Previous Month Research Articles

Spectral exponent assessment and neurofilament light chain: a comprehensive approach to describe recovery patterns in stroke.

Understanding the residual recovery potential in stroke patients is crucial for tailoring effective neurorehabilitation programs. We propose using EEG and plasmatic Neurofilament light chain (NfL) levels as a model to depict longitudinal patterns of stroke recovery. We enrolled 13 patients (4 female, mean age 74.7 ± 8.8) who underwent stroke in the previous month and were hospitalized for 2-months rehabilitation. Patients underwent blood withdrawal, clinical evaluation and high-definition EEG at T1 (first week of rehabilitation) and at T2 (53 ± 10 days after). We assessed the levels of NfL and we analyzed the EEG signal extracting Spectral Exponent (SE) values. We compared our variables between the two timepoint and between cortical and non-cortical strokes. We found a significant difference in the symmetry of SE values between cortical and non-cortical stroke at both T1 (p = 0.005) and T2 (p = 0.01). SE in the affected hemisphere showed significantly steeper values at T1 when compared with T2 (p = 0.001). EEG measures were consistently related to clinical scores, while NfL at T1 was related to the volume of ischemic lesions (r = 0.75; p = 0.003). Additionally, the combined use of NfL and SE indicated varying trends in longitudinal clinical recovery. We present proof of concept of a promising approach for the characterization of different recovery patterns in stroke patients.

Religious leaders' perceptions of the identification and referral of people with mental health problems in a Peruvian city.

Religious leaders have the potential to play a significant role in the identification and referral of individuals with mental health problems. This study sought to understand the perceptions of religious leaders in regards to identifying and referring parishioners with mental health issues to healthcare professionals, in Chimbote, Peru. We performed a cross-sectional study that covered religious leaders of different religious groups in Chimbote. The leaders completed a survey that assessed their characteristics, past experiences of detecting and referring those with mental health problems to healthcare professionals, and perceptions of four clinical cases (for which we used the Clergy's Perception of Mental Illness Survey instrument). We included 109 religious' leaders of four religious groups (11 Catholics, 70 Evangelicals, 21 Mormons, and 7 Adventists). Of these, 50.5% had received at least one request for help with mental health issues from a parishioner in the previous month, over 85% expressed a desire for training in identifying mental health problems, and 22-30% reported receiving any training. While the majority of leaders were able to correctly identify cases of depression, alcohol dependence, and drug problems, only 62% correctly classified a case of schizophrenia. Despite this, 80% stated that they would refer their parishioners to healthcare professionals. Parishioners tend to consult their religious leaders regarding their mental health and approximately 80% stated they would refer such cases to a healthcare professional. However, less than one-third of the leaders had received training to detect mental health problems. These results suggest that there is a need for training programs to improve the ability of religious leaders to identify and refer individuals with mental health issues.

Association of the combination of obstructive sleep apnea risk and sleep duration with ideal cardiovascular health metrics in patients undergoing hemodialysis

BackgroundThe purpose of this study was to explore the separate and combined associations of obstructive sleep apnea (OSA) risk and sleep duration with ideal cardiovascular health metrics in hemodialysis (HD) patients.Methods470 HD participants (average: 59.48 ± 12.89 y, 281 men) were included in this study. Sleep duration was measured as self-reported average sleep time during the previous month. The OSA risk was assessed using the STOP-BANG questionnaire. Participants were divided into three groups based on the number of ideal cardiovascular health (CVH) metrics: 0–2,3–4, and 5–7. Ordinal logistic regression was conducted to model the associations of CVH metrics with sleep duration, OSA risk, and their combined effects by adjusting for specific covariates.ResultsAfter adjusting for covariates, short sleep duration (< 7 h) (OR = 0.53; 95% CI [ 0.30, 0.92]) and OSA risk (OR = 0.58; 95% CI [0.32, 0.83]) were negatively associated with better CVH (ideal vs. intermediate; intermediate vs. poor), respectively. For HD patients with both short sleep duration and OSA risk, the odds of ideal CVH metrics were reduced by 72% (odds ratio 0.28 [95% CI 0.13, 0.60]).ConclusionsShort sleep duration and OSA risk are separately and jointly associated with poor CVH in hemodialysis patients. Suitable interventions for sleep may minimize the risk of developing cardiovascular disease.

