SAGE Open Medicine最新文献

Objective: Alcohol dependence is strongly associated with aggressive behavior, particularly in males. However, the mechanisms underlying this relationship are not fully understood. This study aims to examine the differential mediating roles of three forms of impulsivity (motor, cognitive, and non-planning) and anxiety in the link between alcohol dependence and aggression among Chinese male alcohol-dependent patients.

Methods: A cross-sectional study was conducted in ten main psychiatric hospitals of northern China, and a total of 414 male alcohol-dependent subjects were surveyed by using purposive sampling. Michigan Alcoholism Screening Test, Self-Rating Anxiety Scale, Barratt Impulsiveness Scale, and Buss-Perry Aggression Questionnaire were utilized. Mediation analysis and structural equation modeling were used to analyze the associations among alcohol dependence, anxiety, impulsivity, and aggression.

Results: The results of mediation analysis indicated that motor impulsivity and lack of planning showed the chain mediations with anxiety in the link of alcohol dependence and aggression (p < 0.05). However, only motor impulsivity showed a significant partial mediation effect in the relationship between alcohol dependence and aggression (p < 0.05), while the other two forms of impulsivity (lack of planning and cognitive impulsivity) were not significant (p > 0.05).

Conclusions: The findings suggest that motor impulsivity and anxiety may play important roles in mediating the association between alcohol dependence and aggression, highlighting potential targets for intervention.

Background: Acute heart failure affects ~9% of patients with hematological malignancies. This study aimed to evaluate the impact of acute heart failure on in-hospital mortality among patients with hematological malignancies and to identify independent predictors of mortality in this population.

Methods: The National Inpatient Sample (2016-2021) was queried for adults (⩾18 years of age) with hematological malignancies and those who experienced in-hospital mortality. Among these, we identified patients who were hospitalized with a diagnosis of acute heart failure. Univariate analysis and multivariate regression were employed to analyze the mortality risk. A p ⩽ 0.05 was considered significant.

Results: Among 40,246 patients with hematological malignancies who died in the hospital, the univariate analysis showed a higher in-hospital mortality in the acute heart failure cohort compared to the non-acute heart failure group (8.08% versus 4.52%, p < 0.001). However, after adjusting for sociodemographic factors and comorbidities, acute heart failure was associated with a lower risk of in-hospital mortality (OR 0.87, 95% CI 0.84-0.9, p < 0.001). Predictors of mortality in the acute heart failure cohort were age >60 years, hematopoietic stem cell transplant, severe sepsis, arrhythmias, infective endocarditis, bleeding from any source, acute respiratory failure, hepatic dysfunction, metabolic encephalopathy, and invasive ventilation (all p < 0.01). On subgroup analysis, acute myeloid leukemia, chronic myeloid leukemia, chronic lymphocytic leukemia, and multiple myeloma had a higher in-hospital mortality in the acute heart failure cohort compared to the non-acute heart failure group (p < 0.001).

Conclusion: Acute heart failure in patients with hematological malignancies was associated with poor outcomes in the presence of severe sepsis, organ dysfunction, and the need for mechanical ventilation. Close monitoring and a multidisciplinary team approach are recommended to optimize the treatment plan for this population.

Objective: This study aims to explore the experiences of the carers of people living with dementia while receiving various clinical dementia services in Macao.

Methods: A qualitative approach using Van Manen's phenomenological method was adopted to explore the experiences of the carers of people living with dementia who have been receiving various clinical dementia services in Macao. Data was obtained by face-to-face interviews with 30 purposively selected participants, and then thematic analysis was used.

Results: Two categories related to the experiences of the carers have emerged: (1) The empathetic care as family members, consisting of themes of the caring service of doctors and nurses as warm and nuanced as family members, and the good rapport between nurses and people living with dementia; and (2) Multidisciplinary medical service team, covering themes of supporting the carers gain more knowledge, professional services of medical disciplines, and less waiting time for medical consultation. The categories capture that the carers are satisfied with the friendly attitudes and professional services of medical multidisciplines while they have been receiving various clinical dementia services in Macao.

Conclusion: The phenomenological study can offer innovatively, a deeper understanding of the experiences of the carers of people living with dementia who have been receiving various clinical dementia services in Macao and capture the carers' satisfactions with the friendly attitudes and professional services of medical multidisciplines, and then will be utilized in designing effective initiatives to improve the practice for clinical dementia services in Macao.

Background: Work-related injuries are a significant public health and socioeconomic concern, with the International Labour Organization reporting 2.3 million deaths and 340 million injuries annually worldwide. This study examined work-related injuries and occupational safety practices among sugar factory workers in Tanzania.

Methods: This descriptive cross-sectional study, conducted from January to February 2024, involved 338 workers from two Tanzanian sugar industries. Participants were recruited using systematic sampling. Data were collected via structured questionnaires and environmental observation checklists. SPSS version 27 was used for descriptive univariate and bivariate analyses, with significance set at p < 0.05.

