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Attitudes, knowledge, and behavioral control regarding child abuse reporting in middle eastern nursing professionals: A systematic review and meta-analysis.

INTRODUCTION: Child abuse is critically underreported in the Middle East, with up to 90% of cases going unidentified. Nurses play a central role in child protection systems, yet factors influencing their reporting practices in this region have not been comprehensively synthesized. This study aims to review systematically and meta-analyze evidence on Middle Eastern nurses' knowledge, attitudes, and perceived behavioral control regarding child abuse reporting. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. Five databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library) were searched through November 2025. Studies targeting nursing professionals or students in Middle Eastern countries assessing knowledge, attitudes, intention to report, subjective norms, or perceived behavioral control were included. Random-effects meta-analyses were performed with subgroup analyses comparing students and practicing nurses. RESULTS: Fourteen studies comprising 4018 participants across six countries met the inclusion criteria. The pooled knowledge score was 61.64% (95% CI: 50.14-73.14), with nursing students scoring higher than practicing nurses (75.28% vs. 54.79%, p = 0.03). The pooled attitude score was 60.69% (95% CI: 44.82-76.57). Educational interventions significantly improved knowledge (SMD = 1.54, 95% CI: 0.70-2.38, p = 0.0003). The pooled proportion of nurses intending to report suspected abuse was 75% (95% CI: 0.58-0.92). The pooled subjective norm score was 8.02 (95% CI: 7.75-8.29), and the pooled perceived behavioral control score was 24.34 (95% CI: 22.20-26.46). High heterogeneity (I2 > 95%) reflects substantial variability in educational and legal contexts across the region. CONCLUSIONS: Middle Eastern nurses show moderate knowledge and attitudes toward child abuse reporting, with notable gaps among practicing professionals. Educational interventions are effective but should be integrated with systemic reforms, including mandatory reporting legislation and clear protocols.

Humans

Virtual reality physical education and adolescents' exercise interest and physical fitness: An explanatory sequential mixed-methods randomized trial with exploratory pathway analysis.

Traditional physical education (PE) faces declining student interest and limited fitness gains. Virtual reality (VR) offers immersive, gamified experiences, but evidence regarding its effectiveness and explanatory pathways remains limited. This explanatory sequential mixed-methods randomized trial assigned 360 adolescents (aged 13-16) from three middle schools to either VR-supported PE (n&#xa0;=&#xa0;180) or conventional PE (n&#xa0;=&#xa0;180) for 12&#xa0;weeks, with a 4-week follow-up. Outcomes included exercise interest (validated scale), physical fitness (coordination via MABC-2, cardiorespiratory endurance via the 20-m shuttle run, explosive power via the standing long jump, and speed via the 10-m sprint), and accelerometer-measured physical activity. The qualitative component involved 38 unique students: 32 completed individual semi-structured interviews, and six additional students participated only in focus groups. Three-level linear mixed-effects models and exploratory structural equation modeling were used. The VR group showed significantly greater improvements in exercise interest (d&#xa0;=&#xa0;0.78), coordination (d&#xa0;=&#xa0;0.62), cardiorespiratory endurance (d&#xa0;=&#xa0;0.55), and speed (d&#xa0;=&#xa0;0.48) than the control group (all p&#xa0;<&#xa0;0.001), but not in explosive power (d&#xa0;=&#xa0;0.12, p&#xa0;=&#xa0;0.148). Effects were partially retained at follow-up (interest d&#xa0;=&#xa0;0.65, coordination d&#xa0;=&#xa0;0.48, endurance d&#xa0;=&#xa0;0.42, and speed d&#xa0;=&#xa0;0.30), a pattern not fully consistent with a purely novelty-driven explanation. Exploratory mediation identified exercise interest as a statistically compatible explanatory pathway (indirect effect&#xa0;=&#xa0;0.34, 95% CI [0.22, 0.46]), although the timing of measurement precludes causal interpretation. Qualitative findings contextualized these results by highlighting immersion, feedback, self-efficacy, and perceived transfer. VR-supported PE may enhance adolescents' exercise interest and selected fitness dimensions, but its limited effect on explosive power and possible novelty contribution indicate that it should complement, rather than replace, conventional PE. Longer-term studies are needed.

