Total Participants Research Articles

Combined Self-Reported and Device-Measured Physical Activity Assessment and Disability Incidence in Older Adults

ObjectivesTo clarify the relationship between self-reported and device-measured physical activity (PA) and disability incidences in community-dwelling older adults. DesignProspective cohort study. Setting and ParticipantsIn total, 4504 (median age 75 [range, 72–79] years; women, 52.1%) community-dwelling older adults were included in this study. MethodsDevice-measured moderate-to-vigorous PA (MVPA) was measured using a triaxial accelerometer. Self-reported MVPA was assessed using the Japanese version of the International Physical Activity Questionnaire, Short Form. The cutoff MVPA was 150 min/wk. PA was divided into 4 groups based on self-reported and device-measured assessments: (1) self-reported/device-measured inactive, (2) self-reported active/device-measured inactive, (3) self-reported inactive/device-measured active, and (4) self-reported/device-measured active. The disability incidence, defined as a long-term care insurance certification of any level indicating a requirement for support or continuous care, was prospectively determined using data extracted from the Japanese long-term care insurance system. ResultsOf the participants, 892 (19.8%) developed disabilities within 62 (range, 60–64) months. The prevalence of self-reported inactive/device-measured inactive, self-reported active/device-measured inactive, self-reported inactive/device-measured active, and self-reported active/device-measured active were 884 (34.9%), 441 (17.4%), 693 (27.3%), and 515 (20.3%) participants, respectively. Multivariate Cox regression analysis showed that self-reported/device-measured active, self-reported inactive/device-measured active, and self-reported active/device-measured inactive independently decreased the disability incidence risk (self-reported/device-measured active: hazard ratio [HR], 0.555, 95% confidence interval [CI], 0.412–0.749; self-report inactive/device-measured active: HR, 0.656; 95% CI, 0.518–0.831; self-reported active/device-measured inactive: HR, 0.718; 95% CI, 0.556–0.928). In the post hoc analysis, those who were self-reported active/device-measured inactive were divided into 2 groups according to involvement in sports. Those who played sports had a lower disability risk; however, the difference was not significant. Conclusions and ImplicationsCombined self-reported and device-measured PA assessments may allow for disability risk stratification in older adults. The findings will also help in creating methods for evaluating PA levels to prevent disability incidences among older adults.

Assessment of Knowledge, Attitude, and Practices Related to Sun Exposure among University Students of Rawalpindi and Islamabad

Objective: To assess the knowledge and attitude towards sun exposure related practices among university students of twin cities. Study Design: Quantitative analytical cross-sectional study. Place and Duration of Study: A Quantitative analytical cross-sectional study was carried out in the university students of Rawalpindi and Islamabad Pakistan, from Jan till Apr 2022. Methodology: Total participants were 317. Participants were university students, who were studying during 2021-2022 under registered universities within the twin cities. The data was gathered through online Google Forms. IBM SPSS version 25 was used for analysis. Results: 42.5% participants exposed themselves to the sun doing outdoor activities for over 90 days a year, while 49.3% did so for 1-2 hours a day. 29% of the people got painful burns at least once or twice this year. Only 20% participants took shelter in shade or used umbrellas, 14.5% used hats. 20.4% never used sunscreen, while 22.6% did, and among them, 44.3% were unaware of the SPF they used. 48% do not like using sunscreen. 65.4% believed sun protection creams were the best way to protect themselves. 81.1% think at least 30 minutes of sun a day are advisable for adequate Vitamin D levels. (p<0.05) Conclusion: It was found that people does have knowledge about the importance of shade and clothing material, such as hats,to avoid the harmful effects of sun exposure but they do not practice it. When it comes to sunscreen, most do not use it and those who do, do not possess significant knowledge about its SPF.

