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Mental health disorders such as depression, anxiety, and stress are prevalent in the general population, with various socio-demographic factors potentially influencing their prevalence. This study aimed to assess the prevalence of Depression, Anxiety, and Stress Scale - 21 Items and identify associated risk factors within the general population in Asir, Saudi Arabia. This cross-sectional study, conducted from April 27, 2025, to September 28, 2025, assessed depression, anxiety, and stress using the Depression, Anxiety, and Stress Scale - 21 Items and identified risk factors in the Asir region of Saudi Arabia. Data from 392 participants were collected through an anonymous online survey and analyzed using descriptive statistics and logistic regression. The study included 392 participants, with 55.1% females and 44.9% males. The largest age group was 18 to 30 years (27.3%). Most participants were nonsmokers (84.2%), 46.7% were employed, and 52% had graduate-level education. A majority were married (61.5%), and 32.9% earned <5000 Saudi Arabian Riyal per month. In terms of mental health, 36.5% were classified as normal for depression, 21.7% for anxiety, and 55.4% for stress. Depression was more common in single individuals (odds ratio [OR] = 4.999, P = .011) and those with 3 to 5 children (OR = 2.232, P = .060). Anxiety was higher in divorced/widowed individuals (OR = 3.828, P = .016) and the unemployed (OR = 2.033, P = .017). Stress was more prevalent in single (OR = 6.304, P = .007) and divorced/widowed individuals (OR = 2.994, P = .094), and those with 3 to 5 children (OR = 3.417, P = .030). Females had lower odds of anxiety (OR = 0.543, P = .021). Age, education, smoking, and income showed limited or nonsignificant associations with mental health outcomes. The study found high levels of depression, anxiety, and stress, with unemployment, being single or divorced, and having more children as significant risk factors. These findings highlight the need for targeted mental health interventions, accessible services, stigma reduction, and preventive strategies addressing social and economic influences on mental well-being.
ObjectiveTo evaluate caregiver experiences with presurgical lip, alveolus, and nose approximation (PLANA) therapy, including adherence, burden, support, and perceived effectiveness in infants with cleft lip and/or palate.DesignCross-sectional survey study using an anonymous, voluntary questionnaire administered via Research Electronic Data Capture. Descriptive statistics were used to summarize responses, and qualitative responses were analyzed for common themes.SettingSingle tertiary care academic institution.Patients, ParticipantsCaregivers of infants with cleft lip and/or palate undergoing PLANA therapy were identified through institutional records. Of 48 eligible caregivers, 23 unique responses were included.InterventionsPLANA therapy utilizing the NoseAlign device with concurrent lip taping, applied at home with periodic clinical follow-up.Main Outcome Measure(s)Caregiver-reported adherence, training satisfaction, infant tolerance, caregiver burden, perceived support, and perceived effectiveness.ResultsCaregivers reported high satisfaction with training (73.9% very satisfied) and high adherence, with 87.0% reporting consistent use and 100% reporting daily wear. Most reported no feeding interference (86.4%) and good infant tolerance (73.9% comfortable or very comfortable). Caregiver burden was low, with 60.9% reporting minimal impact on daily routines and 78.3% reporting confidence in application. Perceived support from the medical team was uniformly high (100%). Overall, 90.9% were satisfied with outcomes, and 95.7% would recommend PLANA therapy.ConclusionsPLANA therapy demonstrates high caregiver satisfaction, strong adherence, and favorable perceived outcomes. Its simplified design may reduce caregiver burden while maintaining effectiveness. Further studies are needed to evaluate long-term outcomes and cost-effectiveness.