Results: Among 338 workers, 14.8% reported injuries during the previous production session, with 89.3% occurring while performing tasks outside their assigned duties. The main causes were hand tools (35.7%) and fire or hot substances (21.4%), with abrasions (42.9%) being the most common injury type, primarily affecting the arms or hands (32%). Work-related injuries were significantly associated with occupational factors. Higher injury prevalence was observed among workers with <5 years of experience (48.1%, p = 0.02), factory employees (68.9%, p = 0.001), those without Ocupation Safety and Health (OSH) supervision (26.0% vs 11.1%, p = 0.004), and workers not using personal protective equipment (58.0% vs 42.0%, p = 0.02).

Conclusion: Work-related injuries was relatively low but mostly occurred during unassigned tasks. Strengthening workplace safety culture, ensuring consistent supervision, and promoting proper protective equipment use are essential to reducing work-related injuries.

Introduction: Sick leave documentation is a routine component of emergency visits but remains understudied in obstetrics and gynecology emergency room settings. Understanding the factors associated with sick leave issuance can inform better resource allocation and highlight opportunities for integration into primary healthcare services, particularly in the context of women's health. The purpose of this study was to evaluate the trends, features, and associated factors of sick leave issued in the obstetrics and gynecology emergency room at a major teaching hospital in Saudi Arabia.

Methods: This record-based retrospective epidemiological study was conducted on all obstetrics and gynecology emergency room visits of females aged ⩽60 years between January and December 2022 at a Saudi teaching hospital. Sociodemographic, clinical, and operational variables were extracted. Logistic regression was used to identify predictors of sick leave issuance.

Results: Of the 8743 visits, 7.61% resulted in sick leave. Older age, non-Saudi nationality, musculoskeletal and gynecological complaints, the autumn season, and morning visits were significantly associated with higher odds of sick leave. Among those issued with sick leave, only 4.36% received more than 3 days, which were mostly associated with hospital admission, the winter season, and longer emergency room stays.

Conclusion: A sick leave is often requested for non-urgent complaints that can be managed in the primary healthcare settings. From a public health standpoint, integrating sick leave documentation and women's health services into primary healthcare may reduce unnecessary emergency room visits, optimize healthcare delivery, and support national healthcare transformation goals.

Objective: To evaluate the current level of chemical, biological, radiological, nuclear, and explosive preparedness among healthcare professionals in Jordanian hospitals. This assessment concentrated on evaluating their understanding of chemical, biological, radiological, nuclear, and explosive policies, self-reported proficiency in using personal protective equipment, the extent of their training, and their perceived preparedness in various chemical, biological, radiological, nuclear, and explosive areas.

Methods: A cross-sectional survey of 298 healthcare providers from 5 Jordanian hospitals evaluated chemical, biological, radiological, nuclear, and explosive policy awareness, personal protective equipment competency, and training levels. Hospital preparedness was assessed via roundtable discussions with 30 representatives (emergency physicians, infection control specialists, etc.) using the validated Canadian Center for Emergency Preparedness survey.

Results: The findings showed that 59.1% of healthcare providers reported no hospital chemical, biological, radiological, nuclear, and explosive policy, with only 21.1% having access to it. Competency decreased with personal protective equipment complexity, and most lacked decontamination training (68.5%) and chemical, biological, radiological, nuclear, and explosive drills (76.8%). Biological preparedness was rated highest (59%), while chemical and radiological preparedness were inadequate (30% and 21%). Trained healthcare providers had significantly higher preparedness levels (p < 0.001).

Conclusion: Critical gaps in policy awareness, personal protective equipment skills, and multidimensional preparedness highlight systemic vulnerabilities. Mandatory training, policy standardization, and resource allocation are urgently needed to strengthen Jordan's chemical, biological, radiological, nuclear, and explosive response capacity.

Objective: Gastric cancer remains a major global health concern. This study aimed to identify key genes involved in the inflammation-to-cancer transition in the stomach using an integrative framework combining graph neural networks and causal discovery.

Methods: In retrospective study gene expression data from two gastric cancer-related datasets were categorised into two stages: gastritis to precancerous lesions and precancerous lesions to gastric cancer. Differentially expressed genes were identified and analysed for functional enrichment. A relevance network was constructed using Pearson's correlations. Graph sample and aggregate was then applied to the expression matrix, using this network for training. Node embeddings were generated via neighbourhood aggregation, and causal regulatory relationships were inferred using a constraint-based algorithm. Genes with the highest degrees in the causal network were assessed for prognostic relevance using Kaplan-Meier analysis.

Results: A total of 857 differentially expressed genes were identified in the gastritis-to-precancerous transition and 337 in the precancerous-to-gastric cancer transition, with 83 differentially expressed genes shared. Enrichment analysis highlighted pathways linked to bacterial responses, especially Helicobacter pylori. Graph sample and aggregate enhanced gene representation for causal analysis. The Peter-Clark algorithm inferred 72 genes and 99 causal edges. Nine key genes-mucin 17, brain-expressed X-linked 2, BCL2/adenovirus E1B 19 kDa protein-interacting protein 3, Ras association domain family member 2, NLR family pyrin domain-containing 7, interferon regulatory factor 4, carbamoyl phosphate synthetase 1, nucleoporin 210 and neuronal differentiation 2-were identified, all of which were significantly associated with gastric cancer survival.