Prevalence and Prognostic Impact of Multiple Frailty Domain in Japanese Older Adults

ObjectivesIn this observational study, we aimed to evaluate the independent and overlapping effects of multiple frailty domains on long-term care insurance (LTCI) use. DesignPopulation-based cohort design. Setting and ParticipantsIn total, 9804 community-dwelling older adults were recruited from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. MethodsThe physical domain of frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria. The cognitive domain of frailty was identified as impairment of memory, attention, executive function, or processing speed using standardized thresholds established for each domain in population-based cohorts. The social domain was operationalized using the National Center for Geriatrics and Gerontology-Social Frailty Scale. The use of LTCI was prospectively determined over 60 months using data extracted from the Japanese long-term care insurance system. ResultsThe data from 7745 participants were analyzed, of whom 793 (10.2%) required LTCI certification within 60 months (interquartile range: 60–60 months). The Kaplan–Meier curve analysis demonstrated that a high number of frailty domains was associated with incident LTCI use. The proportions of incident LTCI use were 6.0%, 12.4%, 30.1%, and 43.9% for non-frail participants and those with impairments in 1, 2, and 3 frailty domains, respectively. In the multivariate Cox regression model, physical, cognitive, and social domain impairments independently increased the risk of incident LTCI use [physical domain impairment, hazard ratio (HR), 1.67; 95% CI, 1.39–2.01; cognitive domain impairment, HR, 1.59; 95% CI, 1.37–1.84; social domain impairment, HR, 1.26; 95% CI, 1.05–1.50]. Conclusions and ImplicationsOverlapping frailty domains were strongly associated with incident LTCI use among community-dwelling older adults. These findings emphasize the importance of assessing multiple frailty domains and tailoring interventions according to the unique circumstances of older adults to prevent functional disabilities.

Transforming policing in Ghana through technology: a focus on police operations in the Greater Accra region

Integrating technology into policing has the potential to greatly improve the effectiveness, transparency, and community participation of law enforcement agencies. This study examines the profound influence of technology on the Ghana Police Service, with a specific emphasis on the Greater Accra Region. The main aim of this research is to examine how technological advancements might enhance police results and tackle existing difficulties in the context of law enforcement in Ghana. The study adopts a qualitative research approach and collects data from police officers and community members through the use of semi-structured interviews and focus group discussions. The investigation involved the participation of a combined total of twenty-six police officials from the Tema and Accra Regional Headquarters, as well as twenty-two community members. The data gathering procedure sought to gather a wide range of viewpoints on the present condition of technology in law enforcement, its advantages, difficulties, and prospects for future advancement. The results demonstrate that the utilisation of technology, such as mobile data terminals and social media platforms, can greatly improve the effectiveness of police operations, promote community involvement, and increase transparency. Nevertheless, the presence of obstacles such as insufficient infrastructure, cultural opposition, and the necessity for extensive training were also acknowledged. The research enhances the current knowledge by presenting empirical evidence on the benefits and constraints of technology in law enforcement, particularly in the setting of Ghana. This study emphasises the significance of making strategic investments in technology infrastructure and training, as well as the necessity of establishing legal frameworks to tackle ethical and privacy concerns. Additionally, it proposes that future studies should prioritise examining the enduring viability of technological advancements in law enforcement and investigating their effects in various geographical areas. The study suggests that politicians and law enforcement organisations should promote the deployment of technology in a way that is successful and build public trust in the Ghana Police Service.

Associations of movement behaviours and dietary intake with arterial stiffness: results from the ORISCAV-LUX 2 cross-sectional study

ObjectiveAdopting a physically active lifestyle and maintaining a diet rich in antioxidants can reduce the risk of vascular diseases. Arterial stiffness is an early marker for cardiovascular diseases, indicating vascular...