To assess the perceived effectiveness of the school nurse services through students' responses and to examine whether there is a detectable relationship between the students' subjective health status and the school nurse's service delivery. We conducted our cross-sectional, quantitative research in the West Transdanubian region of Hungary using convenience sampling among high school students (n = 429). Given the non-probability sampling, the findings may not be generalizable to all student populations. Data were collected using standardized (SF-36, EQ-VAS, questions on the prevalence of subjective health complaints from the HBSC survey) and a self-developed questionnaire. Chi-square tests, correlation analyses and multivariable linear regression analyses were performed using SPSS Statistics 27.0 software. Students reported a higher level of health-related knowledge received from the school nurse, along with better perceived applicability of this knowledge in everyday life (p < 0.05). Nearly three quarters of respondents indicated that the school nurse's activities contributed to the development of their health-related attitudes and this perception showed a statistically significant association with both the quantitative and qualitative evaluation of the care provided (p < 0.05). Higher ratings of the perceived effectiveness of school nursing activities were associated with more favourable self-rated mental health and a lower level of reported health complaints; however, these associations were weak in magnitude. The results revealed statistically significant but weak associations between perceived school nurse services and selected indicators of students' self-rated health status. Due to the cross-sectional design and the use of self-reported data, causal inferences cannot be drawn. Nonetheless, the findings suggest that more favourable quantitative and qualitative evaluations of the care provided are linked to higher perceived effectiveness of school nurse activities. Further research on quality indicators of school nurse services and approaches tailored to students' needs may be warranted. The observed associations between students' perceptions of school nurse services and their health perceptions underscore the importance of continuous professional development for school nurses. This may include advanced training in health education and communication skills to further support the perceived effectiveness of their activities. What problem did the study address? We addressed the perceived effectiveness of school nurse services from the perspective of students and examined whether there is a detectable relationship between students' subjective health status and the services provided by school nurses. What were the main findings? The study found that higher levels of health-related knowledge reported as being provided by the school nurse were associated with more favourable student ratings of the applicability of this knowledge in everyday life. Students who reported more positive experiences with school nurse activities also tended to report more favourable health perceptions, which were reflected in the indicators used to evaluate the services. In addition, higher perceived effectiveness of school nurse services was associated with more favourable self-reported mental health and vitality, as well as a lower level of reported health complaints. Where and on whom will the research have an impact? The findings may be particularly relevant for school nurses, as they highlight the importance of their role and the potential need for continuous attention to service quality from the students' perspective. They may also be informative for students and school communities by underscoring that health education and services provided by school nurses are associated with more favourable self-reported health perceptions and overall well-being. No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study beyond students' participation as anonymous questionnaire respondents.
The war in Ukraine has disrupted health and education systems, limiting access to in-person continuing education at a time of increasing rehabilitation needs. Courses on an online learning platform were expanded and translated into Ukrainian to support both immediate and long-term professional development. This study examined how rehabilitation professionals and educators engaged with an online learning platform and how they perceived its relevance for clinical practice and teaching. A convergent mixed-methods design was used. Data were collected from platform analytics, an anonymous online survey, and semistructured interviews. Platform analytics captured participation and completion trends after the translation of more than 400 courses into Ukrainian. The survey (n = 231) explored course selection, application of new knowledge, barriers and facilitators to implementation, and perceived practice changes. Interviews (n = 8) provided deeper insight into how participants integrated online learning into clinical care and education. Quantitative and qualitative data were analyzed separately and integrated during interpretation. Between October 2024 and September 2025, 2189 Ukrainian users completed 21,647 courses, including 11,784 completed in Ukrainian translation. Survey respondents self-reported greater confidence, improved use of evidence-informed decision making, and changes in clinical and teaching practices. Common barriers included limited equipment and difficulty adapting content, whereas facilitators included course relevance, language accessibility, and personal motivation. Interview analysis generated two themes: translating online learning into complex case management and enhancing classroom teaching through online resources. This case highlights engagement with accessible, contextually adapted online learning supported professional development and knowledge sharing during a period of significant system disruption.