A novel risk assessment tool for postoperative delirium in vascular surgery: The stress model (Siena posTopeRative dElirium in vaScular Surgery).

Postoperative delirium (POD) is a common complication with a high health-related impact. The creation of a model (Siena posTopeRative dElirium in vaScular Surgery) to identify high-risk patients with consecutive prompt diagnosis and correct management. This is an observational retrospective study to evaluate POD incidence in patients who underwent elective vascular surgery procedures between 2018 and 2020. POD was detected using CAM and defined as the onset of an acute confusional state, clinically manifesting as a disturbed state of consciousness, cognitive dysfunction, or alteration in perception and behavior. The total population was divided in the development and validation subsamples. Multivariable logistic regression analysis was performed, identifying variables related to the occurrence of POD. An additive score was created and the STRESS score was internally validated using the Validation subgroup. A total of 1067 patients were enrolled. POD occurred in 111 cases (10.4%). Multivariable logistic regression analysis for POD occurrence revealed as significant predictors: age>75 years, CKD, dyslipidaemia, psychiatric disease, CAD, hospitalization in the previous month, preoperative NLR >3.59, preoperative Hb < 12g/dl, preoperative Barthel score <75, major amputation, CLTI revascularization, general anesthesia, and postoperative urinary catheter. These variables were used to create the STRESS score. The model was applied to both development and validation subgroups; AUC was respectively 0.7079 (p < .0001) and 0.7270 (p < .0001). The STRESS score has a good predictive potentiality for POD occurrence in elective vascular surgery procedures. However, implementation and external validation are needed to be correctly used in everyday clinical practice.

Multimodal Imaging of a novel MFSD8/CLN7 mutation associated with non-syndromic symmetric adult-onset macular dystrophy.

To report multimodal imaging features of a novel MFSD8/CLN7 pathogenic variant associated with bilateral and symmetric non-syndromic macular dystrophy. A 63-year-old female patient presented complaining of a gradual subjective decline in visual acuity in both eyes over the previous months. This patient underwent a comprehensive ophthalmological assessment, including multimodal retinal imaging and electrophysiological testing. Given suspicion for a hereditary retinal disorder, genetic testing was pursued. The eye examination revealed blunted foveal reflexes and no lesions or abnormalities in the equatorial or anterior retinal periphery. Multimodal imaging showed a bilateral and almost symmetrical subfoveal interruption of the outer retinal layers including an optical gap. Genetic testing revealed that the MFSD8/CLN7 gene exhibited a homozygous variant, specifically p.Ala484Val (c.1451C>T). This variant was identified as the likely causative factor for the condition. We herein describe the clinical findings of a previously unreported homozygous variant in the MFSD8/CLN7 gene, resulting in a non-syndromic form of bilateral central macular dystrophy.

Preferences for maximum daily returns

Previous research shows that individual investors are attracted to stocks with high maximum daily returns in the previous month (MAX). We examine the underlying sources of this preference. In a discrete choice investment experiment, subjects prefer high-MAX stocks only if these stocks are speculative with a comparably high level of return volatility. However, after controlling for volatility, subjects no longer favor high-MAX stocks. Hence, individuals do not prefer higher maximum daily returns per se. We find additional support for these findings in the aggregate trading patterns of Robinhood retail investors.

