OBJECTIVE: The aim of the study was to assess whether children and adolescents with epilepsy are at higher risk of behavioral disturbances when they have concomitant cognitive disturbances.
METHODS: Behavioral scores were generated using the Child Behavior Checklist (CBCL). Cognitive evaluation was applied by using different age appropriate versions of the Wechsler Intelligence Scale. CBCL scores (total, externalizing, internalizing) were compared between patients with and without intellectual disability (IQ score < 70 and ≥70, respectively).
RESULTS: 144 (10.2 mean age, 6.0-17.9 range) patients were recruited for the study. Patients with mild to moderate intellectual disability (full-scale intelligence quotient (FSIQ) < 70) were not at higher risk of behavioral disturbances (total CBCL score ≥ 63) than patients without cognitive impairment. The mean total CBCL score was 62.0 ± 10.6 (range 42.0-83.5, 95% CI 57.9-62.0) and 59.3 ± 10.3 (range 38.0-80.0, CI 57.4-61.2) for patients with FSIQ < 70 and ≥70, respectively. There was no correlation between FSIQ and total CBCL scores. These findings were true for all IQ subcategories.
CONCLUSIONS: Behavioral disturbances among children and adolescents with epilepsy occur despite the presence or absence of intellectual dysfunction with respect to full-scale IQ.

BACKGROUND: There is limited evidence on effective health systems interventions for preventing female genital mutilation (FGM). This study tested a two-level intervention package at primary care applying person-centred communication (PCC) for FGM prevention.
METHODS: A cluster randomised trial was conducted in 2020-2021 in 180 antenatal care (ANC) clinics in Guinea, Kenya and Somalia. At baseline, all clinics received guidance and materials on FGM prevention and care; at month 3, ANC providers at intervention sites received PCC training. Data were collected from clinic managers, ANC providers and clients at baseline, month 3 and month 6 on primary outcomes, including delivery of PCC counselling, utilisation of level one materials, health facility preparedness for FGM prevention and care services and secondary outcomes related to clients\' and providers\' knowledge and attitudes. Data were analysed using multilevel and single-level logistic regression models.
RESULTS: Providers in the intervention arm were more likely to deliver PCC for FGM prevention compared with those in the control arm, including inquiring about clients\' FGM status (adjusted OR (AOR): 8.9, 95% CI: 6.9 to 11.5; p<0.001) and FGM-related beliefs (AOR: 9.7, 95% CI: 7.5 to 12.5; p<0.001) and discussing why (AOR: 9.2, 95% CI: 7.1 to 11.9; p<0.001) or how (AOR: 7.7, 95% CI: 6.0 to 9.9; p<0.001) FGM should be prevented. They were more confident in their FGM-related knowledge (AOR: 7.0, 95% CI: 1.5 to 32.3; p=0.012) and communication skills (AOR: 1.8; 95% CI: 1.0 to 3.2; p=0.035). Intervention clients were less supportive of FGM (AOR: 5.4, 95% CI: 2.4 to 12.4; p<0.001) and had lower intentions of having their daughters undergo FGM (AOR: 0.3, 95% CI: 0.1 to 0.7; p=0.004) or seeking medicalised FGM (AOR: 0.2, 95% CI: 0.1 to 0.5; p<0.001) compared with those in the control arm.
CONCLUSIONS: This is the first study to provide evidence of an effective FGM prevention intervention that can be delivered in primary care settings in high-prevalence countries.
UNASSIGNED: PACTR201906696419769 (3 June 2019).

Harvester ants are one of the most extensively studied groups of ants, especially the group foraging ants, Messor barbarus (Linnaeus, 1767), which construct long-lasting trunk trails. Limited laboratory investigations have delved into head-on encounters along foraging trails involving workers moving in opposing directions, with fewer corresponding studies conducted in the natural environment. To address this gap, we devised an in-field experimental design to induce lane segregation on the foraging trunk trail of M. barbarus. Using an image-based tracking method, we analyzed the foraging behavior of this species to assess the costs associated with head-on encounters and to figure out the natural coexistence of outgoing and returning workers on a bidirectional route. Our results consistently reveal heightened straightness and speed in unidirectional test lanes, accompanied by an elevated foraging rate compared to bidirectional lanes. This suggests a potential impact of head-on collisions on foraging behavior, especially on foraging efficiency. Additionally, Kinematic analysis revealed distinct movement patterns between outbound and inbound flows, particularly low speed and sinuous trajectories of inbounding unladen workers. The study of encounter rates in two traffic systems hints at the plausible utilization of individual memory by workers within trails, underscoring the pivotal role of encounters in information exchange and load transfer.

