BACKGROUND: Schizophrenia is a severe mental illness that greatly impacts the real-world functioning of patients. In India, caregivers are primarily responsible for their patients and function as their support system, often taking treatment decisions on their behalf. However, they may have insufficient knowledge of the illness, which can have a negative impact on their roles as effective caregivers. The knowledge of schizophrenia and its associations among caregivers has received very little research attention.
OBJECTIVE: To examine the knowledge of mental illness and its socio-demographic and psychosocial associations among caregivers of patients with schizophrenia. The objectives were to assess the knowledge of mental illness and its treatment in caregivers of patients with schizophrenia, to assess the socio-demographic and clinical associations of this knowledge, and to assess the caregivers\' psychosocial variables associated with this knowledge.
METHODS: This cross-sectional observational data was taken from a larger study carried out between August 2018 and January 2021 at an urban tertiary care hospital in the capital city of India. One hundred fifty-eight patients with schizophrenia and their caregivers (n=158) were taken using purposive sampling. Knowledge of Mental Illness Scale was used to evaluate the knowledge and understanding of the illness and its treatment among caregivers. Caregivers coming to this institution in New Delhi were also assessed with respect to their demographic variables, caregiving experience, family functioning, coping strategies, available social support, psychological distress, quality of life, and spiritual, religious, and personal beliefs. The assessment also included demographic and clinical variables of the patients.
RESULTS: Caregivers possessed relatively greater knowledge regarding the medication being taken (52.5%), its side effects (38%), and the diagnosis (36.1%). However, their knowledge was poorer with respect to the meaning and implications of the diagnosis (21.5%) and the purpose of the medication (10.1%). In multivariate regression analysis of these five domains with socio-demographic, clinical, and psychosocial variables; the knowledge of the diagnosis was associated with a family history of psychiatric illness in a second-degree relative, the total duration of treatment, and stigma in caregivers. The meaning of the diagnosis was associated with the environmental domain of quality of life and positive symptoms of the patient. Knowledge of medication was associated with the number of patient hospitalizations, caregivers supervising medications, caregiver age, and the total duration of illness. Knowledge of the purpose of medication was associated with the total duration of illness and patient positive symptoms. Knowledge of medication side effects was associated with the roles domain of family functioning, positive caregiving experience, patient negative symptoms, and the acceptance/redefinition domain of coping.
CONCLUSIONS: A range of associations were examined in this study. Correct knowledge of schizophrenia is necessary to promote timely help-seeking, preventing a longer duration of untreated psychosis and a poor prognosis. In research, knowledge of illness is a construct with immense potential applicability. In patient care, this knowledge may help caregivers participate in treatment planning, improve patient functioning, and support their patients toward better functional outcomes.

Background/Objectives: Arthritis is a chronic, debilitating condition affecting millions of United States (US) adults. Regular physical exercise is particularly important for adults with arthritis. This study aimed to investigate the characteristics associated with regular physical exercise in US adults with arthritis. Methods: This cross-sectional database study used 2021 Medical Expenditure Panel Survey data and included US adults (age ≥ 18) alive with arthritis. A multivariable logistic regression model was developed to test the association of the following variables with regular physical exercise (defined as moderate-vigorous intensity exercise for ≥30 min ≥5 times weekly; yes, no): age, sex, Hispanic, race, census region, marriage status, schooling, employment, health insurance, household income, mental health, general health, smoking status, chronic conditions, pain, and functional limitations. Results: Overall, 5091 people (regular physical exercise n = 2331, no regular physical exercise n = 2760) were involved in this analysis. Most were female, non-Hispanic, white, married, had schooling beyond high school, were unemployed, had private health insurance, had mid-high household income, had good mental health, had good general health, were non-smokers, had two or more chronic conditions, had little/moderate pain, and did not have a functional limitation. In multivariable logistic regression analysis, male vs. female sex (odds ratio [OR] = 1.440, 95% confidence interval [CI] = 1.185-1.749), employed vs. unemployed (OR = 1.277, 95% CI = 1.005-1.624), good vs. poor general health (OR = 2.174, 95% CI = 1.673-2.824), little/moderate vs. quite a bit/extreme pain (OR = 1.418, 95% CI = 1.109-1.818), and no functional limitation (OR = 1.592, 95% CI = 1.282-1.980) were associated with higher odds of reporting regular physical exercise, while Midwest vs. West census region (OR = 0.698, 95% CI = 0.521-0.935) was associated with lower odds of reporting regular physical exercise. Conclusions: This study identified variables associated with regular physical exercise among US adults with arthritis. Further work is needed to develop interventions for characteristics that may help increase exercise and, subsequently, health outcomes in this population.

