Patient-reported data on long-term rehabilitation outcomes and support policies for individuals with spinal cord injury (SCI) in Korea are lacking. To assess real-world rehabilitation experiences among individuals with traumatic SCI in Korea, focusing on service utilization, satisfaction, barriers to access, unmet needs, and quality of life. Retrospective chart review and cross-sectional survey. Regional trauma center between 2016 and 2021. Survey data were collected between October 2023 and March 2024, ensuring a minimum of two years of follow-up after injury for all participants. Adults with traumatic SCI discharged from the regional trauma center. Variables measured with standardized instruments, including EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) and World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Of the 317 screened individuals, 72 completed the survey. After discharge, 72.2% received outpatient rehabilitation, 29.2% were employed, and 8.3% had returned to their pre-injury job. Employment was significantly associated with higher EQ-5D-5L index and WHOQOL-BREF scores. Greater neurological injury severity (motor complete vs. motor incomplete) and older age were associated with lower EQ-5D-5L and WHOQOL-BREF scores across multiple domains. Household income showed a consistent dose-response relationship with the WHOQOL-BREF Environment domain, indicating better perceived environmental and service-related quality of life with higher income. Major barriers included mobility limitations and transportation challenges. Unmet needs were frequent, with financial assistance (77.8%) and daily living support (37.5%) most requested. In this single-center survey, individuals with traumatic SCI reported persistent barriers to community reintegration and unmet rehabilitation needs. Quality of life was most consistently associated with injury severity, while household income showed the strongest association with the WHOQOL-BREF Environment domain. Community-based services should be strengthened. A national SCI registry should be established for long-term care planning.
To evaluate the dissemination and real-world implementation of recommendations from the 5th Edition of the Japanese Esophageal Cancer Practice Guidelines and to inform development of the upcoming 6th Edition, the Guideline Committee of the Japanese Esophageal Society conducted a nationwide Quality Indicator (QI) survey in Japan. A nationwide, cross-sectional, web-based questionnaire survey was distributed to 381 certified institutions participating in the 2023 National Registry of Esophageal Cancer in Japan. Conducted in November 2024, the survey covered six domains-epidemiology, surgery, endoscopy, chemotherapy, radiation therapy, and pathology-reflecting key recommendations of the 5th Edition. Responses were summarized descriptively at the institutional level. Valid responses were obtained from 190 institutions (49.9%). Smoking cessation guidance was implemented in more than 90% of institutions, and over 90% also provided guidance on alcohol abstinence or moderation, although complete alcohol abstinence was less uniformly recommended. Minimally invasive, including robot-assisted, esophagectomy was adopted by over 90% of institutions. The proportion of institutions performing prophylactic cervical lymph node dissection varied by tumor location and stage, reflecting contemporary staging concepts. The DCF regimen was the predominant neoadjuvant therapy for stage II/III disease (94.7%), and immune checkpoint inhibitor-based chemotherapy was widely used for unresectable or recurrent disease. Advanced endoscopic diagnostic modalities, including magnifying and image-enhanced endoscopy, were widely adopted. This nationwide QI survey demonstrates broad adherence to guideline-based multidisciplinary management of esophageal cancer in Japan and provides an evidence base for refining recommendations in the 6th Edition of the Japanese Esophageal Cancer Practice Guidelines.
