of Medical Sciences in Sari, Iran, were evaluated. The study was carried out between July and October 2020. Data collection involved a four-part questionnaire consisting of demographic characteristics, the Pieker Pressure Ulcer Knowledge Test (PPUKT), the Attitude toward Pressure Ulcer Prevention (APUP) tool, and an assessment of nurses' practices related to PU prevention. Results The mean age of participants was 32.82 (SD = 5.93) years and the mean years of working experience was 8.26 (SD = 6.02) years. Of the nurses, 56.2% were female, 63.4% were married, 87.4% were residents in an urban area, and 76.5% had a BSN degree. The mean scores for ICU nurses' KAP regarding PU prevention were 70.57 (SD = 13.51), 52.82 (SD = 6.16), and 22.44 (SD = 5.20), respectively. As presented in Table 1, a positive correlation was observed between nurses' attitudes and their practices (r = 0.232, P = 0.002), while a negative correlation was found between their knowledge and attitudes (r = -0.156, P = 0.035) towards PU prevention. Also, the results showed a positive correlation between the years of ICU work experience among nurses and their knowledge of PU prevention (r = 0.159, P = 0.032). The same result was also observed for the overall years of working experience, although this correlation was marginally significant (r = 0.145, P = 0.051). Based on a one-way ANOVA, there was a direct relationship between knowledge and income, and knowledge were higher in high-income nurses (P = 0.017). Table 1: Means, Standard Deviations, and correlations among study variables. Descriptive statistics Correlational analysis Possible range Observed range Mean (SD) Knowledge Attitude Practice Knowledge 0-100 39.02-100 70.57 (13.51) 1 Attitude 0-100 32.69-67.31 52.82 (6.16) -0.156 1 Practice 0-44 10-37 22.44 (5.20) -0.119 0.232 1 Conclusion The findings of this study indicate that the KAP levels of Iranian ICU nurses regarding PU prevention were desirable, positive, and relatively desirable. Therefore, it is recommended that nurse managers and policy makers address the major barriers and related factors that may affect ICU nurses' practices in preventing PUs.