BACKGROUND: Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations.
OBJECTIVE: This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer.
METHODS: This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn.
RESULTS: The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant.
CONCLUSIONS: The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed).
BACKGROUND: ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492.

Pomacea canaliculata is one of the most notorious invasive aquatic snail, capable of influencing various aquatic organisms through their secretions. Limnodrilus hoffmeisteri and Propsilocerus akamusi are the most prevalent and powerful bioturbators in aquatic ecosystems. However, the mechanism of P. canaliculata\'s secretions affecting bioturbators remains unknown. This study aimed to investigate the effects of P. canaliculata\'s secretion on L. hoffmeisteri and P. akamusi. L. hoffmeisteri and P. akamusi were treated for 24 h with P. canaliculata and the native species Bellamya aeruginosa secretions at different densities (1 or 20). The migration numbers and aggregation rate of L. hoffmeisteri indicated that P. canaliculata secretion caused L. hoffmeisteri to become alert and migrate away from the nucleus community, resulting in poor population identification, especially at high concentrations. Moreover, the antioxidant enzymatic activity, lipid peroxidation, intestinal microbial diversity, and composition of the two bioturbators were analyzed. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) concentration were elevated following P. canaliculata secretion treatment, indicating oxidative damage. Furthermore, the composition and diversity of intestinal microbiota of L. hoffmeisteri and P. akamusi were changed. The abundance of functional microbiota decreased, and pathogenic bacteria such as Aeromonas became dominant in the intestines of both bioturbators. The current research evaluates the effects of P. canaliculata secretion on the behavior, oxidative stress, and intestinal microbial composition and diversity of two bioturbators, providing new insights into the assessment of post-invaded ecosystems.

One of the most crucial tasks of pediatric dentists is to control children\'s negative behaviors. This study aimed to assess dental behavior and the associated risk factors among children aged 4-12. This cross-sectional study recruited healthy, unaffected children aged 4 to 12 years. Parents were interviewed regarding the sociodemographic details and characteristics of their children\'s dental visits. Two collaborative dentists examined the children for dental caries (DMFT/DMFT) and behavioral status (Frankl\'s behavior rating scale). This study included 439 children: 27.3% exhibited uncooperative behavior, and the mean DMFT/dmft was 8.46 ± 3.530. Uncooperative behavior significantly increased when the dental visit was scheduled as an emergency treatment (p = 0.134; Adjusted Odds Ratio (AOR): 1.530) and when there was an elevated DMFT/DMFT ratio (p < 0.001; AOR: 1.308). This study revealed a significant association between children\'s uncooperative behavior and their first dental visit, emphasizing the need for tailored strategies to address behavioral challenges when scheduling pediatric dental care. The proactive measures included controlling caries and avoiding emergencies.

Gyrophoric acid (GA), a lichen secondary metabolite, has attracted more attention during the last years because of its potential biological effects. Until now, its effect in vivo has not yet been demonstrated. The aim of our study was to evaluate the basic physicochemical and pharmacokinetic properties of GA, which are directly associated with its biological activities. The stability of the GA in various pH was assessed by conducting repeated UV-VIS spectral measurements. Microsomal stability in rat liver microsomes was performed using Ultra-Performance LC/MS. Binding to human serum albumin (HSA) was assessed using synchronous fluorescence spectra, and molecular docking analysis was used to reveal the binding site of GA to HSA. In the in vivo experiment, 24 Sprague-Dawley rats (Velaz, Únetice, Czech Republic) were used. The animals were divided as follows. The first group (n = 6) included healthy males as control intact rats (♂INT), and the second group (n = 6) included healthy females as controls (♀INT). Groups three and four (♂GA/n = 6 and ♀GA/n = 6) consisted of animals with daily administered GA (10 mg/kg body weight) in an ethanol-water solution per os for a one-month period. We found that GA remained stable under various pH and temperature conditions. It bonded to human serum albumin with the binding constant 1.788 × 106 dm3mol-1 to reach the target tissue via this mechanism. In vivo, GA did not influence body mass gain, food, or fluid intake during the experiment. No liver toxicity was observed. However, GA increased the rearing frequency in behavioral tests (p < 0.01) and center crossings in the elevated plus-maze (p < 0.01 and p < 0.001, respectively). In addition, the time spent in the open arm was prolonged (p < 0.01 and p < 0.001, respectively). Notably, GA was able to pass through the blood-brain barrier, indicating its ability to permeate into the brain and to stimulate neurogenesis in the hilus and subgranular zone of the hippocampus. These observations highlight the potential role of GA in influencing brain function and neurogenesis.

