ObjectivesTo adapt the Patient–Practitioner Orientation Scale (PPOS), to a Chinese context, and explore the preference towards patient-centred communication among physicians and patients with the Chinese-revised Patient–Practitioner Orientation Scale (CR-PPOS).DesignA cross-sectional questionnaire-based study.SettingClinical settings from eight medical units, including four community hospitals and four general hospitals, in Shanghai, China.Participants1018 participants, including 187 physicians and 831 patients, completed this study in two successive stages.Outcome measurementsPsychometric properties of the CR-PPOS and participants’ score on the CR-PPOS.ResultsCompared with the original PPOS, the 11-item CR-PPOS obtained better psychometric indices. Physicians and patients scored differently on both the total CR-PPOS and its two subscales. Compared with physicians, the scores of patients were more influenced by their personal characteristics, such as age and education.ConclusionsThe CR-PPOS is a better instrument in a Chinese context than the original translated version. The divergence in the extent to which patient-centred communication is preferred among Chinese physicians and patients should be noted. Adapting physicians’ communication strategy to patients’ preferences based on their personal characteristics can be a viable approach towards improving clinical efficiency.

estational age at birth (GAB) is an important determinant of child health and development. Worldwide, approximately 13 million newborns are born preterm (GAB<37 weeks) annually. 1 Prematurity is associated with morbidity and mortality, 2,3 including neurodevelopmental problems, such as cerebral palsy, intellectual disability, learning disability, and poor motor development. [4][5][6] Preterm birth is reportedly associated with increased risks of attention-deficit/ hyperactivity disorder (ADHD), autism spectrum disorder, [7][8][9] and psychiatric disorders in adulthood. 10 In some countries, postterm birth (GAB≥42 weeks) accounts for up to 10% of births 11 and is associated with adverse birth outcomes, in-creased neonatal mortality, cognitive impairment, and increased risk of ADHD. 12 Few studies 13,14 have investigated the associations of GAB with brain structures despite the dynamic neurodevelopment that occurs during early life. During the third trimester of gestation, there is a 4-fold increase in brain size accompanied by marked growth of brain surface area, resulting in the emergence of sulci and gyri. 15,16 Thus, birth before the presumed optimal gestational duration (approximately 40 weeks) may be associated with disruption of neurodevelopmental processes in late pregnancy that persist during postnatal life. IMPORTANCE Preterm and postterm births are associated with adverse neuropsychiatric outcomes. However, it remains unclear whether variation of gestational age within the 37-to 42-week range of term deliveries is associated with neurodevelopment.OBJECTIVE To investigate the association of gestational age at birth (GAB) with structural brain morphometry in children aged 10 years. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study included pregnant women living in Rotterdam, the Netherlands, with an expected delivery date between April 1, 2002, and January 31, 2006. The study evaluated 3079 singleton children with GAB ranging from 26.3 to 43.3 weeks and structural neuroimaging at 10 years of age from the Generation R Study, a longitudinal, population-based prospective birth cohort from early pregnancy onward in Rotterdam. Data analysis was performed from March 1, 2019, to February 28, 2020, and at the time of the revision based on reviewer suggestions. EXPOSURESThe GAB was calculated based on ultrasonographic assessment of crown-rump length (<12 weeks 5 days) or biparietal diameter (Ն12 weeks 5 days) in dedicated research centers.MAIN OUTCOMES AND MEASURES Brain structure, including global and regional brain volumes and surface-based cortical measures (thickness, surface area, and gyrification), was quantified by magnetic resonance imaging. RESULTSIn the 3079 children (1546 [50.2%] female) evaluated at 10 years of age, GAB was linearly associated with global and regional brain volumes. Longer gestational duration was associated with larger brain volumes; for example, every 1-week-longer gestational duration corresponded to an additional 4.5 cm 3 /wk (95% CI, 2.7-6.3 cm 3 /wk) larger total...

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BackgroundThe use of social media in health education has witnessed a revolution within the past decade. Students have already adopted social media informally to share information and supplement their lecture-based learning. Although studies show comparable efficacy and improved engagement when social media is used as a teaching tool, broad-based adoption has been slow and the data on barriers to uptake have not been well documented.ObjectiveThe objective of this study was to assess attitudes of health educators toward social media use in education, examine differences between faculty members who do and do not use social media in teaching practice, and determine contributing factors for an increase in the uptake of social media.MethodsA cross-sectional Web-based survey was disseminated to the faculty of health professional education departments at 8 global institutions. Respondents were categorized based on the frequency of social media use in teaching as “users” and “nonusers.” Users sometimes, often, or always used social media, whereas nonusers never or rarely used social media.ResultsA total of 270 health educators (52.9%, n=143 users and 47.0%, n=127 nonusers) were included in the survey. Users and nonusers demonstrated significant differences on perceived barriers and potential benefits to the use of social media. Users were more motivated by learner satisfaction and deterred by lack of technology compatibility, whereas nonusers reported the need for departmental and skill development support. Both shared concerns of professionalism and lack of evidence showing enhanced learning.ConclusionsThe majority of educators are open-minded to incorporating social media into their teaching practice. However, both users and nonusers have unique perceived challenges and needs, and engaging them to adapt social media into their educational practice will require previously unreported approaches. Identification of these differences and areas of overlap presents opportunities to determine a strategy to increase adoption.