Exploring the Effect of Preamputation Employment and Income on Ambulation in Dysvascular Lower Extremity Amputees After Amputee Rehabilitation: A Retrospective Cohort Study

ObjectiveTo assess the relationship between 2-minute walk test (2MWT) distance, employment status, and median household income in adult dysvascular amputee patients after a 6-week rehabilitation program. DesignRetrospective cohort study. SettingAmputation rehabilitation program. ParticipantsIn total, 505 patients were included in the analysis. Most (71.1%) were men and had below-knee amputations (78.3%); the average age was 65.3±11.6 years. InterventionsNot applicable. Main Outcome Measures2MWT distance at discharge. ResultsMen (68.3±32.6m) and below-knee amputation amputees (70.9±32.0m) walked significantly further than women (58.8±30.0m; P=.003) and above-knee amputees (47.2±25.7m; P<.001), respectively. A significant negative correlation was found between 2MWT distance and age (r=−.32; P<.001) as well as time from consultation to admission (r=−.23; P<.001). An unadjusted general linear model (GLM) revealed that employment status (F2,446=17.47; P<.001) but not income (F4,446=.714; P=.58) was statistically significantly associated with 2MWT distance. An adjusted (age, sex, time from consult to admission, and amputation level) GLM revealed employment status remained significant (F2,434=5.59; P=.004) and income remained insignificant (F4,434=.43; P=.784). Differences in 2MWT distance between employment and income groups did not meet clinical significance. ConclusionsPreamputation employment appears to be associated with postrehabilitation outcomes.

An examination of nursing students’ performance in and Satisfaction with a Patient Safety E-Learning Module

BackgroundThe knowledge nursing students acquire during their undergraduate degree influences the quality of patient care they provide for many years to come. However, previous studies indicate that students may have a limited understanding of core patient safety concepts. ObjectivesThe objectives of this study were to (i) examine nursing students’ performance in an interactive patient safety e-learning module titled ‘One shift, four patients … a day in the life of a new graduate nurse’; and (ii) explore students’ level of satisfaction with the module using the Satisfaction with the Patient Safety E-Learning Module scale. DesignA cross-sectional design was used with students’ knowledge and levels of satisfaction examined using descriptive statistics. Setting and participantsIn total, 1038 third-year undergraduate nursing students from 22 Australian universities attempted the module. ResultsThe mean correct score was 74%, but there were significant differences in knowledge levels evident across the four activities that comprised the module. Participants achieved the highest mean score in Activity 2 (Predicting, monitoring, and responding to adverse events [79%]) and the lowest in Activity 3 (Clinical reasoning [66%]). The mean score for Activity 1 (Infection control and medication safety) was 74%, and for Activity 4 (Cultural competence), the score was 77%.The level of student satisfaction with the module was high with responses to each survey item exceeding 4.0 out of 5.0. The Cronbach’s alpha for the satisfaction scale was 0.99, and the Content Validity Index was >0.9. ConclusionsUniversities are responsible for preparing nursing students to become safe clinicians. The results from this study indicate that participants’ overall level of knowledge of key patient safety concepts was adequate. However, as knowledge is the foundation for safe practice, these results suggest that further attention to imbedding patient safety in nursing curricula is required.

Making Decisions About Calling 988 Versus 911: Understanding End-User Views Before the Launch of 988.

The 988 telephone number was implemented in July 2022 as an easily accessible way to reach the National Suicide Prevention Lifeline and has been envisioned as one step in building a more robust crisis care continuum in the United States. This study aimed to describe how various stakeholders anticipated using 988 compared with the most widely known crisis line: 911. Focus groups (N=15, with 76 total participants) were conducted in three counties in New York State between October and November 2021, before the launch of 988. Five stakeholder groups were included: mental health services consumers, family members of consumers, community members, mental health providers, and crisis call takers. Thematic analysis was used to code and analyze all focus group transcripts. Participants anticipated that key uses for 988 would be accessing support during a crisis, obtaining connections to local resources and services, and receiving alternatives to law enforcement response. However, participants continued to articulate uses for 911 during a mental health crisis, especially for situations involving "safety concerns." The broad expectations for 988 suggest that the line must be flexible and responsive to a range of needs and that communities should clearly define what is available through 988. More implementation research is needed to ensure a detailed understanding of those whom 988 is serving, how the line meets callers' needs, and the line's potential for connecting people to needed services.