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently complicated by multimorbidity, particularly cardiovascular and metabolic disorders such as heart failure and diabetes. These coexisting conditions create therapeutic conflicts and increase the risk of poor outcomes. Effective management strategies addressing both pulmonary and associated disorders in this high-risk population are urgently needed. This study aimed to evaluate whether a Doctor-Nurse Integrated Management (DNIM) model is associated with better clinical outcomes compared to routine care in AECOPD patients with multimorbidity. We conducted a retrospective cohort study at a tertiary hospital in China, screening electronic medical records of patients admitted for AECOPD with confirmed multimorbidity (defined as Charlson Comorbidity Index ≥ 2 or documented cardiac/metabolic comorbidities) between January 2022 and January 2025. Patients were allocated to either a DNIM group, receiving structured collaborative care including joint ward rounds, integrated care plans addressing both pulmonary and comorbid conditions, and collaborative discharge planning, or a routine care (RC) group. Propensity score matching (1:1) was employed to balance baseline characteristics. The primary outcome was a composite of all-cause mortality or readmission for cardiopulmonary events within one year. Secondary outcomes included length of stay (LOS), improvement in COPD Assessment Test (CAT) scores, and in-hospital complications. After propensity score matching, 104 patients (52 pairs) with well-balanced baseline characteristics were included. The DNIM group demonstrated a significantly lower associated risk of the one-year composite endpoint compared to the RC group (Hazard Ratio [HR] 0.58, 95% Confidence Interval [CI] 0.35-0.96, P = 0.034). Patients in the DNIM group also had a shorter mean length of stay (8.4 ± 2.1 vs. 11.2 ± 3.4 days, P < 0.001) and greater improvement in CAT scores (ΔCAT - 6.2 ± 2.5 vs. -4.1 ± 2.2, P < 0.01). Furthermore, the DNIM model was linked to fewer in-hospital complications (11.5% vs. 28.8%, P = 0.028), particularly hyperglycemia and acute heart failure. The Doctor-Nurse Integrated Management model was associated with a better one-year prognosis, reduced length of stay, and decreased in-hospital complications in AECOPD patients with multimorbidity. This integrated approach addresses the complex interplay between COPD and its associated comorbidities, supporting its implementation in respiratory clinical practice to enhance patient-centered outcomes.
To assess the efficacy and safety of intravenous remimazolam besylate for sedation during dental procedures in patients with cognitive disabilities, a group frequently managed under general anesthesia due to poor cooperation and increased perioperative risks. In this single-center prospective single-arm observational study, 43 adult patients with cognitive or motor disabilities (ASA II-III) received outpatient dental care under intravenous remimazolam. Sedation was titrated to moderate levels according to EMA and IACSD guidelines. Outcomes included procedural success, Ramsay Sedation Scale, Post-Anesthetic Discharge Scoring System (PADSS), Modified Aldrete Score (MAS), vital signs, drug dosage, recovery, adverse events, and caregiver feedback. All treatments were successfully completed without anesthesiologist intervention or flumazenil reversal. Mean onset of sedation was 3.8 ± 2.3 min, recovery time 47 ± 20.4 min, and time to discharge 72.5 ± 22.5 min. The mean total remimazolam dose was 14 ± 5.9 mg. Most patients reached Ramsay 4, while 9.7% remained ≤ 3. Vital parameters remained stable with no episodes of hypoxemia or airway compromise. At discharge, PADSS averaged 8.9 ± 1.0 and MAS 9.4 ± 0.6, confirming recovery despite motor or neurological limitations affecting PADSS scoring. Caregiver interviews indicated that 42% of patients slept during the day, 85% slept normally at night, 68% appeared calmer, and only 7% experienced minor adverse effects such as nausea or brief agitation. Remimazolam provided safe and effective intravenous sedation with rapid onset and reliable recovery. Combining PADSS with MAS improved discharge assessment in this patient population. Remimazolam deserves further investigation as a potential practical alternative to general anesthesia for dental procedures in patients with cognitive disabilities, with the potential to enable safe care, procedural success, and favorable recovery profiles. International Standard Randomised Controlled Trial Number (ISRCTN) registry, ISRCTN39322806. Retrospectively registered on 10 November 2025.