Humans

Effects of automated massage chair therapy on mental health and physical health: A comprehensive study.

BACKGROUND AND OBJECTIVE: Automated massage chair therapy is a non-pharmacological intervention widely believed to enhance wellness, yet evidence regarding its effects remains limited. This 3-part study evaluated the effects of automated massage chair therapy on mental and physical health. METHODS: In Part 1, 20 moderately stressed students were randomized to receive a 20-minute automated massage chair therapy session followed by a 20-minute control session, or vice versa, with a 48-hour washout period. Blood pressure (BP), heart rate (HR), electroencephalogram (EEG), State-Trait Anxiety Inventory (STAI), and Visual Analog Scale (VAS) were measured. In Part 2, 20 hypertensive hospital staff received three 20-minute automated massage chair therapy sessions on alternate days. BP, HR, and skin blood flow (SBF) were measured. In Part 3, 20 hospital staff with chronic low back pain received three 20-minute automated massage chair therapy sessions on alternate days. Electromyogram (EMG) and VAS were measured. RESULTS: Automated massage chair therapy significantly reduced diastolic blood pressure (DBP), HR, stress, and anxiety among moderately stressed students. In hospital staff with hypertension, SBF did not change significantly, whereas BP and HR decreased significantly after automated massage chair therapy. In hospital staff with chronic low back pain, low back function improved, and pain was significantly reduced after automated massage chair therapy. CONCLUSION: These findings indicate that automated massage chair therapy may help reduce stress, lower blood pressure, and alleviate low back pain.

Humans

Asthma Exacerbation Risk and School Asthma Readiness.

OBJECTIVES: School-based asthma management is a key facet of child asthma care. We aimed to describe the proportion of students whose schools have child-specific components of asthma care, derive a composite metric of these components ("school asthma readiness"), and assess its association with asthma exacerbations (asthma risk) in the preceding year. METHODS: Within a nested cohort of children enrolled in a larger randomized clinical trial, we assessed the baseline proportion of children whose school had elements of necessary asthma care. We then derived a "school asthma readiness" composite and used ordinal logistic regression to model the association between number of asthma exacerbations in the preceding year and the composite, accounting for demographic, clinical, and school characteristics. RESULTS: Of 202 participants aged 5 to 13&#xa0;years, most identified as Black (95%) and non-Hispanic (98%), and most participants (73%) had an emergency department visit for asthma in the year before enrollment. Most students' schools (79%) had awareness of the child's asthma diagnosis, whereas fewer had reliever medications and valved holding chambers (both 31%) and asthma care plans (7%). Asthma exacerbations in the prior year were associated with a significantly higher school asthma readiness in bivariate (odds ratio [OR], 1.44 [95% CI, 1.14-1.82]; P&#x2009;=&#x2009;.002) and multivariable analysis (OR, 1.31 [95% CI, 1.02-1.7]; P&#x2009;=&#x2009;.037). CONCLUSIONS: A minority of children attended schools that were equipped to manage asthma symptoms. More past exacerbations were associated with higher school readiness, suggesting that more work is needed to support proactive asthma care in schools.

Humans

Sexual Abuse in Girls Aged &#x2264;14: A Retrospective Observational Swiss Study.

