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The purpose of the present study was to explore whether Computer-Based Cognitive Training (C-BCT) versus Paper-Pencil Cognitive Training (P-PCT) is more beneficial in improving cognitive and language deficits in Greek patients living with Alzheimer's disease (pwAD). Twenty pwAD were assigned to two groups: (a) the C-BCT group, receiving a computer-based cognitive training program using the RehaCom software, and (b) the P-PCT group, which received cognitive training using paper and pencil. The cognitive training programs lasted 15 weeks and were administered twice a week for approximately one hour per session. The analyses of each group's baseline versus endpoint performance demonstrated that the P-PCT group improved on delayed memory, verbal fluency, attention, processing speed, executive function, general cognitive ability, and activities of daily living. In contrast, the C-BCT group improved on memory (delayed and working), naming, and processing speed. Comparisons between the two groups (C-BCT vs. P-PCT) revealed that both methods had significant effects on patients' cognition, with the P-PCT method transferring the primary cognitive benefits to real-life activities. Our findings indicate that both methods are beneficial in attenuating cognitive and language deficits in pwAD. The need for large-scale neurobehavioral interventions to further clarify this issue, however, remains a priority. [ABSTRACT FROM AUTHOR]

Background: As the number of large-scale outbreaks continues to rise worldwide, clinical trials are increasingly engaging disease-affected peoples within the Minority World (nations with over 80% poverty rates). Yet global health research inadequately addresses potential ethical issues of including impoverished, disease-affected populations and their contextual vulnerabilities in medical research. Objective: This paper presents a mixed-method analysis from our 2022 semi-structured survey capturing the experiences of Liberian Ebola Virus Disease (EVD) survivors serving as study participants in the Partnership for Research on Ebola Virus in Liberia (PREVAIL) clinical trials. Methods: Firstly, we conducted an extensive literature review of the scholarship related to biomedical research and ethical standards protecting study participants to inform our survey method and design. Applying a theoretical framework on vulnerability, we then qualitatively explored the survey responses of 19 EVD survivors' perceptions and experiences taking part in PREVAIL, including their expectations, treatment, delivered benefits, and quality of care. We further quantitatively codified their statements for underlying themes of reported negative experiences against standard ethical regulations in biomedical research, conducting a statistical analysis to inform generalizability. Most of the 19 survivors reported facing extreme ongoing vulnerabilities related to their disease status, including physical impairments, psychosocial stress, and socio-economic inequity. Results: Initially, the survivors tended to experience a sense of hope and pride in volunteering for PREVAIL. One in five participants reported benefiting from PREVAIL's regular medical diagnoses. However, most of their survey responses indicated prevalent negative shared experiences, including continually being confused or misinformed of their study participant rights, roles, and benefits; being burdened by heavy participation transaction costs; and repeated incidents of poor treatment and discrimination by PREVAIL staff after initial recruitment. PREVAIL participant satisfaction ranking is negatively correlated with receiving insufficient financial compensation (r = −0.51), extensive time requirements for each medical visit (−0.40), and being poorly treated by clinical staff (−0.67). [ABSTRACT FROM AUTHOR]

From the moment the SARS-CoV-2 virus was identified in December 2019, the COVID-19 disease spread around the world, causing an increase in hospitalisations and deaths. From the beginning of the pandemic, scientists tried to determine the major cause that led to patient deaths. In this paper, the background to creating a research model was diagnostic problems related to early assessment of the degree of damage to the lungs in patients with COVID-19. The study group comprised patients hospitalised in one of the temporary COVID hospitals. Patients admitted to the hospital had confirmed infection with SARS-CoV-2. At the moment of admittance, arterial blood was taken and the relevant parameters noted. The results of physical examinations, the use of oxygen therapy and later test results were compared with the condition of the patients in later computed tomography images and descriptions. The point of reference for determining the severity of the patient's condition in the computer imagery was set for a mild condition as consisting of a percentage of total lung parenchyma surface area affected no greater than 30%, an average condition of between 30% and 70%, and a severe condition as greater than 70% of the lung parenchyma surface area affected. Patients in a mild clinical condition most frequently had mild lung damage on the CT image, similarly to patients in an average clinical condition. Patients in a serious clinical condition most often had average levels of damage on the CT image. On the basis of the collected data, it can be said that at the moment of admittance, BNP, PE and HCO3− levels, selected due to the form of lung damage, on computed tomography differed from one another in a statistically significant manner (p < 0.05). Patients can qualify for an appropriate group according to the severity of COVID-19 on the basis of a physical examination and applied oxygen therapy. Patients can qualify for an appropriate group according to the severity of COVID-19 on the basis of BNP, HCO3 and BE parameters obtained from arterial blood. [ABSTRACT FROM AUTHOR]

The Philippines is a source of labor for many countries. Roughly 10 million overseas Filipinos are working and living outside of the Philippines. This paper examines the association between sociodemographic characteristics (sex, age, educational level, and income) and self-rated physical and mental health, access to healthcare, and health habits among immigrant Filipinos living in Santa Cruz de Tenerife, Spain. Through convenience sampling, Filipino migrants (n = 103) aged 18 years and above participated in the online survey between October 2022 and March 2023. The data were analyzed using descriptive statistical analysis and chi-square. Almost all respondents self-rated their health as excellent and very good. Female respondents are more affected by mental health. Most are enrolled in the Universal Health System of Spain (public insurance). There is more utilization of private health insurance among respondents aged 60 years and above and high-wage earners. Cigarette smoking and alcohol drinking are associated with males. More than half of the respondents perform weekly exercise occasionally or never. These findings suggest a potential need for targeted interventions with an emphasis on the practice of preventive health and the promotion of healthy lifestyles, especially among financially disadvantaged migrants with lesser health access. [ABSTRACT FROM AUTHOR]