Integrated care depends on timely awareness of parallel treatment activities and safe access to distributed patient records. However, multimorbid patients often navigate complex, non-linear pathways across care levels, resulting in information fragmentation that compromises decision-making, safety, and coordination. Existing electronic health record systems and interoperability initiatives offer limited support for pathway-oriented information logistics, particularly with respect to governance, provenance, and the integration of the patient's voice. This study aims to design a conceptual information-centric architecture framework to address these systemic gaps in awareness and access. Applying Design Science Research (DSR), the study synthesized rigor from a scoping review with relevance derived from a longitudinal analysis of medical records from 14 multimorbid patients (1954-2024) in Northern Norway. A representative 19-year user scenario, validated by clinical expertise, together with stakeholder and root-cause analyses, informed the identification of recurrent failures in information logistics. High-level non-functional and functional requirements were iteratively derived, foregrounding Information Governance (IG), Data Management (DM), Security and Privacy, and Health Information Quality (HIQ) as essential socio-technical constraints. The resulting architecture was examined through a scenario-based demonstration and an early-stage ex-ante evaluation. The study produced a prescriptive information-centric architecture framework (Meta-artifact) organized into layered, modular components that separate user interaction, pathway logic, and secure storage. Information tokens, consisting of metadata, clinical codes, and location pointers, enable governed, read-only virtual access to source records, reducing duplication and avoiding traditional replication burdens. HIQ operationalizes DM/IG by enforcing requirements for accuracy, currency, consistency, completeness, and contextual relevance across inter-organizational access. In a hospitalization-discharge scenario, the architecture provided timely notifications, governed access to distributed records, and transparent consent and audit controls, demonstrating conceptual feasibility and alignment with the identified problem and requirements. This study contributes early-stage prescriptive design knowledge to improve inter-organizational information logistics. By embedding IG, DM, HIQ, and Security and Privacy as structural pillars and decoupling information from application constraints, the architecture provides a governance-aligned foundation for pathway-oriented coordination, proactive awareness, and safe, on-demand virtual access. This information-centric, token-based architecture, with a modular, standards-neutral design, supports adaptability and provides a foundation for future prototyping and empirical evaluation.
Water, sanitation, and hygiene (WASH) interventions in resource-constrained communities can improve health outcomes, but uptake and sustainability are influenced by acceptability. We evaluated the acceptability of the Spatap, a portable silicone tap attached to a bottle, as a household handwashing intervention in Fijian communities. We distributed Spataps in three communities and conducted a survey two to seven days later, assessing sociodemographic factors, WASH access, and Spatap acceptability (n = 207). We applied a novel quantitative approach, calculating a total acceptability score from seven Likert-scale questions aligned with the component constructs of the Theoretical Framework of Acceptability (with a maximum score of 35) and asked open-ended questions about barriers and enablers to Spatap use. We analysed scores and used multiple linear models to examine predictors. Five months later, we conducted three focus group discussions (FGD) (n = 22) to supplement the survey data and performed thematic analysis using NVivo (ver 12). Spatap acceptability scores ranged from 18 to 35 (median 29), indicating high overall acceptability. Burden and opportunity cost scored lower than other component constructs. Sociodemographic factors were not meaningfully associated with acceptability scores. Few barriers were reported: ease of use, water saving, and convenience were key enablers. FGDs largely supported the survey findings and additionally highlighted ease of use for children and perceived illness reduction as contributors to acceptability. Time spent refilling bottles was burdensome in some larger households, the cost of larger bottles was prohibitive for some, and minor leakage issues were reported. The Spatap was broadly acceptable in the study communities, particularly where its portability, ease of use, and water-saving potential addressed locally important needs. These findings suggest the Spatap may have value as a household WASH intervention in resource-constrained settings, though its appropriateness relative to lower-cost alternatives should be considered. Future implementations should assess the cost-effectiveness and availability of suitable bottles, provide local language and pictorial instructions, and consider targeted engagement with children. The acceptability score method showed potential as a rapid evaluation tool but requires refinement before reapplication.