Prediction Model for Delayed Behavior of Early Ambulation After Surgery for Varicose Veins of the Lower Extremity: A Prospective Case-Control Study

ObjectiveTo analyze influencing factors and establish a prediction model for delayed behavior of early ambulation after surgery for varicose veins of the lower extremity (VVLE). DesignA prospective case-control study. SettingPatients with VVLE were recruited from 2 local hospitals. ParticipantsIn total, 498 patients with VVLE were selected using convenience sampling and divided into a training set and a test set. InterventionsNot applicable. Main Outcome MeasuresWe collected information from the selected participants before surgery and followed up until the day after surgery, then divided them into a normal and delayed ambulation group. Propensity score matching was applied to all participants by type of surgery and anesthesia. All the characteristics in the 2 groups were compared using logistic regression, back propagation neural network (BPNN), and decision tree models. The accuracy, sensitivity, specificity, and area under the curve (AUC) values of the 3 models were compared to determine the optimal model. ResultsA total of 406 participants were included after propensity score matching. The AUC values for the training sets of logistic regression, BPNN, and decision tree models were 0.850, 0.932, and 0.757, respectively. The AUC values for the test sets were 0.928, 0.984, and 0.776, respectively. A BPNN was the optimal model. Social Support Rating Scale score, preoperative 30-second sit-stand test score, Clinical-Etiology-Anatomy-Pathophysiology (CEAP) grade, Medical Coping Modes Questionnaire score, and whether you know the need for early ambulation, in descending order of the result of a BPNN model. A probability value greater than 0.56 indicated delayed behavior of early ambulation. ConclusionsClinicians should pay more attention to those with lower Social Support Rating Scale scores, poor lower limb strength, a higher CEAP grade, and poor medical coping ability, and make patients aware of the necessity and importance of early ambulation, thereby assisting decision-making regarding postoperative rehabilitation. Further research is needed to improve the method, add more variables, and transform the model into a scale to screen and intervene in the delayed behavior of early ambulation of VVLE in advance.

Preliminary Examination of Guardian Cap Head Impact Kinematics Using Instrumented Mouthguards.

Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available. To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs. Case series. The 2022 American football preseason. Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards. Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance. No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P = .20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P = .51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P = .72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P = .32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P = .29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P = .32) between sessions for the 7 players who completed all 6 workouts. These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players.

Role of Individual Social Capital in the Association of Physical Frailty With Functional Ability Among Older Adults

ObjectivesRich social capital is regarded as an individual's social asset, which may contribute to the maintenance of functional ability, even in a state of frailty. This study examined the moderating role of individual social capital in the association between physical frailty and functional ability among older adults. DesignA cross-sectional study. Setting and ParticipantsIn total, 522 community-dwelling older adults aged ≥60 years were recruited from among visitors to public facilities, including community cultural centers and gymnasiums in Aichi, Japan. MethodsFunctional ability was assessed using the 5-item subscale of the Tokyo Metropolitan Institute of Gerontology Index of Competence that assesses instrumental self-maintenance, including transportation, finance management, and shopping. Physical frailty was defined by the Fried Frailty Phenotype Questionnaire, including 5 items of fatigue, resistance, ambulation, inactivity, and weight loss, and the participants were classified into 3 groups: non-frailty, pre-frailty, and frailty. Individual social capital was assessed for 2 dimensions: the cognitive dimension (perceptions of community social cohesion) and the structural dimension (informal socializing and social participation). ResultsThe participants’ mean age (SD) was 74.1 (6.5) years and 78.0% were women. Among the participants, non-frailty was 46.6%, pre-frailty was 47.0%, and frailty was 6.5%. Multivariable linear regression analysis revealed that physical frailty was associated with lower levels of functional ability compared with non-frailty [pre-frailty: β (95% CI) = −0.07 (−0.22 to 0.08), P = .374; frailty: β = −0.67 (−0.99 to −0.35), P < .001]. However, individual structural social capital showed a negative interaction with physical frailty against low functional ability, indicating a moderating association (P = .027). Conclusions and ImplicationsHigh levels of individual structural social capital mitigated the adverse association between physical frailty and functional ability. Fostering rich social capital may preserve the functional ability of frail older adults, helping their independent lives in the community.