An Index for Snowmelt-Induced Landslide Prediction for Zavoj Lake, Serbia

In February 1963, a huge landslide (ca. 1,950,000 m3) blocked the Visočica River and, thus, formed Zavoj Lake. The primary objective of this research was to investigate the importance of snowmelt in relation to landslide occurrence and to define the critical climatic conditions that may trigger massive winter landslides. We used monthly precipitation and average monthly maximum temperature data from meteorological and precipitation stations in the Visočica River basin (Dojkinci) and in the immediate proximity of Lake Zavoj (Pirot, Dimitrovgrad and Topli Do) as data inputs to the Snow-Melt Landslide (SML) index. It considers the summed monthly precipitation for previous months that continuously have an average maximum temperature below 0 °C. According to this method, the event at Zavoj Lake stands out among all other precipitation and snowmelt values for the past 72 years. After applying the SML index, all stations showed values of &gt;300 mm for February 1963, which we consider as the threshold value for potential landslides appearance. In addition to meteorological data, we applied the SML index to data from the Coordinated Regional Downscaling Experiment (CORDEX) regional climate model outputs for the region from 2022 to 2100. As expected, climate change will have influenced the temperature values, especially during the winter. Conversely, the study area is experiencing drastic changes in land use caused by depopulation, leading to a reduced risk of winter landslides in the Visočica basin. We suggest that future climatic conditions in the area will make it more likely to experience extreme summer precipitation events, which might trigger large landslides. The SML method can be implemented for all landscapes that experience snowy winters, providing information in a timely manner so that local residents can react properly when the probability of landslide occurrence rises. The SML index, grounded in essential meteorological principles, provides a tailor-made, data-driven methodology applicable across varied geographical settings. Its utility extends to mitigating hydro-meteorological hazards on scales ranging from local to national scales, offering diverse and effective early warning solutions.

Atmospheric teleconnections between the Arctic and the Baltic Sea region as simulated by CESM1-LE

Abstract. This paper examines teleconnections between the Arctic and the Baltic Sea region and is based on two cases of Community Earth System Model version 1 large ensemble (CESM-LE) climate model simulations: the stationary case with pre-industrial radiative forcing and the climate change case with RCP8.5 radiative forcing. The stationary control simulation's 1800-year long time series were used for stationary teleconnection and a 40-member ensemble from the period 1920–2100 is used for teleconnections during ongoing climate change. We analyzed seasonal temperature at a 2 m level, sea-level pressure, sea ice concentration, precipitation, geopotential height, and 10 m level wind speed. The Arctic was divided into seven areas. The Baltic Sea region climate has strong teleconnections with the Arctic climate; the strongest connections are with Svalbard and Greenland region. There is high seasonality in the teleconnections, with the strongest correlations in winter and the lowest correlations in summer, when the local meteorological factors are stronger. North Atlantic Oscillation (NAO) and Arctic Oscillation (AO) climate indices can explain most teleconnections in winter and spring. During ongoing climate change, the teleconnection patterns did not show remarkable changes by the end of the 21st century. Minor pattern changes are between the Baltic Sea region temperature and the sea ice concentration. We calculated the correlation between the parameter and its ridge regression estimation to estimate different Arctic regions' collective statistical connections with the Baltic Sea region. The seasonal coefficient of determination, R2, was highest for winter: for T2 m, R2=0.64; for sea level pressure (SLP), R2=0.44; and for precipitation (PREC), R2=0.35. When doing the same for the seasons' previous month values in the Arctic, the relations are considerably weaker, with the highest R2=0.09 being for temperature in the spring. Hence, Arctic climate data forecasting capacity for the Baltic Sea region is weak. Although there are statistically significant teleconnections between the Arctic and Baltic Sea region, the Arctic impacts are regional and mostly connected with climate indexes. There are no simple cause-and-effect pathways. By the end of the 21st century, the Arctic ice concentration has significantly decreased. Still, the general teleconnection patterns between the Arctic and the Baltic Sea region will not change considerably by the end of the 21st century.

A 30-year trend of dairy consumption and its determinants among income groups in Iranian households.