Malaria remains a severe, life-threatening disease worldwide, with Sub-Saharan Africa bearing the greatest burden. In Ethiopia, recurrent outbreaks cause substantial morbidity and strain local health systems. During WHO Epidemiologic Week 13 of 2025, Meinit Goldia District experienced a sharp increase in cases with delayed investigation and response. This study aimed to verify the outbreak, identify associated risk factors, and inform targeted control measures. A community-based case-control study was conducted in Meinit Goldia District from 26 March to 30 June 2025. Descriptive analysis used the district linelist of malaria cases and deaths. A multistage cluster sampling technique with proportional allocation was employed. A total of 145 rapid diagnostic test (RDT) confirmed malaria cases and 145 community-based, RDT negative asymptomatic controls were included in the study. Both case and controls were identified through active house-to-house surveillance in malaria-affected kebeles. Data on socio-demographics, ITN utilization, environmental exposures, and malaria knowledge were collected via interviewer-administered questionnaires using Kobo Collect v2025.3.3. Analyses were performed in STATA v17. Variables with P < 0.25 in bivariable analysis entered multivariable logistic regression; significance was set at P < 0.05. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Firth's correction was used for exposures with sparse data. Review of the line list from the malaria-affected kebeles identified 3,630 laboratory-confirmed malaria cases, yielding an attack rate (AR) of 274.7 cases per 1,000 population in the eight outbreak-affected villages. The highest attack rates were observed among males (288.2 per 1,000 population) and residents of Mehal Dashi village. At the district level, the overall AR was 71.3 cases per 1,000 population. In multivariable analysis, the following variables were independently associated with malaria: Never utilized ITNs (AOR = 4.882; 95% CI: 2.011-11.847), Living near broken glass bottles (AOR = 4.847; 95% CI: 1.692-13.889), Open deep well near household (AOR = 3.735; 95% CI: 1.273-10.956), Poor knowledge of malaria transmission, signs, symptoms, and prevention/control measures (AOR = 2.847; 95% CI: 1.502-5.397), Sometimes utilized ITNs (AOR = 2.617; 95% CI: 1.204-5.692), and Wearing long protective clothing at night (AOR = 0.123; 95% CI: 0.054-0.280). The outbreak in Meinit Goldia District was associated with gaps in vector control, local breeding sites, and delayed response. Immediate priorities include targeted ITN distribution and larval source management in high-burden areas, regular IRS, culturally appropriate health education, strengthened early warning and rapid response capacity, and enhanced entomological surveillance.
Several studies have assessed the impact of socioeconomic factors on the health of sickle cell patients, yielding heterogeneous results. We conducted a population-based study using a health-insurance database in France to investigate this association, using longitudinal data over a 9-year follow-up time. Socioeconomic factors were assessed using the validated French deprivation index, an area-level index of social disadvantage. The study population comprised 17,315 patients with a median age of 23 years and a median follow-up of 8.1 years. Patients living in the most disadvantaged areas were at greater risk of vaso-occlusive events (VOEs): 70.4% of patients with a median cumulative time of hospitalization of 33.5 days over the study period in the disadvantaged socioeconomic group, compared to 67.9% of patients and 29.9 days in the comparison group (p = 0.035 and p < 0.001). There was no difference regarding chronic complications, but a trend towards higher mortality in the disadvantaged group (HR: 1.13, 95% CI: 0.94-1.36). There was no difference between groups in access to preventive and curative care recommended in mainland France (vaccination, folic acid supplementation, antibiotic prophylaxis, hydroxycarbamide use).