To actively respond to the challenges posed by population aging, people are paying more and more attention to healthy behavioral lifestyles, and the impact of social capital as an informal system on health behaviors cannot be ignored. This paper explores the impact of social capital on health behaviors of middle-aged and older adults based on 2020 CHARLS data. Using binary logistic regression models, we discussed the association between social capital and five health behaviors. The results suggest that structural social capital significantly increases physical activity and physical examination behaviors among middle-aged and older adults but also decreases the probability of abstinence behaviors. Cognitive social capital increases the probability that middle-aged and older adults will have a reasonable amount of sleep and physical activity. However, it also decreases the probability that smoking cessation behaviors will occur. Further attention needs to be paid to the role of social capital, the creation of a harmonious social environment and the enhancement of social trust, the strengthening of communities and grass-roots social organizations, and the provision of more platforms for the participation of middle-aged and older adults in social activities, to improve the quality of the healthy lives of middle-aged and older adults and, in turn, to promote the establishment of healthy behaviors. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cause of mortality due to cancer for women both in Lithuania and worldwide. The chances of survival after diagnosis differ significantly depending on the stage of disease at the time of diagnosis and other factors. One way to estimate survival is to construct a Kaplan–Meier estimate for each factor value separately. However, in cases when it is impossible to observe a large number of patients (for example, in the case of countries with lower numbers of inhabitants), dividing the data into subsets, say, by stage at diagnosis, may lead to results where some subsets contain too few data, thus causing the results of a Kaplan–Meier (or any other) method to become statistically incredible. The problem may become even more acute if researchers want to use more risk factors, such as stage at diagnosis, sex, place of living, treatment method, etc. Alternatively, Cox models can be used to analyse survival data with covariates, and they do not require the data to be divided into subsets according to chosen risks factors (hazards). We estimate the chances of survival for up to 5 years after a breast cancer diagnosis for Lithuanian females during the period of 1995–2016. Firstly, we construct Kaplan-Meier estimates for each stage separately; then, we apply a (stratified) Cox model using stage, circumstance of diagnosis, and year of diagnosis as (potential) hazards. Some directions of further research are provided in the last section of the paper. [ABSTRACT FROM AUTHOR]

Hearing loss that arises from various causes at different stages of life has a direct impact on individuals' physical and mental well-being. This paper aimed to evaluate the employment, workplace adaptation, productivity, and professional success of individuals who have hearing loss and whose hearing loss is corrected with a cochlear implant. In this cross-sectional study, data were collected between November 2022 and March 2023 with the participation of individuals with cochlear implants living in several settlements in all regions of Türkiye. A total of 142 participants with severe hearing loss who were corrected with a cochlear implant were included in this study. The survey method was used to collect data for the study. The questionnaire consisted of 32 questions and was distributed to the participants online. In the first part of the questionnaire (questions 1–10), the general characteristics of implant patients were investigated. In the second part (questions 11–32), the positive or negative effects of implantation on the work lives of the participants were evaluated. Almost half of the research group (49.3%, n = 70) consisted of women, and the mean age of the participants was determined to be 35.8 ± 14.8 years. There was no significant difference between gender, educational status, implanted side, working time, working style (physical, desk), and factors affecting work life (p > 0.05). Professional satisfaction and success at work increased significantly more in those with acquired hearing loss (p = 0.010). Post-implantation workplace compliance, success, and productivity were found to be higher in those with acquired hearing loss (p = 0.013). Hearing loss had a significantly less negative impact on work performance in those implanted in childhood than in those implanted in adulthood (p = 0.043). It was observed that hearing loss had a greater negative impact on the work life of married people (p = 0.006). Cochlear implantation greatly enhances workplace satisfaction, increases self-confidence, and has a positive impact on the future of profoundly deaf individuals. [ABSTRACT FROM AUTHOR]

Our paper analyzes lessons for medical education and health education stemming from the experience gained in the course of the COVID-19 pandemic. Moreover, it tackles the issue of the social health and psychological wellbeing of medical students involved in online education during the COVID-19 pandemic. The paper systematizes up-to-date data on how medical schools and universities have adapted to the conditions of the COVID-19 pandemic and implemented novel effective solutions for the learning process, such as transitioning from traditional in-person classes to online learning, incorporating virtual simulations and telemedicine experiences for clinical training, and collaborating with health authorities to provide support in testing and contact tracing efforts. The paper contains an analysis of various aspects of medical education, such as the changes in practical classes, the impact of the pandemic on the formation of communication skills, methods for assessing students' knowledge and skills, and many others. It also considers case studies related to the implementation of educational programs, methodologies, and novel digital technologies in a pandemic. Additionally, the paper features an empirical study that is based on the results of our own survey that was carried out with the help of a snowball convenient sampling that involved 710 medical students between 19 and 25 years of age (56% females and 44% males) from 4 Russian regions (Moscow, Krasnodar, Kazan, and Saint Petersburg). We applied the correlation between stress scores, anxiety scores, factors of stress, and strategies for coping with stress and various economic and demographic variables (age, environment, and gender) that were analyzed using the chi-square test. Our results demonstrate that over 85% of the students in our sample yielded an above-average vulnerability to stress due to the COVID-19 restrictions. At the same time, around 61% of the students experienced severe anxiety during online education in the COVID-19 pandemic. The important factors leading to stress and anxiety were the fear of getting infected and social distancing, and the best strategy to deal with stress and increase wellbeing was self-control. Through a comprehensive review of the literature and empirical estimations, our paper identifies key areas of improvement, including curriculum adaptation, technology integration, faculty development, student support, and interprofessional collaboration. The proposed recommendations aim at strengthening medical education systems and preparing healthcare professionals to effectively navigate future pandemics. [ABSTRACT FROM AUTHOR]