The Effect of Graded Activity and Pain Education After Lumbar Spinal Fusion on Sedentary Behavior 3 and 12 Months Postsurgery: A Randomized Controlled Trial

ObjectivesTo examine the effect of an early postsurgical intervention consisting of graded activity and pain education (GAPE) in patients with chronic low back pain (CLBP) undergoing lumbar spinal fusion (LSF) on sedentary behavior, disability, pain, fear of movement, self-efficacy for exercise and health-related quality of life (HRQoL) at 3-, 6-, and 12 months follow-up. DesignA parallel-group, observer-blinded randomized controlled trial. SettingDepartment of Occupational- and Physiotherapy and the Centre for Rheumatology and Spine Diseases, Rigshospitalet, Denmark. ParticipantsIn total, 144 participants undergoing an LSF for CLBP were randomly assigned to an intervention or a control group. InterventionsThe intervention group received 9 sessions of GAPE, based on principles of operant conditioning. Main Outcome MeasuresThe primary outcome was reduction in time spent in sedentary behavior, measured by an accelerometer at 3 months. The secondary outcomes were reduction in time spent in sedentary behavior at 12 months and changes from baseline to 3-, 6-, and 12 months on disability, pain, fear of movement, self-efficacy for exercise, and HRQoL. ResultsNo difference in changes in sedentary behavior between groups was found 3 months after surgery. At 12 months after surgery, there was a significant difference between groups (mean difference: −25.4 min/d (95% confidence interval −49.1 to −1.7)) in favor of the intervention group. ConclusionsCompared with usual care, GAPE had no effect on short-term changes in sedentary behavior but GAPE had a statistical, but possibly not clinical significant effect on sedentary behavior 12 months after LSF. Further, the behavioral intervention was safe to perform.

Machine learning models for classifying non-specific neck pain using craniocervical posture and movement

ObjectivePhysical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR). DesignExploratory, cross-sectional design. Setting and participantsIn total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332). MethodsWe set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms–random forest, logistic regression, Extreme Gradient boosting, and support vector machine–were trained. Main outcome measuresModel performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values. ResultsThe random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715]. ConclusionML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP.

Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial

BackgroundCentral venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. ObjectiveTo investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. DesignThis was a prospective, randomized, controlled, open-label trial. SettingPatients were recruited from 14 medical institutions in China between February and June 2023. ParticipantsIn total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. MethodsPatients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. ResultsAfter 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence intervals (CI):0.203,0.367) in the intervention group and 53.97 % (68/126,95%CI:0.449 ~ 0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125，95%CI: 0.039 ~ 0.142) in the intervention group and 23.8 % (30/126，0.167 ~ 0.322) in the control group, with a statistically significant difference (χ2 = 11.707，p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125，92.0 %，95%CI: 0.858 ~ 0.961) than in the control group (104/126, 82.54 %,95%CI: 0.748 ~ 0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). ConclusionThe low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. RegistrationChinese Clinical Trial Registry (ChiCTR2200064007，www.chictr.org.cn). The first recruitment was conducted in February.https://www.chictr.org.cn/showproj.html?proj=177311

Assessing patient risk, benefit and outcomes in drug development: an observational study of regorafenib clinical trials

ObjectiveOur objective of this study was to analyse all oncological clinical trials using regorafenib to create a complete risk/benefit profile for the drug.BackgroundCreating a novel chemotherapy is costly both in...