Non-immune hydrops fetalis (NIHF) is a rare condition that can lead to serious cardiopulmonary compromise after birth, often resulting in the need for intensive cardiorespiratory support, and in selected cases including extracorporeal membrane oxygenation (ECMO). Outcome is complicated due to a high rate of preterm birth. Morbidity and mortality data regarding NIHF and outcome of ECMO treatment in this population are very sparse. This is the first update and analysis of the Extracorporeal Life Support Organization (ELSO) registry-based data of neonates with NIHF. Neonatal patients with a diagnosis of NIHF and treated with ECMO during the years 2000-2024, reported to the ELSO registry, were retrospectively analyzed. Exclusion criteria were HF due to hemolytic disease, congenital diaphragmatic hernia (CDH), and major cardiac defects. After the application of exclusion criteria, 171 patients remained for final analysis, of these 88 (52%) survived until discharge. Infants with a higher birth weight (p = .011) and those with a gestational age (GA) ≥ 35 weeks (p = .032), as well as female patients (p = .027), had significantly higher in-hospital survival rates. The ECMO support type (veno-arterial vs. veno-venous) did not influence in-hospital mortality rate (p = .524) or complication rate. Female sex and higher BW (> 2.5 kg) remained independently associated with higher in-hospital survival after a binary logistic regression analysis.  Mortality rates over the last 25 years remained largely unchanged. Our analysis revealed baseline characteristics as independent predictors for higher in-hospital survival in these patients. In comparison with other underlying conditions treated with neonatal ECMO, neonates with NIHF present comparable morbidity and mortality rates after veno-arterial or veno-venous ECMO treatment. • NIHF is a rare neonatal disease leading to preterm birth and a high risk of cardiorespiratory compromise, sometimes resulting in the need for ECMO treatment. • ECMO treatment for preterm infants is feasible, with increasing survival rates. • After ECMO treatment, neonates with NIHF show acceptable complication rates and in-hospital survival, supporting a case-selective discussion of ECMO therapy. • Both veno-arterial and veno-venous ECMO are potential rescue therapy options in experienced neonatal ECMO centers with comparable outcomes.
Post-infectious hydrocephalus (PIH) in neonates is associated with substantial neurodevelopmental morbidity, and cerebrospinal fluid diversion alone does not address the underlying inflammatory and parenchymal injury. Mesenchymal stem cells derived from human exfoliated deciduous teeth (SHED) exhibit neurotrophic and immunomodulatory properties with potential translational relevance in inflammatory brain conditions. We report a preterm neonate with severe Acinetobacter-associated PIH requiring ventriculoperitoneal shunt placement who concurrently received intraventricular administration of allogeneic SHED under a compassionate-use framework. The procedure was technically feasible and well tolerated, without immediate procedure-related adverse events. Follow-up neuroimaging demonstrated reduced ventricular size and progressive cortical mantle thickening, accompanied by clinical gains in alertness, feeding, and motor function. Although causal inference cannot be established from a single observation and concurrent cerebrospinal fluid diversion represents a major confounder, this first-in-human experience suggests short-term procedural safety and supports further controlled clinical investigation of intraventricular SHED therapy in neonatal post-infectious hydrocephalus.
High-throughput genome and exome sequencing have uncovered numerous intronic variants in disease genes, yet predicting their impact on pre-mRNA splicing is still challenging. While deep learning tools have improved variant prioritization, their ability to detect atypical regulatory mechanisms remains unknown. We combined predictions from multiple complementary splicing prediction tools with functional RNA studies to evaluate the splicing consequences of intronic variants identified in patients with neurodegenerative diseases. Nine intronic variants with uncertain impact on splicing were selected, including six deep-intronic variants, two non-canonical splice-site variants, and one canonical splice-site variant associated with an atypical phenotype. Three variants were predicted to disrupt a donor splice site, five to create a cryptic donor splice site, and one was located close to a putative acceptor site. Transcript analysis in blood revealed splicing abnormalities in eight of the nine cases. All algorithms failed at least once: deep learning tools missed specific donor site losses or cryptic splice-site activation events, while motif-based approaches failed to predict some donor site activation or generated false-positive predictions. The only variant not directly located in a splice site was predicted to activate a deep intronic splicing enhancer. Motif-based tools suggested the creation of an SRSF2 protein-dependent enhancer. Functional studies based on minigene assays support a role for SRSF2 in promoting pseudoexon inclusion. These findings highlight the complementarity of splicing prediction tools and the need to integrate them into diagnostic pipelines, with transcript-level confirmation remaining critical for accurate pathogenicity assessment.