INTRODUCTION: Child sexual abuse (CSA) is a critical public health concern with enduring physical and psychological consequences. OBJECTIVE: This study aimed to describe the sociodemographic profiles, contextual circumstances, and clinical findings of reported CSA cases involving girls aged &#x2264;14, recorded between 2018 and 2021 at two university hospitals in Switzerland: Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV) and Geneva University Hospitals (H&#xf4;pitaux Universitaires de Gen&#xe8;ve - HUG) to inform prevention and intervention strategies. METHODS: This retrospective observational study included 95 cases identified through forensic consultations at CHUV and HUG. All eligible cases recorded between 2018 and 2021 were analyzed. Collected data included sociodemographic characteristics, assault circumstances, perpetrator-victim relationship, and clinical findings. RESULTS: The median age of children exposed to sexual assault was 7 years (IQR 4-14). Intra-familial abuse predominated among premenarcheal girls (41.7%), while postmenarcheal girls were more frequently assaulted by non-familial perpetrators (76.2%) and experienced higher rates of physical violence (47.6%). Genital lesions were documented in 41% of cases, with a higher prevalence among younger patients, and were rarely specific to CSA. CONCLUSION: This study provides a detailed descriptive overview of CSA cases involving girls aged &#x2264;14 in two Swiss cantons. It highlights age-related patterns in perpetrator profiles, assault characteristics, and clinical findings. Prevention strategies should be age-specific, addressing intra-familial risk in younger children and peer-related or situational vulnerabilities in adolescents. These findings support the implementation of standardized forensic practices, improved surveillance systems, and targeted prevention and care strategies.

Child sexual abuse Intra-familial abuse Pediatric

The impact of artificial intelligence on critical thinking and clinical reasoning in health professions education: A systematic review and meta-analysis.

BACKGROUND: Critical thinking and clinical reasoning underpin healthcare professionals' ability to navigate uncertainties and deliver safe and effective care. With artificial intelligence (AI) advancement and growing adoption, AI-based educational tools are increasingly used to support these cognitive competencies' development. OBJECTIVE: To synthesize randomised and controlled clinical trials on AI-based educational tools in health professions education and examine their effects on critical thinking and clinical reasoning among health professions students. METHODS: Six electronic databases were searched from January 1, 2014 to July 28, 2025 was reviewed: PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Embase and Web of Science. Two independent reviewers performed data extraction and quality assessment using standardized JBI checklists. The GRADE approach was used to assess the certainty of evidence. Studies were pooled via random-effects meta-analyses or narrative syntheses. RESULTS: Fourteen randomised controlled trials and seven controlled clinical trials were included (n&#xa0;=&#xa0;21). Meta-analyses revealed small to medium effect sizes for the surrogate clinical reasoning outcomes of performance-based assessment scores (SMD 0.68; 95% CI [0.38, 0.98], p-value&#xa0;=&#xa0;0.00; I2&#xa0;=&#xa0;38%) and knowledge test scores (SMD 0.39; 95% CI [0.09, 0.69], p-value&#xa0;=&#xa0;0.01; I2&#xa0;=&#xa0;79%). Critical thinking and clinical reasoning skills and dispositions were narratively synthesized, with majority of included studies favouring AI-based interventions but the evidence had low to very low certainty. CONCLUSION: AI-based educational interventions may improve critical thinking and clinical reasoning among health profession students, but the evidence is very uncertain. This review offers preliminary insights but does not allow identification of optimal interventions or discipline-specific recommendations due to small sample sizes and substantial intervention heterogeneity. Further research is required to draw definitive conclusions. PROTOCOL REGISTRATION: CRD42025634074.

Humans

Alternative genetic codes in bacteria and archaea identified with a fast k-mer-based algorithm.

The genetic code is conserved across all domains of life and is often described as universal. Nevertheless, many exceptions to the "universal" code have now been documented, most of these through manual or semiautomated inspection of highly conserved genes. Modern bioinformatics tools improved our ability to find alternative genetic codes but remain computationally expensive, preventing widespread use on thousands of new species identified by sequencing environmental samples. Here, I report a >100-fold accelerated method for inferring the genetic code directly from assembled genomes and apply it to thousands of previously uncharacterized assemblies from archaea and bacteria. I describe three candidate genetic code variations, one of which, an alternative genetic code used by a family of Asgard archaea, is a unique example of sense codon reassignments for this domain. Identifying genetic code variations is important for understanding evolution of the standard code and improving accuracy of protein databases and open reading frame identification.