Declining postal survey response rates, especially among older adults, threaten research validity. This study evaluated the effectiveness and cost-effectiveness of two reminder strategies-a postcard and a re-sent questionnaire-issued seven months after initial mailing among older Japanese adults. We conducted a three-arm randomized controlled trial with 1500 adults aged 48-88 years from the Japan Multi-Institutional Collaborative Cohort Chiba cohort. Non-respondents to a survey mailed seven months were randomized equally to: (1) no reminder, (2) reminder postcard, or (3) re-sent questionnaire with prepaid envelope. The primary outcome was response within 60 days. Logistic regression estimated adjusted ORs. Final sample sizes were 492, 486, and 487 participants. Response rates were 0.8% (control), 12.1% (postcard), and 35.5% (re-sent questionnaire) (P < 0.001). Both interventions significantly increased responses, with no evidence of effect modification by age, sex, or educational attainment. Most responses occurred within two weeks. Cost per response was ¥867 for postcards versus ¥503 for re-sent questionnaires. Both reminder strategies significantly improved response rates versus no reminder. The re-sent questionnaire achieved the highest response and best cost-effectiveness, when implemented seven months after the initial mailing. Re-sending questionnaires should be prioritized to enhance participation in surveys targeting aging populations.
Advocacy of public health principles (PHP) is crucial to tackling health inequities. Advocacy skills are therefore a core competency of Public Health speciality training in the UK. A survey of UK-trained specialist registrars found that the perceived ability to advocate for PHP varied significantly across work settings. This study explores barriers and enablers to PHP advocacy across workplaces, offering insights into how advocacy can be better supported in the UK public health landscape. An online survey was sent to UK-based public health specialty trainees, consultants, and public health practitioners on the portfolio route to consultant practice currently. Free-text survey responses were analysed using template analysis and the Theoretical Domains Framework. Sixty-four respondents completed the survey. This study found that role clarity, organizational support, and advocacy skills significantly affect public health specialists' ability to advocate. Barriers included unclear responsibilities, fear of consequences, resource constraints, and inadequate training and mentorship. Supportive leadership and shared values facilitated success. To promote advocacy, the Faculty of Public Health should ensure specialists are positioned as autonomous experts, address biases in recruitment, and integrate advocacy skills further into training. Organizations must evaluate how their structure, culture, and leadership support public health advocacy.
Universal Credit (UC) is a major UK welfare reform that consolidates six means-tested benefits into a single monthly payment, aiming to simplify benefits delivery and incentivize labor market participation. However, concerns have emerged regarding its potential adverse consequences on recipients' mental and physical well-being. Existing evidence is limited by methodological weaknesses, short follow-up time, and a narrow focus on psychological distress. Applying the heterogeneous difference-in-differences approach developed by Callaway and Sant'Anna, we used waves 6-14 of the UK Household Longitudinal Survey (UKHLS), focusing on working-age individuals receiving social benefits to evaluate the short- and long-term effects of that welfare reform on psychological distress (GHQ-12), mental functioning (SF-12 MCS), physical functioning (SF-12 PCS), but also employment, perceived financial outlook, benefits income, and total income. Transitioning to UC significantly increased GHQ-12 scores by 1.20 points (95% CI: 0.33 to 2.07) and decreased SF-12 MCS scores by 2.19 points (95% CI: - 3.79 to - 0.59), indicating deteriorating mental health. No significant effect was observed for SF-12 PCS. UC was also associated with a £93.05 reduction in monthly benefit income, a £222 decrease in total income, and an 8%-point decrease in perceived financial optimism. No significant effect on employment status was detected. Our findings suggest that the transition to UC adversely affected mental health and financial well-being, while yielding limited employment benefits. These adverse impacts reflect both implementation challenges, such as payment delays and benefit deductions, and structural design flaws, including rigid conditionality and reduced income security for vulnerable groups. The results underscore the need for welfare reforms that integrate health considerations and provide more flexible, targeted support to mitigate unintended harms.