Chimeric antigen receptor (CAR) T-cell therapy has dramatically improved the prognosis of patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) [1,2]. However, immune-mediated toxicities represent a significant emerging clinical challenge, particularly those with late onset or uncommon presentations. We report the case of a 71-year-old woman with heavily pretreated DLBCL who developed immune effector cell-associated hemophagocytic syndrome (IEC-HS) with a fatal outcome six months following CAR-T infusion. This case highlights the occurrence of late -onset CAR-T-related toxicities and the potential role of CAR-T cell persistence in sustaining dysregulated immune activation.
Depression and anxiety are highly prevalent among clinical nurses. This study employed a person-centered analytical approach to identify distinct emotion regulation (ER) profiles among Chinese clinical nurses and examined the structure of depressive and anxiety symptoms within each profile using latent profile analysis (LPA) complemented by network analysis (NA). A cross-sectional survey was conducted among clinical nurses in China. A total of 1,436 eligible nurses (mean age = 34.16, SD = 7.49; 93.5% female) participated. Participants completed the 10-item Emotion Regulation Questionnaire (ERQ), the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder scale (GAD-7). LPA was conducted using the two ERQ subscales, cognitive reappraisal and expressive suppression, to identify distinct ER profiles. NA was then applied to model the relationships among depressive and anxiety symptoms for the total sample and within each ER profile. Centrality (Expected Influence) and bridge centrality (Bridge Expected Influence) indices were calculated to identify core and bridging symptoms. Network accuracy and stability were assessed via bootstrap methods, and network structures were compared across profiles using the Network Comparison Test (NCT). LPA identified five distinct ER profiles: Low Regulation (7.2%), Below-Average Regulation (44.9%), Flexible Regulation (8.6%), Above-Average Regulation (32.0%), and High Regulation (7.2%). The Flexible Regulation group, characterized by high cognitive reappraisal and low expressive suppression, exhibited the lowest levels of depression and anxiety, whereas the Below-Average and Above-Average groups reported the highest symptom severity. NA revealed "Uncontrollable worry" (GAD6) and "Restlessness" (GAD5) as core and bridge symptoms across multiple profiles, while "Sad mood" (PHQ2), "Motor disturbance" (PHQ8), and "Suicidal ideation" (PHQ9) emerged as profile-specific central and bridge symptoms in the Low and Flexible Regulation groups. NCT indicated significant differences in global network structure across several profiles, yet global strength did not differ. This study reveals heterogeneous ER patterns among clinical nurses and demonstrates that the Flexible Regulation group is the most adaptive configuration. Key central and bridge symptoms differ across profiles, offering empirically grounded targets for profile-informed interventions. Regular mental health screening with attention to profile-specific symptom patterns is recommended to support tailored prevention strategies and improve overall well-being among clinical nurses. Not applicable.
To examine the associations between antibiotic use behaviors and knowledge, attitudes, and practices (KAP), digital health literacy, general health literacy, and medication-related beliefs among university students. A cross-sectional study was conducted among 1,012 university students using a structured online questionnaire. Data on KAP, eHealth literacy (eHEALS), general health literacy (HLS-EU-Q6), and beliefs about medicines (BMQ) were collected. Non-parametric tests, correlation analyses, and multivariate logistic regression were performed to identify factors associated with non-prescription antibiotic use. The prevalence of non-prescription antibiotic use was 13.9%. Knowledge scores increased across academic years (p < 0.001) but were not associated with reduced risky behaviors. Attitude scores were negatively associated with non-prescription antibiotic use (OR = 0.536, p = 0.006), whereas risky behavior score was the strongest positive predictor (OR = 2.344, p < 0.001). Prior health literacy training was associated with increased odds of non-prescription use (OR = 1.814, p = 0.038). Knowledge and general health literacy were not significant predictors. Correlation analysis showed a moderate association between knowledge and attitudes (ρ = 0.415) and a negative association between attitudes and risky behaviors (ρ = -0.390). Antibiotic misuse among university students was more strongly associated with behavioral and attitudinal factors than with knowledge levels. These findings highlight the limitations of knowledge-based interventions and support the need for integrated strategies incorporating behavioral approaches and critical health literacy skills to reduce inappropriate antibiotic use.