Genetic Code

Experimental validation of an AI-driven digital healthcare platform for oral health behavior and plaque assessment among vietnamese children.

BACKGROUND: Oral health among children in developing countries, including Vietnam, remains a significant public health concern. Innovative approaches leveraging artificial intelligence AI-based digital health platforms may offer effective strategies for managing dental plaque and promoting better oral hygiene behaviors among school-aged children. This study aimed to evaluate the effectiveness of an AI-driven oral healthcare platform (Denti-i Vietnam) in improving oral hygiene and behavioral outcomes among Vietnamese primary school students. METHODS: A total of 204 primary school students aged 8-10&#xa0;years in Hanoi, Vietnam, participated in this experimental study. Participants were randomly assigned to an intervention group (n&#xa0;=&#xa0;107), which used the AI-driven oral healthcare platform, and a comparison group (n&#xa0;=&#xa0;97), which received traditional oral health education via pamphlets. Oral health behaviors, dental plaque levels (Simplified Oral Hygiene Index; OHI-S), and caries indices (dft/DMFT) were assessed at baseline and after the intervention period. RESULTS: The intervention group demonstrated a significant reduction in the OHI-S score compared to baseline (2.49&#xa0;&#xb1;&#xa0;0.60 to 1.70&#xa0;&#xb1;&#xa0;0.76, p&#xa0;<&#xa0;0.001), particularly in the debris component, indicating enhanced plaque control. Notable improvements were also observed in oral hygiene behaviors, including increased frequency of toothbrushing before and after breakfast (p&#xa0;<&#xa0;0.01) and more frequent parental assistance during brushing (p&#xa0;=&#xa0;0.03). Furthermore, parental awareness of dental caries significantly increased in the intervention group (p&#xa0;=&#xa0;0.001). CONCLUSIONS: The AI-driven oral healthcare platform significantly improved both oral hygiene behaviors and plaque control among Vietnamese primary school children. These findings suggest that AI-driven digital health tools can serve as practical and scalable solutions for promoting oral health in developing countries.

Humans

Comparative effectiveness of game-based learning modalities in nursing and medical education: a systematic review and Bayesian network meta-analysis.

BACKGROUND: Game-based learning (GBL) is increasingly used in healthcare education, but educators must choose among diverse modalities (e.g., quiz platforms, apps, serious games and metaverse environments). Comparative evidence on which modalities perform best across learning domains (knowledge, attitudes, and practice) remains limited. AIM: To compare the effects of distinct GBL modalities on knowledge, attitudes, and practice outcomes in nursing and medical education and to explore whether comparative effects differ by learner group (pre-licensure students and in-service professionals). DESIGN: PRISMA-NMA-aligned systematic review and Bayesian network meta-analysis. METHODS: We searched eight databases and trial registries through September 2, 2024, for randomized controlled trials comparing GBL with traditional teaching (TT). Outcomes were transformed to a 0-100 scale and analysed as change from baseline in Bayesian consistency models; random-effects models were selected using deviance information criterion (DIC). Risk of bias was assessed using RoB 2. We report mean differences (MDs) with 95% credible intervals (CrIs) versus TT, ranking probabilities, and subgroup NMAs by learner group. RESULTS: Thirty-one RCTs (n&#xa0;=&#xa0;3439) were included; 15 contributed complete data to the network. Risk of bias was low in 15 trials and raised some concerns in 16. The network was modest for knowledge (11 trials) and sparse for attitudes (3) and practice (4). Compared with TT, metaverse-based learning showed improved attitudes (MD 15; 95% CrI 12 to 18), based on a single trial. For knowledge and practice, Kahoot-based quizzes (MD 9.1; 95% CrI -8.9 to 27) and app-based learning (MD 4.6; 95% CrI -4.4 to 14) had the highest estimated mean improvements, but credible intervals were wide and included the null for most comparisons. Subgroup rankings differed by learner group, but several comparisons were imprecise and uncertainty was substantial, particularly in sparse networks. CONCLUSIONS: GBL modalities may improve learning outcomes compared with TT, but relative effects appear domain-specific and the certainty of rankings is limited by sparse evidence and imprecision. Future trials should prioritise head-to-head comparisons, robust outcome measurement, and longer-term retention and transfer outcomes in both student and in-service populations.