Milk and dairy products provide essential nutrients and have the potential to prevent chronic diseases, thus reducing healthcare costs. However, there is a lack of consistent and updated data on dairy consumption trends in Iran. This study aims to analyze the trends in dairy consumption among Iranian households from 1991 to 2021, focusing on household-level determinants across different expense groups. The study uses data from the Iranian Household Expenditure and Income Survey conducted annually from 1991 to 2021 to analyze households' dairy consumption. The data includes values and expenses of food and non-food items purchased in the previous month, as well as demographic characteristics of household members. The households were categorized into 10 deciles based on their gross expense. The econometric model used weighted mean per capita milk, yogurt, cheese, and total dairy consumption based on milk equivalent for each decile. The model takes into account changes in income, prices, household composition, education level, occupation, and residency area using panel data. Data preparation and model estimation were performed using RStudio and STATA17 software. Based on the findings, in 1991, per capita milk, yogurt, and cheese consumption were 26.77 kg, 16.63 kg, and 2.42 kg, respectively. By 2021, these figures changed to 22.68 kg, 11.06 kg, and 3.79 kg, reflecting a decrease in milk and yogurt consumption but an increase in cheese consumption. Family size was positively correlated with yogurt consumption and head of the household spouse's job score were positively correlated with milk, yogurt and cheese consumption. Also, the presence of under five-year-old children and older adults members (over the age of 60) in the household was inversely related with yogurt and cheese consumption. Female-headed households tended to purchase more cheese, while their milk purchase level was significantly lower. Residing in urban areas was negatively related to milk, while cheese and total dairy consumption was higher in urban areas. The findings highlight the importance of targeted dairy subsidy interventions and educational programs to improve dairy consumption in Iranian households, especially among vulnerable groups. This will require urging policymakers and food system stakeholders for effective strategies that address macro-level factors to promote dairy consumption.

Low Frequency of Upper Gastrointestinal Bleeding Despite Non-Steroidal Anti-Inflammatory Drugs and Corticosteroids in Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. It has been identified that non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can be essential risk factors for developing complications such as upper gastrointestinal bleeding (UGIB). This study aimed to describe the safety profile of drugs used to treat RA focused in UGIB. A cross-sectional study of patients with RA between 2015 and 2021, a description of the population, and an evaluation of the relationship with UGIB through bivariate analysis and logistic regression. Of 405 individuals, 16 presented UGIB (93.8% women, mean age was 65±13.6 years). No statistically significant differences were found regarding UGIB and medication use, except for the mean dose of corticosteroids. In the multivariate analysis, it was found that the presence of anemia in the last three months had an adjusted OR (ORA) of 16.1 (95% CI 2.74- 24.23) and higher HAQ values during the previous three months had an ORA of 6.17 (95% CI 1.79- 21.24). This study found a low frequency of UGIB in patients with RA. More significant disability and anemia in the previous months were independently associated with UGIB. The low frequency of NSAID use in this population is noteworthy. In general, reasonable medication use related to this complication is recommended.

Impact of the COVID-19 pandemic on the services provided by the Peruvian health system: an analysis of people with chronic diseases

During the pandemic, many individuals with chronic or infectious diseases other than COVID-19 were unable to receive the care they needed due to the high demand for respiratory care. Our study aims to assess the impact of the COVID-19 pandemic on services provided to people with chronic diseases in Peru from 2016 to 2022. We performed a secondary database analysis of data registered by the comprehensive health insurance (SIS), the intangible solidarity health fund (FISSAL), and private healthcare institutions (EPS), using interrupted time series analysis. Our study identified 21,281,128 individual users who received care. The pooled analysis revealed an average decrease of 1,782,446 in the number of users receiving care in the first month of the pandemic compared with the expected values for that month based on pre-pandemic measurements. In addition, during the pandemic months, there was an average increase of 57,911 in the number of new additional single users who received care per month compared with the previous month. According to the time-series analysis of users receiving care per month based on each chronic disease group, the most significant decreases included people with diabetes without complications and chronic lung disease.

Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China.

Cancer-related pain is one of the common priority symptoms in advanced lung cancer patients at the end-of-life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription-level outcomes as potential indicators of undertreated pain in China. This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription-level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively. A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%-45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31-60 days to the 0-30 days of life, the MMED declined 6.08 mg (95% CI: -7.14 to -5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160-1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: -5.86 to -2.37; p = 0.005) within the last month before death compared to the previous month. Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.