Children with autism spectrum disorder (ASD) in low- and middle-income countries may face multiple forms of malnutrition, but data to guide targeted nutrition interventions are limited. We conducted a cross-sectional baseline survey to inform a micronutrient-focused intervention in 48 children aged 2-9 years diagnosed with ASD, recruited from five intervention centers in Central Vietnam. Caregivers completed a 24-hour dietary recall and a one-month food frequency questionnaire. Anthropometric measurements were collected and converted to World Health Organization z-scores. Fasting blood samples were analyzed for hemoglobin, serum ferritin, and serum zinc concentrations. Non-parametric tests and bootstrap confidence intervals were used to compare preschool-aged children (<5 years) with those 5-9 years. Undernutrition was identified in 16.7% (underweight) and 20.8% (stunting), while 6.3% of participants were overweight or obese. Zinc deficiency affected 45.8% of children, low ferritin was found in 16.7%, and anemia in 10.4%. Two concurrent micronutrient deficiencies were present in 16.7%. The median energy intake met 84.6% of national recommendations. Dietary fiber intake was universally inadequate, and most children consumed less than the recommended levels of iodine (97.0%), zinc (64.6%), vitamin C (64.6%), and calcium (56.3%). Older children were significantly more likely to have inadequate calcium intake than younger ones (73.9% versus 40.0%). Dietary patterns were dominated by cereal-based foods, with infrequent intake of legumes, vegetables, dairy, and animal-source foods. These findings reveal a triple burden of undernutrition, micronutrient deficiencies, and emerging overnutrition among children with ASD. The results underscore the urgent need for early nutritional screening and dietary improvement strategies. These baseline data offer critical evidence for designing context-appropriate nutrition interventions in similar low-resource settings.
Objectives. To examine trends in meningococcal B (MenB) vaccination coverage among US adolescents aged 16 and 17 years. Methods. We conducted cross-sectional and longitudinal analyses of 2018 to 2023 National Immunization Survey-Teen data to calculate the annual percentage of eligible adolescents who received the MenB vaccine and to assess changes over time. Results. Only 19.8% of the 41 505 eligible adolescents initiated MenB vaccination between 2018 and 2023. A total of 24.5% (95% confidence interval [CI] = 22.5, 26.6) of adolescents received 1 or more MenB vaccinations in 2023, as compared with 13.2% (95% CI = 11.7, 14.6) in 2018. Among initiators, most received only 1 dose. Conclusions. MenB vaccination coverage among 16- and 17-year-old adolescents increased modestly between 2018 and 2023. As of 2023, approximately 3 out of 4 adolescents in this age group had not received the MenB vaccine. Public Health Implications. As of 2023, less than one quarter of 16- and 17-year-old adolescents had initiated MenB vaccination. Given that MenB has accounted for most meningococcal disease among adolescents and young adults since 2013, efforts to improve uptake are warranted. (Am J Public Health. 2026;116(6):851-854. https://doi.org/10.2105/AJPH.2026.308459).
Ventriculoperitoneal shunt (VP) insertion is a common intervention in paediatric neurosurgery, and as outcomes for children with hydrocephalus improve, clinicians are increasingly asked to provide advice beyond the immediate postoperative period. Participation in sport is an important component of childhood development, yet there is limited evidence or consensus guidance to inform recommendations regarding contact sports for children with VP shunts. As a result, clinical advice is often based on individual experience rather that robust data. A structured electronic questionnaire was distributed to members of the British Paediatric Neurosurgery Group (BPNG). Participants were asked about their experience of rugby related VP shunt complications, the levels of rugby participation they would permit at different ages and whether they would recommend the use of protective head gear. Overall response rate of 42.8% was achieved (30 of 70 respondents). Only one respondent (3%) reported direct experience of rugby related shunt complication. All respondents would permit a 7-year-old with a VP shunt to participate in touch rugby. 