Humans

[Analysis of clinical phenotypes and pathogenicity of a c.4476+5G>T variant of SCN1A gene in a Chinese pedigree affected with Genetic epilepsy with febrile seizures plus].

OBJECTIVE: To explore the pathogenicity and characteristics of a heterozygous splicing variant of SCN1A gene in a Chinese pedigree affected with Genetic epilepsy with febrile seizures plus (GEFS+). METHODS: A retrospective analysis was carried out on the clinical data and results of genetic testing of a GEFS+ pedigree consisting of 5 members who had visited the First Affiliated Hospital of Zhengzhou University on July 1, 2024. Pathogenicity of the splicing variant of the SCN1A gene was validated with a minigene splicing assay. This study was approved by the Medical Ethics Committee of the the First Affiliated Hospital of Zhengzhou University (Ethics No.: KS-2018-KY-36). RESULTS: The proband, a 24-year-old female, presented with FS in conjunct with focal seizures, and both of her younger brothers had Dravet syndrome. All of the three patients had carried a c.4476+5G>T variant of the SCN1A gene, which was unreported previously. Minigene experiment verified that the variant could cause loss of the first 7 bps of exon 24 and 138 bps from exon 23 of the SCN1A gene, resulting in alteration p.V1447_1495delfs*6 and affecting splicing. Based on the guidelines from American College of Medical Genetics and Genomics (ACMG), the variant was predicted as likely pathogenic (PVS1+PM2_Supporting). CONCLUSION: The c.4476+5G>T variant at an intronic site of the SCN1A gene probably underlay the pathogenesis of GEFS+ in this pedigree.

Adult

Standardized visual overlays enhance laparoscopic instruction: A mixed-methods evaluation.

Effective communication during laparoscopic procedures is frequently undermined by spatial disorientation and inconsistent terminology between instructors and trainees. This study examined whether standardized visual overlays on endoscopic monitors could enhance communication and learning. We conducted a three-phase mixed-methods study: qualitative observation of 20 laparoscopic teaching cases; a randomized trial of 63 second-year medical students assigned to control, clock, or alphanumeric grid (AG) overlays during three trials of a standardized transfer task; and intraoperative implementation in 44 cases (30 AG, 14 clock) with post-case surveys and qualitative feedback. In simulation, the clock overlay produced the fastest completion times, whereas the AG yielded the lowest error scores, and both overlays outperformed the control. Intraoperatively, the AG was rated higher than the clock for communication clarity, spatial orientation, perceived operative efficiency, and trainee confidence. Standardized visual overlays, particularly the AG, appear to support intraoperative teaching by providing a shared spatial frame of reference.

Laparoscopy

Open repairs with biceps rerouting does not impact retears in large to massive rotator cuff tears compared to conventional open repair: a randomized clinical trial.