BACKGROUND: Digital competencies are essential for nurses to actively participate in the digitisation of healthcare systems. Therefore, it is important to assess their skill levels to identify strengths and areas for improvement.
METHODS: This study aims to investigate nurses\' knowledge, attitudes, behaviours, subjective norms and behavioural control regarding digital health. A knowledge-attitude-practice model guided the development of a structured questionnaire divided into six sections. A sample of 480 registered nurses of Naples will be involved in the study. After conducting a pretest, an invitation will be publicised through the institutional communication channels of Nurses Provincial Order of Naples. Nurses will respond via a unique link or quick response code sent through a PEC email system (a legally valid email system, which guarantees delivery and receipt). They will have 30 days to complete the survey, scheduled between May and July 2024.
BACKGROUND: No ethics committee approval was required, as the study does not involve minors, direct or indirect physical or physiological harm to participants, or clinical trials. Anonymity will be guaranteed at all data collection and processing levels. The results will be broadly distributed through conference presentations and peer-reviewed publications. The effective use of digital technologies by healthcare professionals can bring significant improvements to healthcare services and help improve the health of individuals and community health. The study\'s findings will serve as a foundation for developing and implementing educational programmes related to eHealth and telemedicine, promoting the harmonisation of such programmes.

OBJECTIVE: The primary aim of this study was to investigate the feasibility and acceptability of general practitioners (GPs) using sit-stand desks to facilitate standing during consultations. A further aim was to examine the views of patients about GPs standing for their consultations.
METHODS: A pre-post single-group experimental trial design.
METHODS: General practices in England, UK.
METHODS: 42 GPs (working a minimum of five clinical sessions per week) and 301 patients (aged ≥18 years).
METHODS: The intervention consisted of each GP having a sit-stand desk (Opløft Sit-Stand Platform) installed in their consultation room for 4 working weeks. Sit-stand desks allow users to switch, in a few seconds, between a sitting and standing position and vice versa, by adjusting the height of the desk.
METHODS: To test feasibility and acceptability, GPs reported their views about using sit-stand desks at work at baseline and follow-up. Sitting time and physical activity were also measured via accelerometer at baseline and follow-up. Patients who attended a consultation where their GP was standing were asked to complete an exit questionnaire about the perceived impact on the consultation.
RESULTS: Most GPs reported using their sit-stand desk daily (n=28, 75.7%). 16 GPs (44.4%) used their sit-stand desk during face-to-face consultations every day. Most GPs and patients did not view that GPs standing during face-to-face consultations impacted the doctor-patient relationship (GPs; 73.5%, patients; 83.7%). GPs\' sitting time during work was 121 min per day lower (95% CI: -165 to -77.58) at follow-up compared with baseline.
CONCLUSIONS: Use of sit-stand desks is acceptable within general practice and may reduce sitting time in GPs. This may benefit GPs and help reduce sitting time in patients.
BACKGROUND: ISRCTN76982860.

This study aimed to develop a scenario-based questionnaire for evaluating medium-level leadership behaviors within the Greek National Healthcare System (NHS), drawing upon the principles of servant leadership theory. Data for this pilot study were collected in the first quarter of 2019, using a sample of 33 (22.9% of all medium-level managerial positions) medium-level managers from the Greek NHS hospital cluster located in North Attica. To assess managerial behaviors, an ordinal scale was employed, revealing non-normal data distributions. Consequently, our analysis involved presenting descriptive statistics, utilizing non-parametric tests to explore distinctions in managerial behaviors, and conducting thematic analysis of responses to open-ended questions, with frequencies and relative frequencies of each theme meticulously recorded. Overall, our findings indicate that, in most cases, managers exhibited positive behaviors toward their employees, regardless of whether the outcomes were positive, negative, or unknown. Positive behaviors towards the administration were comparatively rare. Significant differences were observed, highlighting that managers were more inclined to exhibit positive behaviors when the outcome was known, particularly in scenarios involving employee management. Within each scenario, behavioral patterns varied, with managers demonstrating a propensity to take credit for employee success in positive outcomes but distancing themselves from negative outcomes when reporting to the administration. Furthermore, the survey responses underscored the prevalence of positive attitudes regarding accountability and stewardship, with stewardship showing a positive correlation with scenario-based behaviors. Finally, our study brought to light several challenges in the management of the Greek NHS, including the absence of comprehensive managerial evaluation, the lack of meritocracy, regulatory deficiencies, and a shortage of leadership skills among current managers. These findings emphasize the importance of scenario-based assessments for Greek hospital managers, as they can help connect managerial behaviors to stewardship, accountability, and skills, ultimately contributing to the enhancement of leadership within the Greek NHS.