This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project's implementation, the completeness of documentation was still low. Our findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform. [ABSTRACT FROM AUTHOR]

(1) Background: The increasing older population and demographic shifts highlight the need to understand the digital profiles of older adults, a pivotal factor in developing innovative technologies like the e-VITA virtual coach. This personalized coach provides recommendations for sustainable well-being in a smart home environment. (2) Methods: This study focuses on analyzing the characteristics of older individuals categorized as Internet users (onliners) and non-users (offliners). European Social Survey data from 2021 were utilized for European analysis, determining Internet usage based on frequency. Offliners are defined as users who never use the Internet, and onliners as those who use it, albeit with different frequencies. In Japan, data from the 9th International Comparative Survey on the Lives and Attitudes of the Elderly were employed, based on the responses of 1367 subjects, which defined onliners as individuals using communication devices and offliners as those not utilizing fax machines, cell phones, or the Internet. (3) Results: This paper presents a primary analysis of older end-user context and perspectives, outlining effective strategies for the diffusion of an active and healthy aging coaching system in the market and society. (4) Conclusions: the study emphasizes the importance of analyzing digital behavior in any user-centered design approach to ensure the system's acceptance after deployment. [ABSTRACT FROM AUTHOR]

WWDISA is an optional module of the DISA Laboratory Information system (LIS) that offers a web portal that allows access to test results over the internet for patient clinical management. This study aims to assess the applicability of using the WWDISA web application, and the lessons learned from its implementation in six health facilities in Mabote district, Inhambane province. Data from 2463 and 665 samples for HIV-viral load (HIVVL) tests, extracted from paper-based and WWDISA systems, respectively, were included, from January to December 2020. Data were simultaneously collected on a quarterly basis from both systems to allow comparison. The WWDISA turnaround time (TAT) from sample collection to results becoming available was found to be 10 (IQR: 8–12) days and significantly lower than the health unit manual logbook (p value < 0.001). Regarding the system efficiency, it was found that among 1978 search results, only 642 (32.5%) were found, and the main challenges according to the users were lack of connectivity (77%) and the website going down (62%). The WWDISA module has been shown to be effective in reducing the TAT, although a stable internet connection and accurate data entry are essential to make the system functional. [ABSTRACT FROM AUTHOR]

This paper focuses on research in expert elicitation as a part of the early stage health technology assessment (eHTA). The current state of affairs is analysed and two elicitation approaches are compared—the four fixed intervals method and the histogram method—as applied to an example of early assessment of clinical effectiveness of artificial thymus for patients with DiGeorge syndrome. A survey was carried out consisting of four questions concerning the topic, with the aim to apply the elicitation methods. Eight experts answered the questions using both elicitation methods. Based on their answers, the methods were compared visually and by means of statistical tests. In order to compare the perception of the two elicitation methods, the survey also included questions regarding the experts' subjective preferences. The results of the comparison of the two elicitation approaches did not clearly confirm which method was more beneficial and better; however, it was possible to indicate which of the two methods is better suited for different types of experts. Before selecting an elicitation method as a part of eHTA, it is advisable to effectively consider the technology to be assessed and the type of experts to be invited to share their opinion. [ABSTRACT FROM AUTHOR]

Background: The transition from hospital to community settings for most mental health service users is often hindered by challenges that affect community adjustment and continuity of care. The first few weeks and days after discharge from mental health inpatient units represent a critical phase for many service users. This paper aims to evaluate the changes in the resilience, personal recovery, and quality of life status of individuals with mental health challenges recently discharged from acute mental health care into the community. Methods: Data for this study were collected as part of a pragmatic stepped-wedge cluster-randomized, longitudinal approach in Alberta. A paired sample t-test and Chi-squared/Fisher test were deployed to assess changes from baseline to six weeks in the recovery assessment scale (RAS), brief resilience scale (BRS), and EuroQol-5d (EQ-5D), using an online questionnaire. Results: A total of 306 service users were recruited and 88 completed both baseline and six weeks, giving a response rate of 28.8%. There was no statistically significant change in the level of resilience, recovery and quality of life as measured with the brief resilience scale, recovery assessment scale and EQ-5D from baseline to six weeks (p > 0.05). Conclusions: The study showed that there was neither an improvement nor deterioration in resilience, recovery, or quality of life status of service users six weeks post-discharge from inpatient mental health care. The lack of further progress calls into question whether the support available in the community when patient's leave inpatient care is adequate to promote full recovery. The results justify investigations into the effectiveness of innovative and cost-effective programs such as peer and text-based supportive interventions for service users discharged from inpatient psychiatric care. [ABSTRACT FROM AUTHOR]

