Objectives: This study explored the relationship between visual perceptual skills and participation performance in 4–6-year-old children diagnosed with autism spectrum disorder (ASD).
Methods: A cross-sectional design was employed for children diagnosed with ASD. Visual perceptual abilities were assessed using the Motor-Free Visual Perception Test–Fourth Edition (MVPT-4), and participation levels were measured using the Children Participation Questionnaire (CPQ). Statistical analysis was done using SPSS version 26, employing one-sample t-tests and Pearson correlation analysis.
Results: A total of 48 participants were included in the study: mean age, 4.98±0.82 years; 66.7% were male; 79.2% attended regular schools. One-sample t-tests indicated significant deficits across all CPQ dimensions (P<0.001). Visual perception was negatively correlated with autism severity (r=-0.429, P=0.002) and positively correlated with participation diversity (r=0.404, P=0.004). In the activities of daily living (ADL) and instrumental ADL (IADL) occupations, visual perception was significantly associated with all CPQ elements. Conversely, play and leisure occupations showed mostly negative correlations with the CPQ occupations, while social participation and education showed mixed results. Visual perception was positively correlated with most elements but negatively associated with enjoyment (r=-0.428; P=0.002).
Conclusions: Preschool children with ASD demonstrate significant participation restrictions. Visual perception emerged as a critical determinant of participation, particularly in ADL and educational contexts. Early interventions targeting visual perception skills may enhance independence and functional engagement, though interventions should also address the enjoyment and emotional experience occupations to ensure holistic participation outcomes.
To the Editor,
I read with great interest the narrative review by Savel (2025) examining formal education in leader-ship and management for practicing clinicians, particularly those working in critical care settings. While the review clearly describes the educational opportunities available, several broader conceptual issues may merit further discussion.
Background: The Circassian community in Israel represents a unique, endogamous population residing in two villages in the northern region of Israel: Kfar Kama (209 meters above sea level [m.a.s.l.]) and Rihaniya (674 m.a.s.l.).
Objectives: This study sought to investigate whether the small difference in altitude between these two locations (465 m) affects red blood cell (RBC) and hemoglobin (Hb) parameters in the residents.
Methods: We examined the data from 2,517 blood samples collected from adult Israeli Circassians over 2.5 years (January 2020–June 2022). To ensure independent observations, analysis was limited to each participant’s most recent complete blood count (CBC). Subjects were stratified by sex, age, anemia status, and residential location.
Results: Our analysis revealed that a difference of about 465 meters in residential altitude significantly elevated Hb, RBC count, and hematocrit (HCT) levels in non-anemic male and female cohorts. This elevation was accompanied by a small but significant decrease in mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Furthermore, we found that the effect of altitude on most RBC characteristics differed in anemic individuals of both sexes, although their RBC count still increased.
Conclusions: Even minor differences in residential altitude can significantly influence Hb and RBC parameters. This observation appears only in non-anemic individuals, probably reflecting physiological altitude Hb adaptation mechanisms. While further research is needed to fully elucidate the underlying mechanisms, our findings provide new data on the physiological impact of altitude on human health, particularly at low altitudes.
Background: Chronic hypoxemia in patients with COPD is associated with increased morbidity and mortality. Although arterial partial pressure of oxygen (PaO2) is widely used, it does not adequately reflect systemic oxygen transport. Arterial oxygen content (CaO2) may provide a more comprehensive assessment.
Objective: This study aimed to evaluate whether or not CaO2 is a better predictor of mortality than PaO2 in patients with COPD.
Methods: This retrospective observational cohort study included 147 COPD patients aged ≥45 years. Patients were categorized according to CaO2 levels (low, normal, high). Mortality at 1, 3, and 5 years was analyzed. Statistical methods included ROC curves, Kaplan–Meier survival analysis, and Cox regression models.
Results: A total of 66 deaths (45.2%) occurred in the study cohort. Mortality was highest in the low CaO2 group. The CaO2 demonstrated better predictive performance than PaO2 (AUC 0.73 vs 0.53, respectively). Low CaO2 was associated with a 2.5-fold increased risk of mortality. Despite improvements in PaO2 after long-term oxygen therapy, CaO2 did not significantly change.
Conclusions: The CaO2 is a more informative marker of oxygen transport and mortality risk than PaO2 in COPD patients. It should be considered a complementary parameter in clinical assessment.