80% would allow a 14-year-old to play contact rugby, and 77% would permit an 18-year-old to participate in professional or elite rugby. The use of a scrum cap was recommended by 77% of respondents. Most paediatric neurosurgeons support return to rugby for children with VP shunts, commonly recommending protective headgear. These findings support the importance of providing informed, individualised guidance for resuming play.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
Pregnant patients were surveyed to determine marijuana use, their interest in additional education of the risks marijuana use in pregnancy, and if they had been educated by their providers about these. Fisher's exact tests were used to determine significant differences in both demographics and survey answers on provider education between those who used and did not use marijuana during pregnancy. 409 patients were surveyed with 367 completing the survey. 87 participants (23.7%) of those surveyed endorsed marijuana use in their current pregnancy. Significant differences between those who used marijuana and those who did not were seen in race/ethnicity (17.1% among White people versus 38.9% among those of other race/ethnicity; p = 0.017), age (with 33.3% of 18-24 year olds reporting the highest use vs. 0.0% of ≥ 40 year olds reporting the lowest use; p = 0.014) and education level (with those who had not completed high school reporting the highest rates of use, p = 0.001). 15.3% of all respondents received counseling on the risks of marijuana use during pregnancy. Among those who used marijuana, 25.3% received the counseling, compared to 12.1% of those who did not use (p = 0.003). 41.4% of those who used marijuana expressed an interest in additional information on this topic, significantly higher than those who did not use (p < 0.001). A gap exists in the area, as only 25%of pregnant patients who used marijuana reported receiving counseling, compared to the 41% who stated a desire for additional information. This emphasizes the need for both accessible resources on how marijuana affects both the pregnant mother and infant, as well as education for providers on this gap in care.
The aim was to compare the prevalence of molar incisor hypomineralisation (MIH) obtained from two cross-sectional surveys conducted in 2018 and 2023 and to evaluate their association with other variables in schoolchildren attending elementary schools in Tepatitlán de Morelos (Jalisco, Mexico). Children (5-13 years old) enrolled in elementary schools in Tepatitlán de Morelos, Mexico, were evaluated. Intra-oral examinations were performed in schools by calibrated examiners. In both surveys, the presence and characteristics (including severity) of MIH and hypomineralised second primary molars (HSPM) were scored according to the European Academy of Paediatric Dentistry (EAPD) MIH-index. In 2023, dental plaque and dental caries were scored additionally. Descriptive and statistical analyses were performed (α = 5%, 95% CI). In total, 959 schoolchildren were evaluated; MIH prevalence was 35.78% in 2018 and 26.58% in 2023 (p = 0.002). Tooth-level prevalence of MIH decreased significantly from 12.71% to 8% when comparing the two surveys (p < 0.001). Higher prevalence of HSPM was observed in children with MIH, compared to children without MIH in both surveys (p < 0.001). Neither the number of teeth presenting cavitated caries lesions (p = 0.193), nor the plaque score (p = 0.061) was associated with the presence of MIH in 2023. Children with severe MIH had a higher likelihood to have cavitated caries lesions compared to children with mild MIH (p = 0.001). A statistically significant decrease in the MIH prevalence was determined at both child and tooth level in the period 2018-2023.