Colonoscopy is an essential method for diagnosing and treating colorectal cancer, relying on effective bowel preparation to thoroughly examine the large intestinal mucosa. Traditional education involves printed instructions and verbal explanations but does not guarantee clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. A mobile medical model using Android devices for bowel preparation education was tested in a single-blind, randomized trial. This trial enrolled outpatients undergoing colonoscopy at the Endoscopy Center for Diagnostic and Treatment between 27 October 2021 and 31 December 2022. This study introduced the ColonClean app alongside traditional methods. After examination, endoscopists rated the preparation quality using the Aronchick scale. A data analysis was conducted using SPSS 25.0 to determine if there was a significant improvement in bowel preparation quality between the control group (traditional method) and the experimental group (traditional method plus the ColonClean app). Forty patients were recruited in each group. In the experimental group, all ratings were "fair", with 75% receiving an "excellent" or "good" rating, showing statistical significance (p = 0.016). The ColonClean app improves bowel preparation quality more effectively than traditional care instructions. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is a serious global health issue. Limited studies previously analyzed health literacy components in patients undergoing smoking cessation interventions. This study focuses on individuals enrolled in smoking cessation services and investigates the distribution of health literacy in three domains (health care, disease prevention, and health promotion) and four abilities (access, understand, appraise, and apply health information). The study also explores the correlation between background factors (age, BMI, etc.) and health literacy, as well as the differences in health literacy levels among different background variables (gender, etc.). Methods: 228 individuals completed the health literacy questionnaire. Descriptive statistical analysis, Pearson Correlation, and a Chi-Squared Test were employed to investigate the various health literacy levels and background variables. Results: 68% had excellent or sufficient health literacy. A total of 32% were considered problematic or to have inadequate health literacy. Of the three domains of health literacy, participants performed better in the healthcare domain. More than one-third were problematic in accessing and appraising information. Conclusions: this paper, being the pilot study in providing an analysis of health literacy components in individuals undergoing smoking cessation, could serve as a useful reference for devising interventions for different population groups in trying to maximize successful cessation rates. [ABSTRACT FROM AUTHOR]

(1) Background: This paper aims to assess the existence of significant differences between two dietary regimes (omnivorous vs. semi-vegetarian) with reference to some oxidative stress markers (SOD, GPx, TRxR, GR, AGEs, and AOPPs) using non-parametric combination methodology based on a permutation test. (2) Methods: At the endocrinology unit of Messina University Hospital, two hundred subjects were asked to fill out a questionnaire about their dietary habits. None were under any pharmacological treatment. Using the NPC test, all comparisons were performed stratifying patients according to gender, age (≤40 or >40 years), BMI (normal weight vs. overweight), physical activity (sedentary vs. active lifestyle), TSH, FT4 levels in quartiles, and diagnosis of Hashimoto's thyroiditis. We evaluated differences in oxidative stress parameters in relation to two examined dietary regimes (omnivorous vs. semi-vegetarian). (3) Results: The antioxidant parameters GPx and TRxR were significantly lower in subjects with an omnivorous diet than in semi-vegetarians, particularly in females, both age groups, subjects with normal weight, those not affected by Hashimoto's thyroiditis, and both the sedentary and active lifestyle groups. Finally, the AGE and AOPP markers were significantly lower in semi-vegetarians. (4) Conclusion: Thanks to the NPC methodology, we can state that dietary patterns exert a significant influence on some oxidative stress parameters. [ABSTRACT FROM AUTHOR]

Since the onset of the coronavirus disease, COVID-19 pandemic, concern arose for those who might be at higher risk of a worse COVID-19 prognosis, such as those with cystic fibrosis (CF). In this context, we evaluated the features of hospitalized patients with CF due to severe acute respiratory infection (SARI) in Brazil and we also performed a systematic review including all the studies published from the beginning of the first case of COVID-19 (17 November 2019) to the date of this search (23 May 2022) which included, concomitantly, patients with CF and COVID-19 in the worldwide population. In our Brazilian data, we evaluated the period from December 2019 to March 2022, and we included 33 demographical and clinical patients' features. We classified the patients into groups: (G1) SARI due to another viral infection than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (23; 5.4%), (G2) SARI due to an unknown etiological agent (286; 67.1%), and (G3) SARI due to SARS-CoV-2 infection (117; 27.5%). The individuals in G3 tended to be older, especially over 50 years old, and presented a higher prevalence of dyspnea, peripheral capillary oxygen saturation (SpO2) <95%, and cardiopathy. The highest prevalence for intensive care unit (ICU) treatment (52; 44.4%) and invasive mechanical ventilation (29; 24.8%) was for patients in G3. Almost half of the patients in G3 died (51; 43.6%); in contrast, none in G1 died. However, we observed 43 (15.0%) deaths in G2. In addition, 12 (4.2%) and one (0.9%) death not associated with SARI occurred, respectively, in the G2 and G3. The patients who died due to SARS-CoV-2 infection had a higher frequency of SpO2 <95% (46; 90.2%), ICU treatment (34; 66.7%), and invasive mechanical ventilation (27; 52.9%) when compared to those who recovered. The systematic review comprised a total of 31 papers published as observational studies. These studies comprised 661,386 patients in total, including children, adults, and elderly age groups. However, only 19,150 (2.9%) patients were diagnosed with CF and, from these patients, 2523 (0.4%) were diagnosed with both CF and COVID-19. It was observed that the most common outcome was the need for hospitalization (n = 322 patients with CF), and the need for oxygen support (n = 139 patients with CF). One hundred patients with CF needed intensive care units, fifty patients needed non-invasive mechanical ventilation support, and only three patients were described as receiving invasive mechanical ventilation support. Deaths were described in 38 patients with CF. Importantly, lung-transplanted patients with CF represented an increased risk of death in one publication; in accordance, another study described that lung transplantation and moderate to severe lung disease were independent risk factors for severe outcomes after SARS-CoV-2 infection. In contrast with the literature, in conclusion, Brazilian patients in G3 presented a severe phenotype, even though most of the other studies did not observe worse outcomes in patients with CF and COVID-19. [ABSTRACT FROM AUTHOR]