Prevalence, pain intensity and symptoms associated with primary dysmenorrhea: a cross-sectional study

BackgroundPrimary dysmenorrhea (PD) is an etiological cyclic pelvic pain related to the menstrual period; it can negatively impact women’s quality of life and productivity. The aim of the present study was to estimate the prevalence of PD and analyze associated symptoms in Brazilian women.MethodsAn online cross-sectional study was carried out in Brazil, with a structured questionnaire regarding dysmenorrhea and associated symptoms. PD intensity was measured with the Numerical Rating Scale for Pain and classified as mild (1–3), moderate (4–7) and severe (> 8). The association between qualitative variables was performed using Pearson’s Chi-Square Test. The quantification of this association was measured using multinomial logistic regression models, with calculation of Odds Ratio and confidence interval. A significance level of 5% was considered.ResultsA total of 10,070 women were included. Most participants classified PD intensity as moderate (40.4%, 41.9% and 49.7%) and severe (21.2%, 24.8% and 28.4%) in the previous month, 3 months and 5 years, respectively. The most common symptoms associated with PD were irritability, abdominal distension sensation, anxiety and feeling more emotional. The increased of the risk (OR > 1.0) for moderate and severe PD-related pain intensity is related to age, nulliparity and presence PD since adolescence.ConclusionThere is a high prevalence of PD among Brazilian women, and the most common symptoms reported were irritability, abdominal distension sensation, anxiety and feeling more emotional.

Prevalence and determinants of COVID-19 vaccine acceptance among vulnerable populations in Thailand: An application of the health belief model

BackgroundAssessing the acceptance of vaccinations among vulnerable populations is essential to ensure proper coronavirus disease 2019 (COVID-19) control. This study used the Health Belief Model to examine the intention to vaccinate against COVID-19 among vulnerable populations in Thailand. MethodsThis analytical cross-sectional study was conducted in Thailand between October and November 2021. Using multistage random sampling, 945 individuals from vulnerable populations (i.e., older adults, pregnant women, market or street vendors, and individuals with chronic diseases) were selected and invited to complete a self-reported questionnaire. The questionnaire assessed participants’ socioeconomic characteristics, COVID-19 preventive measures, knowledge, preventative health beliefs, and vaccine intention. A generalized linear mixed model was used to identify factors associated with the intention to receive the vaccine. ResultsThe prevalence of intent to accept the COVID-19 vaccine was 75.03% (95% confidence interval [CI]: 72.16–77.68). The Health Belief Model factors associated with vaccine acceptance were cue to action (adjusted odds ratio [AOR] = 3.13; 95% CI: 2.07–4.71), perceived benefits (AOR = 2.04; 95% CI: 1.38–3.01), and perceived severity (AOR = 1.77; 95% CI: 1.18–2.65). Significant other covariates were wearing a face mask in the previous month (AOR = 2.62; 95% CI: 1.59–4.31), being 1–2 m away from other people (AOR = 1.58; 95% CI: 1.11–2.24), trust in government (AOR = 1.44; 95% CI: 1.03–2.02). Additionally, women were more likely to accept the COVID-19 vaccine compared to men (AOR = 1.43; 95% CI: 1.02–2.01). ConclusionsApproximately one quarter of vulnerable individuals do not intend to be vaccinated. Health Belief Models can explain vaccine acceptance, and aid the Ministry of Public Health in planning future efforts to increase vaccine uptake. Healthcare professionals' advice, village health volunteers’ information, and partnership collaborations are critical. Facilitating mobile community units, launching educational campaigns, maintaining a distance of 1–2 m from others, and wearing masks may increase COVID-19 vaccine acceptability. This research can help prepare for future pandemics.