BACKGROUND: The treatment of large to massive rotator cuff tears leads to a high failure rate and several techniques have been proposed to improve these results. Rerouting the long head of the biceps tendon (LHBT) appears to be a biological reinforcement to increase tendon healing. Therefore, this study aimed to compare the clinical and radiological outcomes of open repair for large and massive rotator cuff tears reinforced with the LHBT to conventional open repair. METHODS: A prospective randomized study was conducted with patients diagnosed with large to massive rotator posterosuperior rotator cuff tear and intact LHBT, randomized into 2 groups: biceps rerouting and conventional open repair. The functional outcomes were assessed by the American Shoulder and Elbow Surgeon score, University of California at Los Angeles score, and SF-12 questionnaire preoperatively and at 6, 12, and 24 months postoperatively. Pain level was also assessed by the visual analog scale including the first day and 2 weeks postoperatively. Structural outcomes were rotator cuff and LHBT healing with magnetic resonance imaging and acromiohumeral distance (AHD) through radiography. RESULTS: We evaluated 58 patients, 29 in each group. At the end of the follow-up there were no statistically significant differences between groups in American Shoulder and Elbow Surgeon (76.1 vs. 80.4, P = .761), University of California at Los Angeles (27.1 vs. 29.1, P = .634), or visual analog scale scores (1.3 vs. 1.1, P = .781). Additionally, rotator cuff healing rates (48.3% vs. 44.8%, P = .402) and LHBT healing rates (79.3% vs. 82.7%, P = .738) were similar. AHD increased in both groups, with no significant difference in delta AHD (P = .513). Both groups showed significant clinical improvement over time in all evaluated outcomes (P < 0,01). No postoperative complications were reported. CONCLUSIONS: We could not identify an advantage of open repair with LHBT rerouting as reinforcement over conventional open repair. Nonetheless, all clinical scores improved at the end of the 24 months of follow-up in both groups.

Humans

Cost-Effectiveness and the Economics of Genomic Testing and Molecularly Matched Therapies.

Cost-effectiveness analysis of precision oncology can help guide value-driven care. Next-generation sequencing is increasingly cost-efficient over single gene testing because diagnostic algorithms require multiple individual gene tests to determine biomarker status. Matched targeted therapy is often not cost-effective due to the high cost associated with drug treatment. However, genomic profiling can promote cost-effective care by identifying patients who are unlikely to benefit from therapy. Additional applications of genomic profiling such as universal testing for hereditary cancer syndromes and germline testing in patients with cancer may represent cost-effective approaches compared with traditional history-based diagnostic methods.

Humans

Virtual, Augmented, and Mixed Reality Technologies in Neurosurgical Training: Enhancing Skills and Surgical Outcomes: A Systematic Review.

OBJECTIVE: To systematically review the role of virtual reality (VR), augmented reality (AR), and mixed reality (MR) in neurosurgical education and training. DESIGN: Systematic review conducted in accordance with the PRISMA guidelines. SETTING: A comprehensive search was performed across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English-language studies published between 1 January 2020 and 30 April 2026. PARTICIPANTS: Studies involving neurosurgeons, fellows, residents, and medical students (maximum sample size: n = 48) were included. RESULTS: Of 7,204 initially identified studies, 25 met the inclusion criteria. VR was primarily used for surgical simulation (100% of VR studies) and anatomical education (62.5%). AR demonstrated broader applications, including preoperative planning (40%) and intraoperative support (30%). MR was evenly distributed across simulation, planning, and intraoperative support (40% each). The most frequently improved outcomes were training effectiveness (52%) and technical proficiency (44%). Methodological quality scores, assessed using the Modified Medical Education Research Study Quality Instrument (MMERSQI), ranged from 39.5 to 84.5, indicating varied rigor. CONCLUSION: VR, AR, and MR technologies show potential to enhance surgical precision, technical skills, and educational outcomes in neurosurgical training. However, standardization of methodologies and cost-effective solutions remain essential. Future research should focus on long-term clinical impact and integration of AI-driven training models.

Virtual Reality

Nutrition and Diet-Related Training and Curriculum in the US Predoctoral Dental Programs.