(1) Background: This paper aims to assess temporal trends (2016–2020) in incidence, patient's characteristics, complications, length of hospital stay (LOHS) and in-hospital mortality (IHM) among patients with and without idiopathic pulmonary fibrosis (IPF) undergoing lung transplantation (LTx). We also analyse the effect of the COVID-19 pandemic on LTx in these populations. (2) Methods: A retrospective, population-based observational study was conducted using the Spanish National Hospital Discharge Database. Multivariable adjustment was conducted with logistic regression to analyse the IHM. (3) Results: We identified 1777 admissions for LTx during the study period, of which 573 (32.2%) were performed in patients with IPF. The number of hospital admissions for LTx rose from 2016 to 2020, both in patients with and without IPF, but a marked reduction was observed from year 2019 to year 2020. Over time, the proportion of single LTx decreased and bilateral LTx increased significantly in both groups. The incidence of LTx complications increased significantly over time along with the increase in the incidence of IPF. No significant differences in the incidence of complications or in the IHM between patients with and without IPF were found. Suffering any complication of the LTx and pulmonary hypertension were conditions positively associated with IHM in patients with and without IPF. The IHM remained stable from 2016 to 2020 in both study populations and was not affected by the COVID pandemic. (4) Conclusions: Patients with IPF account for almost a third of all lung transplants. The number of LTx increased over time in patients with and without IPF, but a marked reduction was observed from 2019 to 2020. Although the proportion of LTx complications increased significantly over time in both groups, the IHM did not change. IPF was not associated with increased complications or IHM after LTx. [ABSTRACT FROM AUTHOR]

Background: This paper examined the gap between obesity and its diagnosis for cohorts of patients with overweight, obesity, and morbid obesity in the Veterans Administration (VA) population. Using the risk adjustment models, it also identified factors associated with the underdiagnosis of obesity. Methods: Analysis was performed on a VA data set. We identified diagnosed patients and undiagnosed patients (identified through BMI but not diagnosed using ICD-10 codes). The groups' demographics were compared using nonparametric chi-square tests. We used logistic regression analysis to predict the likelihood of the omission of diagnosis. Results: Of the 2,900,067 veterans with excess weight, 46% were overweight, 46% had obesity, and 8% of them had morbid obesity. The overweight patients were the most underdiagnosed (96%), followed by the obese (75%) and morbidly obese cohorts (69%). Older, male, and White patients were more likely to be undiagnosed as overweight and obese; younger males were more likely to be undiagnosed as morbidly obese. (p < 0.05) Comorbidities significantly contributed to diagnosis. Conclusions: The underdiagnosis of obesity continues to be a significant problem despite its prevalence. Diagnosing obesity accurately is necessary to provide effective management and treatment. [ABSTRACT FROM AUTHOR]

Like other forms of domestic violence, child-to-parent violence (CPV) is a social and health-related problem. The identification of risk factors has preventive and therapeutic implications. This paper analyzes the risk profiles and gender differences of 206 CPV cases between 12 and 28 years of age (58% males) from clinical and judicial contexts in Spain, assessed using the Child to Parent Violence Risk (CPVR) Assessment tool. Two profiles were compared according to the extent of their violence: those using only CPV (specialist, 64.1%) and those also using other types of violence (generalist, 35.9%), as coded by professionals working with the cases. Generalist perpetrators had a significantly higher prevalence in terms of the bidirectionality of the violence (being victims at home), bullying victimization, empathy problems, anger management issues, attitudes justifying violence, antisocial behavior, failure of previous interventions, violence between parents, cohabitation problems other than CPV, problematic education style, and inversion of the hierarchy. Females were less likely to be generalists, and, in the case of female specialists, violence from parents and issues in the family context may have been among the main explanations for their violence. The results suggest differences between groups, which is consistent with previous research, but also the need for more accurate typological classification methods. [ABSTRACT FROM AUTHOR]

Understanding healthcare professionals' perceptions towards a computerised decision support system (CDSS) may provide a platform for the determinants of the successful adoption and implementation of CDSS. This cross-sectional study examined healthcare professionals' perceptions, barriers, and facilitators to adopting a CDSS for antibiotic prescribing in Jordanian hospitals. This study was conducted among healthcare professionals in Jordan's two tertiary and teaching hospitals over four weeks (June–July 2021). Data were collected in a paper-based format from senior and junior prescribers and non-prescribers (n = 254) who agreed to complete a questionnaire. The majority (n = 184, 72.4%) were aware that electronic prescribing and electronic health record systems could be used specifically to facilitate antibiotic use and prescribing. The essential facilitator made CDSS available in a portable format (n = 224, 88.2%). While insufficient training to use CDSS was the most significant barrier (n = 175, 68.9%). The female providers showed significantly lower awareness (p = 0.006), and the nurses showed significantly higher awareness (p = 0.041) about using electronic prescribing and electronic health record systems. This study examined healthcare professionals' perceptions of adopting CDSS in antimicrobial stewardship (AMS) and shed light on the perceived barriers and facilitators to adopting CDSS in AMS, reducing antibiotic resistance, and improving patient safety. Furthermore, results would provide a framework for other hospital settings concerned with implementing CDSS in AMS and inform policy decision-makers to react by implementing the CDSS system in Jordan and globally. Future studies should concentrate on establishing policies and guidelines and a framework to examine the adoption of the CDSS for AMS. [ABSTRACT FROM AUTHOR]