Designathons in health research: a global systematic review

IntroductionA designathon is a three-stage participatory activity informed by design thinking. There is a growing literature on designathons in health. This study synthesised designathons’ effectiveness and implementation-related factors to address...

Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape health inequalities in slums. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. We constructed intersectional strata for each health condition from combinations of significant SDoH obtained using univariate analyses. We then estimated the intersectional effects of health condition in a series of MAIHDA logistic regression models distinguishing between additive and interaction effects. We quantified discriminatory accuracy (DA) of the intersectional strata by means of the variance partitioning coefficient (VPC) and the area under the receiver operating characteristic curve (AUC-ROC). The total participants were 2,199 <5y, with 120 records (5.5%) dropped because health conditions were recorded as "not applicable". The main outcome variables were three health conditions: 1) whether a child had diarrhea or not, 2) whether a child had fever or not, and 3) whether a child had cough or not in the previous two weeks. We found non-significant intersectional effects for each health condition. The head of household ethnic group was significantly associated with each health condition. We found good DA for diarrhea (VPC = 9.0%, AUC-ROC = 76.6%) an indication of large intersectional effects. However, fever (VPC = 1.9%, AUC-ROC = 66.3%) and cough (VPC = 0.5%, AUC-ROC = 61.8%) had weak DA indicating existence of small intersectional effects. Our study shows pathways for SDoH that affect diarrhea, cough, and fever for <5y living in slums are multiplicative and shared. The findings show that <5y from Luo and Luhya ethnic groups, recent migrants (less than 2 years), and households experiencing CHE are more likely to face worse health outcomes. We recommend relevant stakeholders to develop strategies aimed at identifying these groups for targeted proportionate universalism based on the level of their need.

Patient Satisfaction from Services Provided at Low Vision Clinic in Tertiary Care Hospitals- A Cross-Sectional Study

Patients have always been the main stakeholders in the modern world of medicine. Objective: To assess the level of satisfaction of people with low vision with the provision of low vision services at Hayatabad Medical Complex in Peshawar. Moreover, to compare the satisfaction level of people with low vision concerning the degree of vision impairment. Methods: An interviewer-administered, questionnaire (PSQ-18), was used to collect data from 125 low-vision patients at a low-vision clinic. The survey used Likert's five-point rating scale to measure satisfaction with LV services. The data was analyzed using SPSS. Results: The results of the study demonstrated that the vast majority of study participants (n = 62, 50%) were delighted with the low vision care they received, followed by thirty-eight (30.4%) participants who remained satisfied, whereas twelve (9.6%) patients were dissatisfied. Male participants were more likely to be satisfied (94%) than female participants (63%). Amongst the total study participants, the proportion of participants with moderate vision impairment was approximately doubled as compared to those with severe vision impairment. Conclusions: The study found that moderate vision impairment participants were more satisfied than those with severe impairment, indicating an inverse relationship between satisfaction and the degree of vision impairment. 99% of participants were satisfied with the technical quality of the services provided.

Making Oneself "Fit": Community Perspectives on Disaggregated Race and Ethnicity Data Collection and Reporting in Healthcare Settings.

Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.

The Analysis of Factors Affecting Social Security of Labour in Indonesia

This research aims to analyze the factors affecting Social Security of labour in Indonesia in the 1991-2022 period reviewed from the variables of total active participants (JPA), Gross Domestiv Product (GDP0, Inflation, Minimum Wage (UM) and Workforce Participation Rate (TPAK). The research employs secondary data, namely annual data obtained from the Central Statistics Agency and BPJS Ketenagakerjaan (Employee Social Security System) report. This research employs regression analysis method of Autoregressive Distributed Lag (ARDL). This research result indicates that in the long term, the variables of GDP, Inflation and Minimum Wage have a positive and significant effect on the JPA, respectively, Meanwhile, TPAK has a negative and insignificant effect on JPA. Keywords: Total Active Participants, Gross Domestic Product, Inflation, Minimum Wage, Workforce Participation rate, Autoregressive Distributed Lag