Undocumented immigrants are more than 5 times as likely as US citizens to be uninsured. Before 2020, undocumented young adults aged 19 to 25 years in California were eligible for restricted-scope Medi-Cal, which only covers emergency services. To examine the association of the California 2020 full-scope Medi-Cal expansion to young adults aged 19 to 25 years regardless of immigration status with coverage outcomes and to assess subgroup differences by race and ethnicity, sex, and age. This cross sectional study included American Community Survey respondents who were noncitizens aged 19 to 25 years before (2016-2019) and after (2021-2022) the policy's implementation in California; the treatment group was compared with California noncitizens aged 26 to 32 years and young adults aged 19 to 25 and 26 to 32 years from 6 comparison states (Arizona, Florida, Illinois, Nevada, New York, and Texas). Analysis was conducted from January 2024 to August 2025. California's 2020 Medi-Cal expansion. Triple difference analysis was used to estimate the association of the California Medi-Cal expansion with health insurance coverage (any, Medicaid, and private coverage) among noncitizens aged 19 to 25 years relative to California noncitizens aged 26 to 32 years and young adults in the 6 comparison states. The sample included 19 773 and 32 515 noncitizen American Community Survey respondents in California aged 19 to 25 years and 26 to 32 years, respectively, and 28 535 and 43 213 individuals aged 19 to 25 years and 26 to 32 years, respectively, residing in comparison states. Baseline weighted percentages for the 19- to 25-year treatment group included 52.1% (95% CI, 51.0%-53.2%) male, 31.9% (95% CI, 30.7%-33.0%) Asian non-Hispanic, 1.8% (95% CI, 1.5%-2.2%) Black non-Hispanic, 54.6% (95% CI, 53.4%-55.9%) Hispanic, 9.7% (95% CI, 8.9%-10.5%) White non-Hispanic, and 2.0% (95% CI, 1.6%-2.3%) other race non-Hispanic. Medi-Cal expansion was associated with a 4.2 (95% CI, 1.3-7.1)-percentage-point increase in Medicaid and a 3.5 (95% CI, 0.2-6.8)-percentage-point increase in any coverage. In subgroup analyses, percentage-point increases in Medicaid were statistically significant for Hispanic young adults (6.7 [95% CI, 2.6-10.9] percentage points), males (3.6 [95% CI, 0.1-7.1] percentage points), females (5.0 [95% CI, 0.7-9.3] percentage points), those aged 19 to 22 years (4.4 [95% CI, 0.7-8.1] percentage points), and those aged 23 to 25 years (4.0 [95% CI, 0.7-7.3] percentage points). In post hoc analyses, the estimates translated to increases in Medi-Cal and any coverage of 24.4 and 20.3 percentage points, or 30 665 and 25 554 young adults, respectively. In this cross-sectional study, the California 2020 Medi-Cal expansion was associated with significant coverage gains. Because the American Community Survey did not distinguish between restricted- and full-scope Medi-Cal, the analysis may have underestimated coverage increases, and further research is warranted to understand the health care and economic costs and benefits of California's expansion.
Myxosporean parasites have been identified in amphibians globally; however, in Japan, no amphibian-infecting myxosporeans have been formally recorded. Thus, in this study, 20 native Japanese frog species were surveyed to clarify the diversity of myxosporeans that infect amphibians. A survey of 102 anurans representing 20 species across six families collected in Japan revealed the presence of a myxosporean belonging to the genus Sphaerospora that parasitizes the kidneys of the Japanese rice frog, Fejervarya kawamurai. The myxosporean is described herein as a new species based on its distinct morphological characteristics and phylogenetic position. Spores are spherical to subspherical with an overall dimension of 11.1 (10.2-12.2) × 11.5 (9.3-14.0) µm. The polar capsules are spherical, with a diameter of 3.3 (2.5-4.3) µm. Typical spores possess a characteristic caudal appendage. This discovery is considered the first record of anuran-parasitic Sphaerospora in East Asia and the fifth global record of a frog-parasitic species in this genus. Phylogenetic analysis based on partial SSU rDNA sequences unequivocally placed the new species within a well-supported monophyletic clade of anuran-parasitic Sphaerospora, comprising taxa distributed across the Palaearctic (Asia and Europe), Afrotropical, Nearctic, and Neotropical realms.