The research of common drought indexes for the application to the drought monitoring in the region of Jin Sha river

Abstract Based on MODIS data from 2010 to 2020 and precipitation, air temperature, and soil moisture data of 33 meteorological stations in Jinsha River Basin from 1990 to 2020, the applicability of different remote sensing drought indexes in Jinsha River Basin was studied. These indexes include temperature condition index (TCI) and temperature vegetation drought index (TVDI), the results of vegetation condition index (VCI), vegetation supply water index (VSWI), standardized precipitation evapotranspiration index (SPEI), and standardized precipitation index (SPI) showed that TCI and TVDI, VSWI and TCI, VSWI and TVDI, VSWI and TVDI, VSWI and TVDI, VSWI and TVDI, VSWI and TVDI, SPEI and SPI, respectively. The correlation between VSWI and VCI was significant. VCI had the lowest correlation with SPEI and SPI. The average correlation coefficient between TCI and VSWI was similar. The correlation between VSWI, SPEI, and SPI was low in January, March, and October and reached significant or above levels in other months. TVDI had the highest correlation with SPEI and SPI. TVDI was significantly correlated with soil moisture every month of the year, indicating that TVDI can be effectively used for remote sensing drought monitoring in Jinsha River Basin and has strong adaptability. According to the temporal and spatial analysis of drought monitoring in the Jinsha River Basin by TVDI, the drought areas in December and January are mainly located in the middle reaches of the Jinsha River Basin, while the light drought areas are mainly located in the upper and lower reaches of the Jinsha River Basin. From March to June, the risk of severe drought increased in the middle reaches of the Jinsha River, and the moderate drought area in the Jinsha River Basin also increased. The drought from July to November was weaker than in the previous months. The moderate drought area is mainly located in the middle and lower reaches of the Jinsha River, and the mild drought area is mainly distributed in the upper reaches of the Jinsha River Basin.

Comparison of quantification of intraretinal hard exudates between optical coherence tomography en face image versus fundus photography.

To compare the quantification of intraretinal hard exudate (HE) using en face optical coherence tomography (OCT) and fundus photography. Consecutive en face images and corresponding fundus photographs from 13 eyes of 10 patients with macular edema associated with diabetic retinopathy or Coats' disease were analyzed using the machine-learning-based image analysis tool, "ilastik." The overall measured HE area was greater with en face images than with fundus photos (en face: 0.49 ± 0.35 mm2 vs. fundus photo: 0.34 ± 0.34 mm2, P < 0.001). However, there was an excellent correlation between the two measurements (intraclass correlation coefficient [ICC] = 0.844). There was a negative correlation between HE area and central macular thickness (CMT) (r = -0.292, P = 0.001). However, HE area showed a positive correlation with CMT in the previous several months, especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy (CMT 3 months before: r = 0.349, P = 0.001; CMT 4 months before: r = 0.287, P = 0.012). Intraretinal HE can be reliably quantified from either en face OCT images or fundus photography with the aid of an interactive machine learning-based image analysis tool. HE area changes lagged several months behind CMT changes, especially in eyes treated with anti-VEGF injections.

Association between emotional stability and suicidality in a Brazilian sample of the general population during the COVID-19 pandemic and the moderation role of financial hardship

BackgroundEmotional stability is considered a protective factor for suicidal behavior. Nonetheless, suicidality is the result of a complex interaction of protective and risk factors, a key one being financial difficulties. We aimed to investigate the association between emotional stability and suicidality in Brazilian individuals during the COVID-19 pandemic, and the moderation role of financial hardship MethodsA total of 2140 participants, 79.4% women, answered an online survey from November 2020 to January 2021, containing questions about suicidality as well as concerning economic hardship. We conducted multiple regression and moderation analysis using SPSS PROCESS v3.5 Macro model 1 ResultsThe participants who reported not having presented suicidal ideation or suicide attempt in the previous month showed a significantly higher level of emotional stability. There was a significant interaction with financial hardship (p=0,006) for suicide attempt as the outcome, with significant association between emotional stability and suicide attempts only in the absence of financial hardship LimitationsThe limitations of this study include the lack of control for distinct mental disorders and levels of financial problems ConclusionThe presence of financial hardship may suppress the protective role of emotional stability in suicidal behavior.