This paper presents the laparogastroscopy procedure, a mini-invasive, palliative method as an alternative to gastrostomy to be recommended by gastroenterologists. Laparogastroscopic stenting with endoluminal transtumoral drilling solves the problem of oral nutrition in patients with unresectable esophageal cancer, avoiding percutaneous feeding. The results of this technique are presented in a retrospective analysis of a study group of 63 patients with advanced esophageal carcinoma admitted between January 2015 and December 2020 at Department of General Surgery of Emergency County Hospital Sibiu, Romania, in terms of post-operative morbidity and mortality. The type of stents used were Pezzer prostheses (48.6%), silicone prostheses (31.9%), and self-expanding metal stents (6.9%). Eight patients (12.7%) had fistulas (at admission to the clinic), which were successfully sealed. Post-operative dysphagia was absent in most patients and minimal in 16.6% of patients, so all patients could initiate oral feeding, improving their nutritional status. The average length of hospitalization for all patients was 9.22 ± 5.05 days. The most frequent local complications were restenosis (9.5%), stent displacement (7.9%), and bleeding (4.8%). The mean survival time was 10.75 ± 15.72 months. Laparogastroscopic stenting could be a valuable alternative in palliative esophageal cancer surgery, improving the quality of life and nutritional status in patients unsuitable for endoscopic stenting. [ABSTRACT FROM AUTHOR]

Background: Stroke remains a major leading cause of morbidity and death globally. For ischemic stroke, the most frequent type of stroke, there are numerous risk models and risk assessments offered. Further research into potential risk factors or triggers is being sought to improve stroke risk models. Schizophrenia, bipolar disorder, and alcohol use disorder are all common causes of serious mental illnesses in the general population. Due to the tangled relationship between stroke and many chronic illnesses, lifestyle factors, and diet that may be present in a patient with a mental disease, the relationship between mental diseases and stroke requires further validation. Consequently, the purpose of this study is to assess the potential influence of bipolar disorder, schizophrenia, and alcohol use disorder on stroke patients as compared to non-stroke participants, after controlling for demographic, physical, and medical conditions. We aimed, as a secondary objective, to evaluate the impact of these pre-existing disorders on stroke severity levels. Methods: This research is a case-control survey study involving 113 Lebanese patients with a clinical diagnosis of ischemic stroke and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from several hospitals in Lebanon (April 2020–April 2021). Based on the participant's consent, data was collected by filling out an anonymous paper-based questionnaire. Results: All of the odds ratios (ORs) generated by our regression model were greater than 1, indicating that the factors studied were associated with an increased risk of ischemic stroke. As such having schizophrenia (adjusted OR [aOR]: 6.162, 95% confidence interval [CI]: 1.136–33.423), bipolar disorder (aOR: 4.653, 95% CI: 1.214–17.834), alcohol use disorder (aOR: 3.918, 95% CI: 1.584–9.689), atrial fibrillation (aOR: 2.415, 95% CI: 1.235–4.721), diabetes (aOR: 1.865, 95% CI: 1.117–3.115), heart diseases (aOR: 9.890, 95% CI: 5.099–19.184), and asthma-COPD (aOR: 1.971, 95% CI: 1.190–3.263) were all involved with a high risk of developing an ischemic stroke. Moreover, obesity (aOR: 1.732, 95% CI: 1.049–2.861) and vigorous physical activity (aOR: 4.614, 95% CI: 2.669–7.978) were also linked to an increased risk of stroke. Moreover, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke alcohol use disorder (aOR: 1.719, 95% CI: 1.385–2.133), bipolar disorder (aOR: 1.656, 95% CI: 1.281–2.141), and schizophrenia (aOR: 6.884, 95% CI: 3.294–11.492) compared to people who had never had a stroke. Conclusion: The findings in our study suggest that individuals with schizophrenia, bipolar disorder, and alcohol use disorder may be at a higher risk for ischemic stroke and exhibit more severe symptoms. We believe that the first step toward creating beneficial preventative and treatment interventions is determining individuals with schizophrenia, bipolar disorder, or alcohol use disorder, assessing their risk of ischemic stroke, developing more integrated treatments, and closely monitoring the long-term outcome in the event of an ischemic stroke. [ABSTRACT FROM AUTHOR]

This paper describes a descriptive cross-sectional study that was conducted to identify and compare the factors affecting health-related quality of life (HRQoL) according to the type of work. The method involved a secondary analysis of 4131 workers who participated in the first year of the 8th Korea National Health and Nutrition Examination Survey (2019). In this study, a complex sample plan file was created and then weighted and analyzed. For the analyses, frequency, χ2-test, t-test, and linear regression analyses were used for complex sample analysis. Factors that significantly affected the HRQoL of daytime workers were educational background, living with a spouse, regular work, depression for two consecutive weeks, and suicidal thoughts. The explanatory power was 18.9% (p < 0.001). The factor that significantly affected the HRQoL of shift workers was whether they took dietary supplements for 2 weeks or more during the past year, and the explanatory power was 17.6% (p = 0.007). This study confirmed that the factors affecting HRQoL differ according to the type of work. Based on the results of this study, when developing a program to improve the HRQoL of workers, it is necessary to establish a differentiated strategy according to the type of work. [ABSTRACT FROM AUTHOR]