BACKGROUND: This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that an advanced digitally enabled workforce is associated with strong safety leadership and culture and better patient health and safety outcomes.
OBJECTIVE: This study aimed to examine the relationship between digital maturity and quality and safety outcomes in US hospitals.
METHODS: The data sources were hospital safety letter grades as well as quality and safety scores on a continuous scale published by The Leapfrog Group. We used the digital maturity level (measured using the Electronic Medical Record Assessment Model [EMRAM]) of 1026 US hospitals. This was a cross-sectional, observational study. Logistic, linear, and Tweedie regression analyses were used to explore the relationships among The Leapfrog Group\'s Hospital Safety Grades, individual Leapfrog safety scores, and digital maturity levels classified as advanced or fully developed digital maturity (EMRAM levels 6 and 7) or underdeveloped maturity (EMRAM level 0). Digital maturity was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership as confounding variables. Hospitals were divided into the following 2 groups to compare safety and quality outcomes: hospitals that were digitally advanced and hospitals with underdeveloped digital maturity. Data from The Leapfrog Group\'s Hospital Safety Grades report published in spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospital beds were obtained from the CMS database.
RESULTS: The results revealed that the odds of achieving a higher Leapfrog Group Hospital Safety Grade was statistically significantly higher, by 3.25 times, for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7; odds ratio 3.25, 95% CI 2.33-4.55).
CONCLUSIONS: Hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes. The study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity compared with hospitals with underdeveloped digital maturity.

In the face of global adversities such as pandemics, military conflicts, and socio-political unrest, the resilience and well-being of populations can be severely tested. This study examines the fluctuating levels of distress within the Israeli population over a period of 2.5 years, encompassing events like the COVID-19 pandemic and various socio-political and security crises. Utilizing a quasi-longitudinal design, data were collected at thirteen time-points, mirroring the demographic makeup of the Israeli Jewish adult population. Measures of psychological distress, societal and individual resilience, hope, morale, and perceived danger were assessed, alongside demographic variables. Statistical analyses included ANOVA and stepwise regression models. Distress levels displayed significant oscillations in response to adverse events. High distress was noted during the latter stages of the study, particularly following a major security incident on October 7, 2023. The regression analyses identified morale and perceived danger as consistent important associations with distress, with individual resilience also inversely related across all time points. The study reveals the dynamic nature of psychological distress in relation to a range of adversities. Morale emerged as a key buffer against distress, whereas perceived danger was a significant stressor, especially during acute- existential threats. These findings have important implications for mental health interventions and policy-making aimed at fostering resilience and mitigating distress in crisis conditions.