Those living in care homes are often the most vulnerable in our society, either due to their age, frailty or ongoing physical and mental health needs. Care homes are more susceptible to infectious diseases due to their communal living environments, resulting in transmission of infections through day-to-day interactions. Infection prevention and control (IPC) is therefore a priority for all care homes, including safe practices for laundry management. Despite the clear risk posed by contaminated textiles, the implementation and understanding of effective laundry IPC measures in care homes remains underexplored. This study aimed to assess current laundry management practices, awareness of IPC guidance, and the barriers care homes face in adopting standardised laundering protocols. Using a mixed-methods approach, data were gathered from 1,062 online survey responses, follow-up interviews, and focus groups with care home managers, staff, and industry experts. Key findings revealed a significant lack of awareness and inconsistent application of the national Health Technical Memorandum (HTM-01-04). Over 50% of care homes lacked formal management of laundry training programs, and only 46% of care home staff reported having clear IPC procedures for linen management. Additional challenges included spatial constraints, costs, equipment maintenance, and the difficulty of laundering mixed textiles, such as residents' personal clothing, at appropriate disinfection temperatures without damage. The survey also showed that nearly half of the managers expressed a preference for the outsourcing of laundry to commercial laundries. The findings highlight an urgent need for accessible, practical, and sector-specific linen IPC guidance, tailored to the unique care home environments. In response, adapted guidance and educational resources were co-created with sector stakeholders to support implementation. This study is the first of its kind in the UK and emphasises that safe linen management is fundamental to infection control in care homes, protecting both vulnerable residents and staff from healthcare-associated infections.
Diagnosing and treating rare diseases in children is a major challenge for pediatricians globally. There is a lack of adequate knowledge of these conditions and diagnostic testing is not easily accessible, which frequently results in delays in care. The knowledge, experiences and challenges faced by pediatricians in Tanzania are not known. This study used a nationwide cross-sectional online survey to describe the knowledge of pediatricians in Tanzania on rare diseases, their experiences, and the challenges they face in treating these children. The survey tool was shared on the Pediatric Association of Tanzania WhatsApp group where most pediatricians are registered. 168 pediatricians completed the survey, giving a response rate of 52%. All of them had encountered a child with a presumed rare disease in their career, with 60% having seen one in the 6 months preceding the survey. The commonest presumed rare condition encountered was genetic/metabolic, and the most common difficulty (97%) encountered was lack of access to diagnostic testing. A third of respondents reported that rare diseases were taught in university and 60% felt unprepared to look after these children. Three quarter of respondents could not access to experts to advise them on management. Presumed rare diseases are commonly encountered by pediatricians in Tanzania, and there are challenges in diagnostic testing, gaps in training, lack of confidence in providing care and inability to access experts on rare disease management. To improve care of children with rare diseases, diagnostic testing should be made available, accessible and affordable. A review of medical training curricula should be done to incorporate rare disease education and skill development. Platforms and pathways to connect pediatricians with regional and global experts should be put in place to provide timely and appropriate care to children with rare diseases.
This study aims to address a critical gap by investigating how superior leadership (SL) influences error management (EM) at the Saudi Ministry of Health (MOH). It empirically explores how SL dimensions like empowerment foster a comprehensive EM in a non-Western context, moving beyond general assumptions to provide needed, context-specific empirical insights. A descriptive and analytical design was used, using a survey approach. Data was collected from a simple random sample of 322 MOH employees in Saudi Arabia. A customized questionnaire measured both EM and SL dimensions as defined within this research. Results reveal that SL significantly impacts EM. "Encouraging creativity/innovation" promoted error reporting by mitigating fear of reprisal, whereas empowerment was found to enhance organizational learning. A "supportive environment" promoted knowledge sharing, fostering a positive EM. Despite the limited focus and survey methodology of this study, it highlights the pivotal role of leadership in health emergencies. It calls for MOH policies to promote leadership excellence and a learning culture through training and empowerment. By addressing this gap, the present study provides new regional insights, necessitating further research on this dynamic. This study's originality lies in empirically investigating how specific leadership dimensions influence EM facets in the novel context of the Saudi MOH. It fills a research void by providing context-specific evidence, moving beyond generalizations to offer an empirically backed understanding of leadership's critical role in building resilient systems.