Background: The International Association for the Study of Pain (IASP) has defined three mechanisms for chronic pain: nociceptive, neuropathic, and nociplastic. Accurate differentiation between these mechanisms is essential for treatment selection but remains challenging due to symptom overlap and reliance on clinical judgment. Patient-reported questionnaires may support diagnosis, though their diagnostic accuracy relative to physician assessment has not been fully established.
Objectives: This study aimed to investigate the prevalence and overlap of chronic pain mechanisms in a tertiary pain clinic population and to compare physician-assigned diagnoses with results from patient-reported questionnaires.
Methods: This cross-sectional study recruited 89 adult patients with chronic pain from the Rambam Institute for Pain Medicine at Rambam Health Care Campus in Haifa, Israel. Each participant underwent a comprehensive physician evaluation based on the criteria of the International Classification of Diseases and Related Health Problems, 11th revision, and completed the Central Sensitization Inventory (CSI), PainDETECT, and 2016 American College of Rheumatology (ACR) Fibromyalgia Diagnostic Criteria surveys. Diagnostic agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using physician diagnosis as the reference standard.
Results: Physician diagnoses identified neuropathic pain in 51 patients (57.3%), nociceptive pain in 38 (42.7%), and nociplastic pain in 25 (28.1%), with substantial diagnostic overlap (32.6% with ≥2 mechanisms). The CSI demonstrated high sensitivity (92.0%) but low specificity (45.3%) for nociplastic pain. PainDETECT showed moderate accuracy for neuropathic pain (sensitivity 68.6%, specificity 52.6%) and higher specificity for nociceptive pain (86.3%). The 2016 ACR Fibromyalgia criteria provided a more balanced diagnostic profile (sensitivity 88.0%, specificity 68.8%).
Conclusions: Questionnaire-based measures are useful for screening chronic pain mechanisms but demonstrate variable accuracy when compared to physician diagnoses, particularly in the context of overlapping pain phenotypes. Refinement of diagnostic thresholds, combined assessment strategies, and updated questionnaires may improve differentiation of pain subtypes and enhance clinical decision-making.
Mifepristone (RU-486), the first clinically effective progesterone antagonist, was initially identified as having antiglucocorticoid activity. Although early interest focused on its role as a glucocorticoid receptor antagonist, recognition of its antiprogesterone effects led to studies of its role in pregnancy termination. This article reviews the steps leading to its use as an abortifacient, from its initial identification for this indication and draws on the author’s direct involvement in the field with reflections on his contribution to the early clinical development of mifepristone. These studies established the efficacy of mifepristone in pregnancy termination. Unfortunately, its wider therapeutic applications have received limited attention.
Background: Sleep disturbances, particularly insomnia, are increasingly recognized as behavioral determinants of type 2 diabetes (T2DM). However, their contribution to validated diabetes risk scores beyond traditional sociodemographic and lifestyle factors remains insufficiently explored.
Objective: To examine the association between insomnia severity, sociodemographic variables, lifestyle habits, and estimated T2DM risk using three validated non-invasive risk assessment scales.
Methods: A cross-sectional study was conducted among 84,898 Spanish workers aged 18–69 years undergoing occupational health evaluations (2021–2024). Sociodemographic and behavioral data were collected through standardized questionnaires, including adherence to the Mediterranean diet (MEDAS-14), physical activity (IPAQ-SF), and smoking status. Insomnia was assessed using the Insomnia Severity Index (ISI). Diabetes risk was estimated using three validated non-invasive risk-assessment tools: the Finnish Diabetes Risk Score, the QDScore/QDiabetes, and the Trinidad Risk Assessment Questionnaire for Type 2 Diabetes Mellitus. As these instruments were developed and validated in different populations, comparisons of absolute risk categories across scales should be interpreted with caution. Multivariable logistic regression models adjusted for age, sex, social class, smoking, diet, and physical activity were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Severe insomnia was associated with approximately 2.1–2.6-fold higher odds of high estimated diabetes risk across all three scales in the pooled analyses, with significant trends across categories of insomnia severity (all P for trend <0.001). This association persisted across sex and activity strata. Adding ISI modestly improved model discrimination (ΔAUC ≈ +0.015; P≤0.003) and reclassification (continuous net reclassification improvement [NRI], 6.5%–8.1%).