Prenatal maternal depressive symptoms were associated with higher MD in the uncinate fasciculus and the cingulum bundle. These structures are part of the limbic system, which is involved in motivation, emotion, learning, and memory. As paternal depressive symptoms were also related to lower FA in the cingulum, the observed effect may partly reflect a genetic predisposition and shared environmental family factors and to a lesser extent a specific intrauterine effect.

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IMPORTANCEMaternal tobacco use during pregnancy has been associated with various health consequences, including suboptimal neurodevelopment in offspring. However, the effect of prenatal exposure to maternal smoking on child brain development has yet to be elucidated. OBJECTIVE To investigate the association between maternal smoking during pregnancy and offspring brain development in preadolescence as well as the mediating pathways. DESIGN, SETTING, AND PARTICIPANTS This prospective, population-based cohort study was embedded in the Generation R Study, Rotterdam, the Netherlands. The Generation R Study was launched in 2002, with follow-up ongoing. Child brain morphology was assessed at 9 to 11 years of age (ie, 10-12 years between exposure and outcome assessment). Data analysis was performed from March 1, 2021, to February 28, 2022, and at the time of manuscript revision. Participants included the singleton children of pregnant women residing in the study area with an expected date of delivery between April 1, 2002, and January 31, 2006; 2704 children with information on maternal smoking during pregnancy and structural neuroimaging at 9 to 11 years of age were included. A subsample of 784 children with data on DNA methylation at birth was examined in the mediation analysis. EXPOSURES Information on maternal smoking during pregnancy was collected via a questionnaire in each trimester. As a contrast, paternal smoking was assessed at recruitment. MAIN OUTCOMES AND MEASURES Brain morphology, including brain volumes and surface-based cortical measures (thickness, surface area, and gyrification), was assessed with magnetic resonance imaging. For mediation analysis, DNA methylation at birth was quantified by a weighted methylation risk score. RESULTS The 2704 participating children (1370 [50.7%] girls and 1334 [49.3%] boys) underwent brain imaging assessment at a mean (SD) age of 10.1 (0.6) years. Compared with nonexposed children (n = 2102), exposure to continued maternal smoking during pregnancy (n = 364) was associated with smaller total brain volume (volumetric difference [b] = −14.5 [95% CI, −25.1 to −4.0] cm 3 ), cerebral gray matter volume (b = −7.8 [95% CI, −13.4 to −2.3] cm 3 ), cerebral white matter volume (b = −5.9 [95% CI, −10.7 to −1.0] cm 3 ), and surface area and less gyrification. These associations were not explained by paternal smoking nor mediated by smoking-associated DNA methylation patterns at birth. Children exposed to maternal smoking only in the first trimester (n = 238) showed no differences in brain morphology compared with nonexposed children. CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that continued maternal tobacco use during pregnancy was associated with lower brain volumes and suboptimal cortical traits of offspring in preadolescence, which seemed to be independent of shared family (continued) Key Points Question Is maternal tobacco use during pregnancy associated with preadolescent brain morphology among offspring? Findings In this cohort study of 2704 children in ...

Background Emerging evidence suggests an association of maternal PUFA concentrations during pregnancy with child cognitive and neuropsychiatric outcomes such as intelligence and autistic traits. However, little is known about prenatal maternal PUFAs in relation to child brain development, which may underlie these associations. Objectives We aimed to investigate the association of maternal PUFA status during pregnancy with child brain morphology, including volumetric and white matter microstructure measures. Methods This study was embedded in a prospective population-based study. In total, 1553 mother–child dyads of Dutch origin were included. Maternal plasma glycerophospholipid PUFAs were assessed in midpregnancy. Child brain morphologic outcomes, including total gray and white matter volumes, as well as white matter microstructure quantified by global fractional anisotropy and mean diffusivity, were measured using MRI (including diffusion tensor imaging) at age 9–11 y. Results Maternal ω-3 (n–3) long-chain PUFA (LC-PUFA) concentrations during pregnancy had an inverted U-shaped relation with child total gray volume (linear term: β: 16.7; 95% CI: 2.0, 31.5; quadratic term: β: –1.1; 95% CI: –2.1, –0.07) and total white matter volume (linear term: β: 15.7; 95% CI: 3.6, 27.8; quadratic term: β: –1.0; 95% CI: –1.8, –0.16). Maternal gestational ω-6 LC-PUFA concentrations did not predict brain volumetric differences in children, albeit the linolenic acid concentration was inversely associated with child total white matter volume. Maternal PUFA status during pregnancy was not related to child white matter microstructure. Conclusions Sufficient maternal ω-3 PUFAs during pregnancy may be related to more optimal child brain development in the long term. In particular, exposure to lower ω-3 PUFA concentrations in fetal life was associated with less brain volume in childhood. Maternal ω-6 LC-PUFAs were not related to child brain morphology.