Methylphenidate (MPH), a first-line treatment for attention-deficit/hyperactivity disorder (ADHD), is increasingly debated for its use for cognitive enhancement by university/college students without an ADHD diagnosis. However, current knowledge relies on self-reported data, while consumption-based data remain limited. This wastewater-based epidemiology study assessed MPH consumption at population level by measuring ritalinic acid (a urinary MPH consumption biomarker) in influent wastewater samples (n = 679) across 2021 and 2022 in two Belgian cities, Leuven and Brussels. Afterwards, these data were triangulated with available survey data collected by students. In Leuven, where university/college students comprise 55% of the population, MPH consumption doubled during exam periods and rose markedly during exam preparation periods. In Brussels, where students comprise only 7%, fluctuations were minimal. These findings suggest a strong link between academic performance pressure and MPH use, supported by survey data. Given associated health risks, targeted pharmacovigilance and public health interventions among students are needed.
ObjectiveReports from caregivers and other witnesses describe episodes of unexpected or paradoxical lucidity among adults diagnosed with dementia. However, until now, there has not been a representative national survey documenting its prevalence in the U.S. adult population. This study reports on (a) the prevalence of terminal or unexpected lucidity in adults diagnosed with Alzheimer's disease or other dementias, and (b) its distribution across sociodemographic characteristics and parameters of clinical cases.MethodData are from a nationally representative population-based survey of observers (N = 5940) of dementia patients, aged 40+, who experienced one or more episodes of unexpected lucidity.ResultsThe national prevalence of unexpected lucidity, according to observers, is 43.6% (weighted n = 2587). Episodes occur regardless of the age or sex of patients, parameters of the clinical case, or characteristics of observers.ConclusionFindings reveal that lucid episodes are not rare, but possibly a normative feature of the dementing process. If so, this has implications for clinical practice and ethical decision-making involving "deeply forgetful people."
To evaluate prevalence of sugar dating among undergraduate students and assess the demographics and motivations of sugar babies. This study included 1582 undergraduate students 18 years or older in an urban, private university in the U.S. (82 sugar participants and 1500 controls). From October 2019 to May 2020, a cross-sectional, online survey asked participants about sugar dating experiences, substance use history, and childhood traumas. Prevalence of sugar dating was 5.2%. Sugar babies were 2 to 5 times more likely to have experienced childhood trauma defined by the 10 item ACE questionnaire. Sugar babies were more likely to have financial support (loans, scholarships, Federal Pell grants, work-study), use illegal drugs, and have greater daily alcohol consumption. Many sugar babies have experienced vulnerabilities (financial need, childhood traumas) that could heighten their risk of exploitation by sugar sponsors. Future studies should explore the dynamics of sugar relationships among undergraduate students and the risks accompanying these relationships.
Over 90% of nurse practitioners (NPs) are employed in hospitals in Taiwan. The influence of different practice environments and manager leadership styles on NP interprofessional collaboration and quality of care in acute care hospitals has been inadequately studied. This study was designed to investigate the influence of practice environment and leadership style on NP interprofessional collaboration and the quality of care they provide in acute care settings. A cross-sectional design and a national online survey were employed to collect data from 1,198 NPs who are members of the Taiwan Association of Nurse Practitioners (TANP). The measures utilized in this study include the Nurse Practitioner Acute Care Organizational Climate Questionnaire, the Multifactor Leadership Questionnaire-Form 6S, and the Provider-Perceptions of Team Effectiveness Questionnaire (Provider-PTE). A multiple regression model was applied to identify the factors potentially associated with interprofessional collaboration and quality of care. Physician relations and professional visibility were identified as the two most critical factors within the practice environment, enhancing interprofessional collaboration and quality of care, and "management with expectation" was identified as a key leadership strategy for improving both outcomes. These three factors accounted for 44.8% and 30.6% of the respective variances in NP interprofessional collaboration and quality of care. Improving practice-environment factors such as relationship with physicians and professional visibility, as well as managing NPs using an expectations-based leadership style, offer the potential to significantly enhance NP interprofessional collaboration and the quality of care they provide. Health care organizations may consider developing policies that focus on improving the practice environment as well as implementing transactional leadership styles to promote NP interprofessional collaboration and the quality of care they provide.