Sleep measures as a predictor of suicidal ideation among high-risk adolescents.

Suicide is the second leading cause of death among youth aged 15-24years. Identifying modifiable risk factors relevant to adolescents is crucial for suicide prevention. Sleep patterns have been linked to suicidality in adults, but lack sufficient study in youth. This ecological momentary assessment (EMA) study aimed to explore the relationship between objectively and subjectively measured sleep characteristics and next-day suicidal ideation in high-risk youth. We included 29 adolescents (12-18 years old) admitted to the inpatient psychiatric ward post-suicide attempt or due to suicidal intent within the previous month. We conducted objective (actigraphy) and subjective (sleep diary) sleep pattern assessments over ten consecutive days. Daily suicidal ideation was evaluated using a questionnaire based on the validated C-SSRS interview. A significant positive association was observed between sleep onset latency (SOL) and expressing a "death wish" the following day (OR = 1.06, 95% CI [1-1.11], p = .04), with each minute of longer SOL increased the risk for a death wish the following day by 6%. In addition, a marginally significant negative association was observed between total sleep time (TST) and expressing a "death wish" the following day (OR = 0.57, 95% CI [0.3-1.11], p = 0.1), with each one-hour decrease in objectively measured TST increasing the odds of a death wish by 43%. Our study highlights the interplay between sleep patterns and suicidal ideation, with SOL and TST playing a significant role that may function as proximal risk factors for suicidality and as a target for intervention while treating suicidal youth.

Usefulness of the Berg Balance Scale for prediction of fall risk in multiple sclerosis.

The Berg Balance Scale, possibly the most widely used balance-related measure, has gained popularity in clinical trials. It provides information about patients' balance-related abilities and can be used to assess improvement or worsening after rehabilitation. The aim of this study is to determine the cut-off value of the Berg Balance Scale for the fall risk in patients with multiple sclerosis (MS). This study was designed as a prospective descriptive trial, and 186 patients with MS were included. Fall history was recorded by interview; balance was assessed using the Berg Balance Scale (BBS). The mean ages of 96 patients with a fall history within the previous month and 90 patients without a fall history were 35.98 ± 8.58 and 35.71 ± 9.33years, respectively. The mean value of the BBS score of the faller group was 49.44 ± 5.43 while 52.36 ± 3.53 in non-faller group. The cut-off value of the BBS for fall risk in patients with MS was determined as 50.50 points. For patient safety and the success of rehabilitation, it is crucial to evaluate the risk of falling in patients with MS, one of the neurological patient groups where complaints about falling are most prevalent. The results showed that BBS is a sensitive and specific measure for identifying in patients with MS at risk of falling.

The professionalism of clinical teachers in clinical education.

Professionalism has long been recognised as a core competency for clinical teachers as role models and educators. The present study aimed to evaluate the adherence to professionalism of clinical teachers from the perspectives of resident doctors and undergraduate medical students. This is a descriptive and cross-sectional study. All learners, including undergraduate medical students and residents who were studying in the medical school and teaching hospitals affiliated with Shahid Sadoughi University, were entered into this study as evaluators (n = 311). Of these, 151 clinical teachers were assessed by the learners. The students were asked to assess the two clinical teachers with whom they had interacted during the previous month in the clinical department. The Faculty Professionalism Evaluation Questionnaire was used in this study. The results of the confirmatory factor analysis (CFA) confirmed the adequacy of the model. The total mean score was 1.98 (standard deviation=0.36, range = 0.96 to 2.82). In addition, the total mean score of the adherence to professionalism among clinical teachers was reported at the level of "met expectations". The results showed that the teachers' scores in the domains of "doctor-patient relationship" and "doctor-student relationship" were reported under the "met expectations" level. Their scores in the "inter-professional relationship" and "doctor-self relationship" domains were reported as "below expectations". The results showed the scores of teachers' professionalism were significantly lower from the viewpoints of residents than in the perceptions of medical students (p=0.0001). The professionalism scores of clinical teachers were evaluated as "below expectations" from the learners' perspectives.