Conclusions: Insomnia severity was independently associated with higher estimated risk of T2DM beyond measured sociodemographic and lifestyle determinants. Incorporating sleep health—via brief tools such as the ISI—into diabetes risk assessment could enhance early prevention strategies in clinical and occupational settings.
There has been an international resurgence in antisemitism in healthcare education and practice since October 7, 2023, prominently affecting the United States (US), United Kingdom (UK), Canada, and Australia. In the US, federal investigations by the US Department of Justice, and the Congressional Subcommittee on Education and the Workforce were initiated into antisemitic harassment and hostile learning environments in medical schools. Healthcare organizations in the UK also came under investigation, and the US Congress opened an investigation into alleged antisemitism within a national psychological association. Quantitative and descriptive studies of the prevalence and characteristics of this phenomenon within medical, psychology, and social work education and practice are scant. We conducted a narrative review given the under-recognized nature of antisemitism in this context and the limited literature on this international, inter-professional issue. We searched PubMed using a search string to capture peer-reviewed descriptive and quantitative studies of antisemitism in medicine, psychology, social work, nursing, pharmacy, physician assistant, dentistry, physical, and occupational therapy education and practice. We searched 17 ProQuest databases for media and other online or written materials and conducted a hand search for additional relevant publications. We identified studies showing a high prevalence of antisemitism particularly in medical education, psychology, and social work, where >50% of subjects experienced antisemitism since October 7, 2023. Fewer than 2% of institutions had incorporated education about antisemitism into anti-discrimination training. Our review revealed that antisemitism as a form of bigotry, hatred, and discrimination has been inadequately addressed, now taking on urgency given its reach including an anti-Israel bias “mutation” and the need to assure unbiased healthcare. Actionable recommendations to counter antisemitism in healthcare derived from the publications to date are presented.
Extremism, displacement, and ongoing conflict have affected Palestinians and Israelis personally and collectively, endangering their health and lives. A theory circulating in public health publications posits that settler colonial determinants of health (SCDH) are the root cause of health inequities in the region. We argue that this assertion is misleading, ignores key facts, and exacerbates polarization, thus harming health. Public health is an evidence-based, scientific discipline based on hypotheses, research, and analysis. Throughout the scientific process, careful assessments of bias are essential. Knowledge is subsequently translated into policy and action. The SCDH theory rejects this approach as tainted by “colonialism.” We also argue that the SCDH concept, as applied to health disparities in Israel-Palestine, is an ideologically driven theory in search of evidence. Rather than developing testable hypotheses, the promoters of SCDH use selective evidence to support its relevance to health in the region. The theory collapses when examined against relevant facts related to regional history and the health status of Israelis and Palestinians. It invokes one-sided racism as a driver of health inequities in a context-inappropriate manner, and ignores many upstream determinants including actions of the Palestinian leadership, and their role as drivers of health. It denigrates peace-building and collaboration which are key to future health and wellbeing in the region, and which have a proven record in improving health outcomes. We call on public health professionals to distance themselves from unfounded rhetoric that polarizes the communities, and undermines the discipline’s scientific integrity, while contributing nothing to promote health in the region.
Background: Avoiding rectal thermometry is recommended in patients with neutropenic fever. Permeability of the anal mucosa may result in a higher risk of bacteremia in these patients. Still, this recommendation is based on only a few studies.
Methods: This retrospective study included all individuals admitted to our emergency department during 2014–2017 with afebrile (body temperature <38.3°C) neutropenia (neutrophil count <500 cells/microL) who were over the age of 18. Patients were stratified by the presence or absence of a rectal temperature measurement. The primary outcome was bacteremia during the first five days of index hospitalization; the secondary outcome was in-hospital mortality.
Results: The study included 40 patients with rectal temperature measurements and 407 patients whose temperatures were only measured orally. Among patients with oral temperature measurements, 10.6% had bacteremia, compared to 5.1% among patients who had rectal temperature measurements. Rectal temperature measurement was not associated with bacteremia, neither in non-matched (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.07–1.77) nor in matched cohort analyses (OR 0.37, 95% CI 0.04–3.29). In-hospital mortality was also similar between the groups.
Conclusions: Patients with neutropenia who had their temperature taken using a rectal thermometer did not experience a higher frequency of events of documented bacteremia or increased in-hospital mortality.