BACKGROUND: Declining physical activity and increasing screen time (ST) among Chinese adolescents have become major concerns shared by scholars, while mental health issues are also on the rise. Previous studies have confirmed the association between physical activity and screen time and psychological symptoms, but it is unclear how their psychological symptoms, especially for Chinese university students who have a high proportion of psychological symptoms, and no research evidence has been found.
METHODS: This study investigated physical activity, screen time, and psychological symptoms in 11,173 university students aged 19-22 years in six regions of China. A binary logistic regression analysis was used to analyze the association between moderate-to-vigorous physical activity (MVPA) and screen time and psychological symptoms. And the generalize linear model (GLM) analysis was used to further analyze the association between MVPA and screen time and psychological symptoms.
RESULTS: The detection rate of psychological symptoms among Chinese university students was 16.3%, with a higher percentage of female students (17.5%) than male students (14.7%). The proportion of male students (8.2%) with MVPA > 60 min/d was higher than that of female students (2.3%), and the proportion of male students (33.8%) and female students (34.5%) with screen time > 2 h/d was basically the same. The generalize linear model (GLM) analysis showed that university students with MVPA < 30 min/d and screen time > 2 h/d (OR = 1.59, 95% CI: 1.10-2.31) had the highest risk of psychological symptoms (OR = 1.59, 95% CI: 1.10-2.31) compared to university students with MVPA > 60 min/d and screen time < 1 h/d as the reference group. The risk of psychological symptoms was the highest among those with MVPA < 30 min/d and screen time > 2 h/d (OR = 1.59,95% CI: 1.10-2.31). In addition, university students with MVPA > 60 min/d and a screen time of 1-2 h/d (OR = 0.09, 95% CI: 0.03-0.25) had the lowest risk of psychological symptoms (P < 0.001). The same trend was observed for both male and female students.
CONCLUSIONS: Chinese university students have a certain proportion of psychological symptom problems, and there is a significant between MVPA and screen time and psychological symptoms, and the same trend exists for both male and female students. Chinese university students should perform MVPA for not less than 60 min a day, and at the same time control the duration of screen time, and screen time should be controlled between 1 and 2 h a day, which has a better promotion effect on psychological health.

UNASSIGNED: Otomycosis is common in environments with hot, humid weather, and it may be challenging to manage.
UNASSIGNED: To profile common clinical presentations, the pathogenic fungi, the treatment modalities with responses, and explore clinical factors associated with having positive fungal culture in Otomycosis.
UNASSIGNED: Retrospective review of patients with Otomycosis. Demographic and clinical parameters, otoscopic findings and mycological study results were recorded. The treatment modalities used and treatment response were summarized. Comparative statistical analyses of associated factors to positive fungal culture were performed with Chi square test, and Student\'s t-test, using SPSS version 22.0.
UNASSIGNED: Total of 71 patients with M: F=1:1.8, mean age 38.5±19.8 years. Average duration of symptoms was 5.4 ±4.6 weeks; common presenting complaint was itchy ear (33.8%). Majority of patients (85.9%) had unilateral ear involvement, 50.0% applied ototopic medications before presentation, 8.5% had multiple co-morbidities. 20 patients had positive fungal culture results; common fungal isolate was Aspergillus niger 9 (45.0%).Clinical factors associated with positive culture of fungus were age, non-previous use of ototopic drugs, and presence of co-morbidity. The most common treatment was local ear debridement and use of topical antifungal creams. Majority (91.5%) of the patients responded with resolution of fungal infection. Complications rate was 8.4%.
UNASSIGNED: Otomycosis commonly present with itchy ears, the pathogenic fungi commonly being Aspergillus species. The factors associated with positive fungal culture were age, non-usage of ototopic agents and presence of co-morbidity. Treatment modality used was local debridement and topical antifungal agents, which produced favourable response in most patients.

BACKGROUND: Interoception encompasses the conscious awareness of homeostasis in the body. Given that fetal movement awareness is a component of interoception in pregnant women, the timing of initial detection of fetal movement may indicate individual differences in interoceptive sensitivity.
OBJECTIVE: The aim of this study is to determine whether the association between the gestational week of initial movement awareness and interoception can be a convenient evaluation index for interoception in pregnant women.
METHODS: A cross-sectional study was conducted among 32 pregnant women aged 20 years or older at 22-29 weeks of gestation with stable hemodynamics in the Obstetric Outpatient Department. Interoception was assessed using the heartbeat-counting task, with gestational weeks at the first awareness of fetal movement recorded via a questionnaire. Spearman rank correlation was used to compare the gestational weeks at the first awareness of fetal movement and heartbeat-counting task scores.
RESULTS: A significant negative correlation was found between the gestational weeks at the first fetal movement awareness and heartbeat-counting task performance among all participants (r=-0.43, P=.01) and among primiparous women (r=-0.53, P=.03) but not among multiparous women.
CONCLUSIONS: Individual differences in interoception appear to correlate with the differences observed in the timing of the first awareness of fetal movement.