This research aimed to adapt "Positive Attitudes Toward and Perceived Importance of Wearable Display Technology (PATPIWDT) as an Effective Learning Tool Among Nursing Students" into Turkish and to examine the validity and reliability of its translation. This methodological study included 698 nursing students recruited via convenience sampling. Construct validity was evaluated using Confirmatory Factor Analysis (CFA) with the Maximum Likelihood (ML) estimation method. Internal consistency was assessed using Cronbach's Alpha and McDonald's Omega coefficients. The model demonstrated excellent fit according to the confirmatory factor analysis results. The CFA results for the "Positive Attitudes" subscale indicated a good model fit (CMIN/DF = 4.79, GFI = 0.93, CFI = 0.97, RMSEA = 0.07, SRMR = 0.03). For the "Perceived Importance" subscale, the single-factor structure showed acceptable fit indices (CMIN/DF = 5.82, GFI = 0.98, SRMR = 0.03). As a result of examining the standardized loadings of the items, it was seen that the item factor loadings were 0.40 and above, indicating sufficient factor loading. Cronbach's alpha coefficients were 0.91 for the positive attitudes subscale and 0.84 for the perceived importance subscale. The respondents also demonstrated an above-average overall score, with a mean of 3.40 (SD = 0.69). The Turkish version of the scale provides a dependable measure of nursing students' positive attitudes toward wearable screens and how important they consider this technology for future educational use.
The RapidHIT™ ID System, enables CODIS eligible STR profile generation from reference samples in approximately 90 minutes. While initially optimized for buccal swabs, DNA collection cards, both treated (Nucleic-card™ and EasiCollect™) and untreated (Bode Buccal DNA Collector™), offer alternatives for collection and storage of reference samples. This study evaluated the performance of these cards using ACE GlobalFiler™ Express cartridges across a range of potentially impactful scenarios, including assessment of varying punch sizes, contamination control measures, treated versus untreated collection cards, sample placement within the cartridge, and impact of varying storage times on the collection cards. Results from cross-contamination testing confirmed no detectable contamination between samples, and a 6 mm punch size yielded the highest first-pass success rate and profile quality. Treated cards showed consistent performance during initial runs, regardless of whether they were processed wet or dry. For reruns, the EasiCollect™ cards on average produced higher overall signal when the wetting protocol was used. The untreated Bode card showed greater signal consistency when used dry, while wet treatment improved initial success rates. Proteinase K treatment enhanced DNA recovery from samples aged up to three years. Collectively, these findings provide practical, evidence-based guidelines for implementing DNA collection card-based workflows on the RapidHIT™ ID system, supporting its application across varied forensic and operational environments.
To investigate the predictors of anatomical response in patients with diabetic macular edema (DME) following anti-vascular endothelial growth factor (anti-VEGF) therapy and establish a nomogram model for predicting the probability of anatomical response. This study enrolled 200 DME patients treated with anti-VEGF regimen. Based on the reduction rate of central macular thickness (CMT) following treatment, patients were classified into an anatomical weak responder group (CMT reduction < 20%) and an anatomical responder group (CMT reduction ≥ 20%). Baseline clinical data and OCT biomarkers were analyzed with multivariate logistic regression. A nomogram model was constructed by using R software. Bootstrapping was used for model validation, receiver operating characteristic (ROC) curve and calibration curve were used for evaluating the discrimination and calibration of prediction model, and decision analysis curve (DCA) was used for evaluating the practicality of model. Predictors for anatomical response in DME patients are serum creatinine (Scr), CMT, photoreceptor outer segment length (PROSL), and cystoid macular edema (CME) presence as independent variables. The nomogram prediction model based on the above four predictors had good representativeness (Bootstrap method: precision: 0.820), differentiation [the area under curve (AUC) value: 0.819], and the DCA analysis showed that the prediction model, whose threshold probability was in the range of 0 to 1, had clinical practical value. The anatomical response to anti-VEGF treatment for DME is independently associated with baseline Scr, CMT, PROSL, and the presence of CME.