Background: Mandibular third molar (M3M) removal and the management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. Pain represents a great symptom for patients affected by pericoronitis and it is the most common indication for third molar removal. The aim of the present article is to search for patterns of pre-operative pain in patients before undergoing third molar surgery and to test for a relation between some patterns of symptoms, such as pain intensity, site of symptomatic tooth, and referred area of pain. Methods: This retrospective observational study enrolled a total of 86 patients, aged (mean ± SD) 34.54 ± 13.62 years (range 17–78 years), scheduled for outpatient third molar extraction at the Oral Surgery School, Department of Medical Biotechnologies, Policlinico "Le Scotte", University of Siena. Pericoronitis and pain were the symptoms of the patients and the indication of extraction. Inclusion criteria were the presence of partially impacted third molars, confirmed with a preoperative panoramic radiograph, and preoperative pain. Exclusion criteria were known neurological disease (such as previous trigeminal or facial nerve injuries), impaired communicative or cognitive disease, diagnosed diabetes mellitus, and oral surgical intervention within 30 days before data collection. Patients were visited and asked to answer a morphometric analytic questionnaire about their perception of pain referred to the third molar. Analyses were performed on statistical evaluation on age, age ranges, patient gender, prior third molar extraction, site of pericoronitis, pain score (1–10), and pain area. Two-tailed p values of less than 0.05 were considered significant if not otherwise specified. Results: No correlations were found between age, gender, previous extraction, tooth site (maxillar on mandible), pain score, and pain area. Patterns of third molar pericoronitis pain among 86 patients were reported. A significant correlation was found between pain score and pain area (p = 0.0111, rs = 0.3131). Conclusions: Pain intensity has indeed some kind of responsibility in determining the orofacial distribution of pain. The pain area referral patterns of the present article could be considered as a pain model resulting from the pericoronitis of maxillar and mandibular third molars. [ABSTRACT FROM AUTHOR]

Background/objectives: Sarcopenia, characterized by the progressive loss of muscle mass and strength, poses significant risks to physical health, leading to a reduced quality of life (QoL), increased disability, and higher mortality rates among older adults. Early detection and intervention are crucial to prevent the cascading effects of sarcopenia, including falls, fractures, and hospitalization. This study determined an optimal cut-off point of the SarQoL® score that can serve as an effective screening tool among community-dwelling Korean older adults. Methods: The study involved 451 South Korean older adults, assessing the correlation between SarQoL® scores and sarcopenia as defined by the Asian Working Group for Sarcopenia (AWGS) criteria. Participants completed the Korean version of the SarQoL questionnaire. Results: Findings revealed that individuals diagnosed with sarcopenia had significantly lower SarQoL® scores compared to non-sarcopenic participants, with a cut-off score of ≤58.5 providing good diagnostic accuracy (AUC = 0.768, sensitivity = 69.3%, specificity = 75.2%). Conclusions: These results underscore the questionnaire's reliability and validity in screening for sarcopenia-related QoL impairment and its potential utility as a clinical tool. Implementing the SarQoL® in routine assessments could improve clinical outcomes by enabling earlier and more precise identification of sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Developed countries report specific issues regarding the declining midwifery workforce, and their shortage could have serious consequences for women's sexual and reproductive health. The aim was to understand the perception of autonomy among midwives working in Spain, as well as factors related to their intention to leave the profession and their work environment. Method: A descriptive and cross-sectional study using an online questionnaire. Population: midwives working in Spain in any field (clinical, research, teaching, or management). Results: A sample of 1060 midwives was obtained. Of these, 53.7% (n = 569) feel autonomous in their work, 92.4% (n = 978) perceive that their profession frequently suffers from external interference, 46.6% (n = 494) have experienced sexist behaviors at work, and 53% (n = 561) have considered leaving the profession in the last year. Midwives with less than 10 years of experience (57.7%), those aged 31–45 years (59.8%), those with temporary contracts (38.3%), and those working in hospital care (71.9%) show a higher rate of considering leaving the profession (p < 0.001). Conclusions: Considering the current midwifery workforce crisis in Spain, it seems urgent to improve the working conditions of midwives to ensure the continuity and quality of women's sexual and reproductive healthcare. [ABSTRACT FROM AUTHOR]

Background/Objectives: Regular follow-up treatment is important for the management of diabetes and to reduce the risk of complications. In this study, we aimed to evaluate the proportion of adult diabetic patients who miss appointments, in addition to the potential correlation between personal characteristics, personality, and the context of family structure and characteristics and missed appointments by adult patients with type 2 diabetes. Methods: This study was a cross-sectional descriptive study. The data were gathered through self-administered questionnaires and the patient medical records of 106 individuals who received healthcare services at the Khon Kaen Province primary care unit. Data were gathered from 1 November 2023 to 28 December 2023. Adjusted odds ratios (aORs) and Chi-Square statistics were used to evaluate the relationships with multivariate analyses via multinomial logistic regression and the Kruskal–Wallis test. Results: The majority of patients in the sample, 39.62%, regularly missed appointments. There was a significant association between occasionally missed appointments and middle adulthood (p-value 0.013) and regular exercise (p-value 0.025). A moderate level of the agreeableness personality trait showed a significant association with missed appointments (p-value 0.042). Conclusions: It is important to have a comprehensive understanding of the patient's personality and family characteristics to effectively plan their healthcare and provide optimal support for diabetes treatment. [ABSTRACT FROM AUTHOR]