PURPOSE: Nutrition and diet are vital for oral and systemic health. It is unclear how well US predoctoral dental programs prepare students in nutrition screening and counseling. This study analyzed US dental school curricula on these topics. METHODS: A cross-sectional online survey was sent to the publicly available email addresses of 67 of 72 academic dental deans at US Commission on Dental Accreditation-accredited dental schools. Items assessed availability, modes and hours of instruction, curricular topics, clinical integration, and instructors. Descriptive statistics summarized responses. RESULTS: A total of 21 academic deans responded, for an overall response rate of 29%. Most (85%) of responding academic dental deans reported that nutrition and diet education was mandatory, with none treating it as optional. Of these schools, 83% offered both classroom and clinical training, while 17% provided only didactic teaching. Didactic hours varied; 42% reported 10 or fewer hours. Foundational nutrition topics were common, although dietary guidelines such as MyPlate were reported less often (66%). Oral health-related nutrition content was broadly covered, with all respondents reporting instruction related to caries, erosion, periodontal disease, and oral dysfunction. Counseling content was less consistent, particularly public health nutrition (67%) and the impact of oral dysfunction on diet and nutrition (72%). CONCLUSION(S): Most responding academic dental deans report including nutrition and diet education in their curricula. However, it remains uncertain whether these topics are incorporated at schools that did not participate in the survey. Variability in curricular time, counseling, and teaching highlights the need for clearer competencies and more clinical training. Improving this could better prepare future dentists for common dietary risks affecting oral and systemic health.

dental caries

Gender-specific pathways linking body dissatisfaction, self-disgust, and social anxiety in Chinese adolescents: A three-wave longitudinal study.

Adolescence is a critical period for physical and psychological development. Body dissatisfaction is a significant concern during this stage, contributing to psychological issues such as social anxiety. However, the longitudinal relationships among body dissatisfaction, self-disgust, and social anxiety, as well as the potential role of gender differences in these dynamics, remain unclear. A total of 1109 junior high school students in China completed the baseline survey, with data collected at three time points (Mage = 12.67 years, SD&#x202f;=&#x202f;0.68; 51.9% girls). Data were collected using the Body Areas Satisfaction Scale (BASS), the Self-Disgust Scale (SDS), and the Social Anxiety Scale for Children (SASC). Structural equation modeling (SEM) was employed to examine the longitudinal mediating effects among body dissatisfaction, self-disgust, and social anxiety, as well as to explore gender differences in these relationships. After controlling for autoregressive effects of self-disgust and social anxiety across waves, body dissatisfaction at T1 was found to indirectly predict social anxiety at T3 through self-disgust at T2, while indirectly predicting self-disgust at T3 through social anxiety at T2. Multi-group analyses revealed significant gender differences: for females, only the mediating pathway with self-disgust as the mediator was significant; for males, only the pathway with social anxiety as the mediator was significant. These findings contribute to a more nuanced understanding of the emotional mechanisms linking body dissatisfaction to social anxiety and highlight the importance of considering gender-specific pathways in prevention and intervention efforts.

Adolescent

Arthroscopic Correction of Pincer-Type FAI in the Presence of Acetabular Retroversion Results in Excellent Patient-Reported Outcomes With Low Risk of Reoperation or Conversion to Arthroplasty at Minimum 5 Years.