UNASSIGNED: Studies suggest a relationship between the emotional evocativeness of visual imagery and viewer responses, however, there is limited understanding of these associations, especially as they relate to viewers\' personal experiences of adversities.
UNASSIGNED: In this exploratory study, we examined the relationship between the visual content of mask images and viewers\' responses. In an online survey 699 participants (of n = 1,010 total initial participants) rated 98 masks based on valence, arousal, and personal relevance and completed the Life Events Checklist. The masks included those created by service members (SMs) with traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD), depicting physical, psychological, and moral injuries and matched neutral masks created by creative arts therapists and arts in health scholars.
UNASSIGNED: The findings indicated that responses to mask image content (traumatic versus neutral) were associated with viewers\' personal history of adversity and trauma. Specifically, images representing injury/trauma provoked stronger reactions on valence and arousal than neutral images. Moreover, participants with personal histories of trauma had heightened emotional responses to distressing imagery.
UNASSIGNED: These findings have implications for art therapists as well as for clinical and general populations in that these results highlight the potential impact of distressing imagery particularly for individuals with personal histories of experiencing or witnessing traumatic events.

Recognizing the risk factors for dyslipidemia during pregnancy is crucial for safeguarding the health of both the mothers and the offspring. Growing evidence emerged and suggested links between environmental factors, including metals, and alteration in lipid levels or dyslipidemia in general populations. However, knowledge of the associations during pregnancy remains extremely lacking. Herein, we aimed to explore whether elevated metal exposure constitutes a risk factor for dyslipidemia in pregnant women. Based on the Tongji-Shuangliu Birth Cohort (TSBC), a total of 663 pregnant women were recruited and their urinary levels of 17 metals and blood lipid biomarkers in early pregnancy were measured, namely triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). The multivariable linear regression models revealed that exposure to selected metals during early pregnancy was significantly associated with some important biomarkers. In particular, after natural log-transformed for the levels of lipid biomarkers and metals, copper (Cu) exposure was positively associated with HDL-C (β = 0.024, 95% CI: 0.001, 0.046), while zinc (Zn) was associated with TG (β = 0.062, 95% CI: 0.013, 0.110) and selenium with TC (β = 0.028, 95% CI: 0.004, 0.054). Exposure to rubidium (Rb) was positively associated with multiple lipid biomarkers, including HDL-C (β = 0.020, 95% CI: 0.002, 0.037) and LDL-C (β = 0.022, 95% CI: 0.001, 0.042). Mixture exposure analysis further identified significant associations between Cu and HDL-C, Zn and TG, Rb and HDL-C, when multiple metal exposures were considered in the Bayesian kernel machine regression model simultaneously. Our findings showed that exposure to several metals during early pregnancy was associated with an increased prevalence of blood lipid abnormalities in pregnant women. These findings underscore the potential impact of metal combinations on lipid metabolism and increase our understanding of the risk factors associated with abnormal lipid metabolism during pregnancy.

Various muscles can be involved in idiopathic eosinophilic myositis (IEM), with the ocular muscles being notably affected. Ocular eosinophilic myositis is a rare condition that typically affects the rectus muscles. A tissue biopsy stands as the gold standard for diagnosis. Different subtypes exist based on the extent of eosinophilic infiltration. Limited data is available about treatment, although glucocorticoids have shown successful outcomes. We present the case of a 60-year-old man who, a few years after being diagnosed with ocular myasthenia gravis, was diagnosed through a tissue biopsy with ocular eosinophilic myositis. Treatment with oral glucocorticoids significantly improved his symptoms.