Conclusion: This study integrates graph neural networks and causal inference to identify critical genes involved in gastric inflammation-cancer progression, providing novel insights into the pathogenesis of gastric cancer and potential biomarkers for validation in future studies.

Objective: Sub-Saharan African countries perennially suffer acute donor blood shortfalls. Clinical audit is a quality improvement strategy that enables the identification of actionable points to improve healthcare delivery. This study audited the blood donor recruitment processes at two Ghanaian secondary healthcare facilities to identify areas that can be leveraged to improve donor blood stocks.

Methods: This was a sequential, exploratory mixed-methods study. First, 30 real-time observations of prospective blood donor-laboratorian interactions were undertaken using checklists. Subsequently, 2 sets of semi-structured questionnaires were used to collect data on pre-donation screening, blood donor privacy, and postblood donation care from the perspectives of 135 blood donors and 134 laboratory staff.

Results: The observational data collection found a general inter- and intrapractitioner variation in blood donor recruitment procedures. Overwhelmingly, prospective donors were males (91.1%), or 20-39 years old (80.7%). Also, only 5.9% of prospective donors were voluntary nonremunerated, whereas 34.8% were deferred. Overwhelmingly, laboratory staff and prospective donors indicated that neither donor information leaflet (97.0% versus 98.5%, respectively), nor medication deferral list (93.3% versus 97.8%, respectively) was employed during the blood donor screening process. Also, whereas 88.2% of successful donors indicated being unaware of any focal person to contact in the event of adverse postdonation symptoms, laboratorians indicated that there was no focal person for handling issues related to successful (94.8%) or deferred (90.0%) blood donors. Furthermore, 42.3% of laboratorians indicated that prospective donors with permanent deferral results are fully informed, compared to 58.2% who indicated uneasiness when disclosing reactive screening results.

Conclusions: The adoption of standard operating procedures may help prevent interfacility and interpractitioner variability in blood donor recruitment practices. Interventional implementation research may help to improve pre- and postdonation services offered to both successful and deferred donors in the study settings.

Objectives: Spontaneous bacterial peritonitis is a potentially fatal complication and a serious sequel occurring in patients with cirrhotic ascites. Although the complications of cirrhotic ascites are high and lethal, there was limited information on the burden and risk factors of spontaneous bacterial peritonitis in Ethiopia and the study setting. Our study aims to determine the prevalence of spontaneous bacterial peritonitis and associated factors among patients with cirrhotic ascites attending public hospitals in Harari region, eastern Ethiopia, from December 15 to 31, 2022.

Methods: An institution-based retrospective cross-sectional study was conducted among randomly selected 319 patients with cirrhotic ascites attending public hospitals in Harari region from January 1, 2021 to December 15, 2022. Data were extracted from individual medical records, patient cards, and follow-up charts using a semi-structured questionnaire/checklist. Data were entered using EpiData version 3.1 and analyzed using the Statistical Package for Social Science version 22. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with spontaneous bacterial peritonitis. An adjusted odds ratio (with 95% confidence interval) was used to report the adjusted association, and statistical significance was declared at p < 0.05.

Results: The prevalence of spontaneous bacterial peritonitis was 34.8% (95% confidence interval: 30.1%-40.2%). In this study, gastrointestinal bleeding (adjusted odds ratio = 1.99 (1.13-3.50)), alcohol intake (adjusted odds ratio = 2.17 (1.02-4.65)), hepatitis infection (adjusted odds ratio = 1.95 (1.09-3.46)), serum electrolytes abnormalities (adjusted odds ratio = 6.36 (3.61-11.23)), and low peritoneal fluid protein (adjusted odds ratio = 4.52 (2.51-8.12)) were important factors associated with spontaneous bacterial peritonitis.

Conclusions: More than one out of three patients with cirrhotic ascites had spontaneous bacterial peritonitis in eastern Ethiopia. In this study, alcohol intake, gastrointestinal bleeding, hepatitis, electrolyte imbalances, and low levels of peritoneal fluid protein were predictors of spontaneous bacterial peritonitis. Reducing alcohol intake, preventing hepatitis infection and cirrhotic complications, and managing serum electrolytes and peritoneal fluid protein levels would be essential to prevent and reduce the risks of spontaneous bacterial peritonitis and its lethal consequences. Therefore, a prospective large-scale study is crucial to understanding the burden and associated factors with spontaneous bacterial peritonitis in patients with cirrhotic ascites. Furthermore, improving access to diagnostic tools such as ultrasound in local health facilities and providing short training for local health providers to guide early diagnosis and treatment of spontaneous bacterial peritonitis.