BACKGROUND: Acetabular retroversion is a distinct morphologic variation that may result in pincer-type femoroacetabular impingement (FAI). The role of arthroscopic management within this cohort is not fully understood. PURPOSE: To assess patient-reported outcome measures (PROMs) and survivorship at 5-year follow-up in a series of cases undergoing arthroscopic correction of pincer-type FAI with acetabular retroversion. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A single-center, prospective hip preservation registry was reviewed for all cases undergoing primary hip arthroscopy for symptomatic FAI between January 2014 and July 2020, with documented radiographic assessment of acetabular retroversion (ie, presence or absence of crossover sign, ischial spine sign, and/or posterior wall sign on a standing, standardized anteroposterior radiograph). Exclusion criteria were T&#xf6;nnis grade >1, concomitant pathologies (protrusio, Perthes disease, avascular necrosis), excessive pelvic rotation or tilt on radiographs, and/or no crossover sign. Cases were assigned to 1 of 2 groups: moderate-global retroversion group (study group: crossover sign plus either or both ischial spine sign and posterior wall sign) or control group (crossover sign only). Case-control (1:1) fuzzy matching was performed based on age (&#xb1;2 years), sex, and T&#xf6;nnis grade (exact). Clinical outcome evaluation included assessment of PROMs (modified Harris Hip Score [mHHS], 36-item Short Form [SF36], University of California-Los Angeles Activity Scale [UCLA], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), achievement of Patient Acceptable Symptom State (PASS), satisfaction, rates of revision arthroscopy, and arthroplasty-free survivorship, both preoperatively and 5 years postoperatively. Statistical analysis was performed using SPSS v29. RESULTS: A total of 201 cases (120 global, 81 moderate) in the moderate-global retroversion group were matched with 201 control cases. Mean age was 30.6 &#xb1; 10.2 years; the sample was 90% male. The rate of revision arthroscopy was similar: n = 11 (6%) in both groups (P = .974). No conversion to periacetabular osteotomy (PAO) occurred in either group. Arthroplasty-free survivorship was 98.2% (retroversion group) and 98.8% (control group) (&#x3c7;2 = 0.189; df = 1; P = .664). Significant improvements in PROMs from baseline were noted (P < .001 for all, in both groups). In total, 81% (moderate-global retroversion group) and 73% (control group) were satisfied at 5 years (P = .103). No significant difference was seen in PASS achievement rates for any of the PROMs between groups: mHHS, 62.1% versus 65.9% (P = .498); UCLA, 60.0% versus 52.2% (P = .192); SF36, 59.8% versus 64.7% (P = .458); WOMAC, 63.5% versus 67.3% (P = .553), for moderate-global retroversion and control groups, respectively. CONCLUSION: Hip arthroscopy for moderate and global acetabular retroversion resulted in significant improvement in clinical outcomes, with high satisfaction and arthroplasty-free survivorship at 5 years, consistent with a case-control matched group without acetabular retroversion (focal retroversion, pincer FAI). Arthroscopy alone, without anteverting PAO, was an effective surgical management approach for symptomatic FAI in the presence of acetabular retroversion.

Humans

Interventions to improve school attendance: a systematic review and meta-analysis of evidence from randomised controlled trials.

BACKGROUND: Poor school attendance adversely affects youth behaviour and health trajectories. We reviewed and synthesised the evidence from randomised controlled trials (RCTs) on interventions to improve school attendance. METHODS: This systematic review and meta-analysis updates the Education Endowment Foundation (EEF) 2022 review on attendance interventions. We synthesised RCT data to inform recommendations. We searched ERIC (via EBSCOhost), PsycINFO, Web of Science and Google Scholar for publications 1 January 2020-16 October 2024 to identify attendance interventions delivered to students, parents/guardians or school staff. We also extracted and analysed RCTs identified in the EEF review. Two reviewers independently extracted data from published articles and assessed risk of bias and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation, GRADE assessment). We synthesised and meta-analysed data per our protocol (PROSPERO: CRD42024610037). RESULTS: We screened 9366 titles and abstracts and included 61 articles (2000-2024): 43 articles published 2020-2024 plus 18 articles from the previous review (2000-2020), reporting 57 trials of 54 interventions. Pooled mean difference and 95% CIs for days of school attended was 0.63 (-0.34 to 1.61), I2=64.0%, low certainty, for mentoring interventions and 0.43 (0.10 to 0.76), I2=91.9%, moderate certainty, for parental engagement interventions. Other intervention areas including targeted approaches, behavioural programmes and social-emotional interventions had smaller, heterogeneous evidence bases. Risk of bias was moderate-to-low in most trials. CONCLUSION: A large range of interventions exist to address the diverse causes of school absence. Parental engagement demonstrated a small positive effect on attendance, particularly among younger age groups. Most trials were from the USA; implementation and evaluation in other countries will inform effectiveness.

CHILD