Background/Objectives: Emergency Medical Response Systems (EMRSs) play a vital role in delivering medical aid during natural and man-made disasters. This quantitative research delves into the analysis of risk and effectiveness within Serbia's Emergency Medical Services (EMS), with a special emphasis on how work organization, resource distribution, and preparedness for mass casualty events contribute to overall disaster preparedness. Methods: The study was conducted using a questionnaire consisting of 7 sections and a total of 88 variables, distributed to and collected from 172 healthcare institutions (Public Health Centers and Hospitals). Statistical methods, including Pearson's correlation, multivariate regression analysis, and chi-square tests, were rigorously applied to analyze and interpret the data. Results: The results from the multivariate regression analysis revealed that the organization of working hours (β = 0.035) and shift work (β = 0.042) were significant predictors of EMS organization, explaining 1.9% of the variance (R2 = 0.019). Furthermore, shift work (β = −0.045) and working hours (β = −0.037) accounted for 2.0% of the variance in the number of EMS points performed (R2 = 0.020). Also, the availability of ambulance vehicles (β = 0.075) and financial resources (β = 0.033) explained 4.1% of the variance in mass casualty preparedness (R2 = 0.041). When it comes to service area coverage, the regression results suggest that none of the predictors were statistically significant. Based on Pearson's correlation results, there is a statistically significant correlation between the EMS organization and several key variables such as the number of EMS doctors (p = 0.000), emergency medicine specialists (p = 0.000), etc. Moreover, the Chi-square test results reveal statistically significant correlations between EMS organization and how EMS activities are conducted (p = 0.001), the number of activity locations (p = 0.005), and the structure of working hours (p = 0.001). Conclusions: Additionally, the results underscore the necessity for increased financial support, standardized protocols, and enhanced intersectoral collaboration to strengthen Serbia's EMRS and improve overall disaster response effectiveness. Based on these findings, a clear roadmap is provided for policymakers, healthcare administrators, and EMS personnel to prioritize strategic interventions and build a robust emergency medical response system. [ABSTRACT FROM AUTHOR]

Background/Objectives: Digital health applications (DHAs) promise to improve disease self-management, but adherence remains suboptimal. We aimed to explore self-monitoring practices of rheumatic and musculoskeletal diseases (RMD) patients. A web-survey was conducted over 7 months including RMD patients to study their self-monitoring practices and the potential of DHAs. Methods: Health, sociodemographic, and technology adherence indicators were retrieved for comparison. Regression analyses and unsupervised profiling were performed to investigate multiple patient profiles. Results: From 228 responses gathered, most reported willingness to use DHAs to monitor their condition (78% agreement), although the majority rarely/never tracked symptoms (64%), often due to stable condition or no perceived value (62%). Of those tracking regularly, 52% used non-digital means. Participants with regular self-monitoring practices were more open to use a self-monitoring app (OR = 0.8 [0.6, 0.9]; p = 0.008) and be embedded in multidisciplinary care (OR = 1.4 [1.1, 1.6]; p < 0.001), but showed worse health status (g = 0.4; p = 0.006). Cluster analyses revealed three distinct groups of reasons for not tracking regularly ( χ 2 = 174.4; p < 0.001), two characterised by perceived low disease activity. Conclusions: Effective use of DHAs remains limited and non-digital means prevail in symptom monitoring. Findings suggest that better patient engagement strategies and passive monitoring should be adopted in early development stages of DHAs for better long-term disease self-care. [ABSTRACT FROM AUTHOR]

Background/Objectives: Fibromyalgia (FM) affects up to 5% of the global population and is a leading cause of significant social and economic consequences. Higher health literacy leads to better understanding of treatment plans, improved self-care, and adherence to recommendations, enhancing overall quality of life. This study aims to determine whether different aspects of the disease are influenced by patients' education level and literacy when applying the same therapy and to assess how patients' perceptions of therapy outcomes vary over time based on their educational level. Methods: This study involved 140 fibromyalgia (FM) patients diagnosed using the 2016 ACR criteria, with 128 completing the study. Participants attended three visits over 28 weeks and were stratified into four groups based on educational level: Group 1—secondary school or less; Group 2—high school graduates; Group 3—college graduates; Group 4—university graduates. Patients were assigned to groups (n = 32, 32, 30, and 34, respectively) after the initial evaluation (T0). The treatment was assessed (T1) and followed up three months later (T2) to evaluate changes in functional status and quality of life. All patients underwent the same rehabilitation program, cognitive therapy, and kinesiotherapy. Results: Significant differences in disease impact on the patient's life (FIQ total score) were observed between groups from the initial evaluation (p = 0.000). The overall FIQ score was notably affected by non-pharmacological therapy in patients with higher education. These differences continued to be significant even three months after the treatment ended (p = 0.000). Functional limitations were evident from the start (p = 0.000) and improved significantly post-treatment in patients with higher education (p = 0.000). However, subjective evaluations of disease impact (assessed by the first item of FIQ) did not consistently align with objective findings (hand grip strength). Functional limitations did not significantly differ in subjective evaluations (F1Q1) across educational levels (p = 0.045), and inverse correlations were noted between functional status and SF-12 well-being components. Conclusions: This study underscores that higher education enhances fibromyalgia management and functional outcomes, particularly when combined with non-pharmacological therapies. However, subjective perceptions may not always align with objective improvements, indicating that factors beyond education, such as personal and external influences, also impact disease management. Thus, improving health literacy through educational interventions could further benefit FM patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Oral health is a critical component of overall well-being. However, students with disabilities (SWDs) face unique challenges in maintaining oral hygiene and accessing dental care. This study aims to explore oral health behaviours, dental care utilisation, and barriers to accessing dental care among SWDs in Al-Ahsa, Saudi Arabia, from the perspectives of their parents. Methods: A descriptive cross-sectional study was conducted among parents of SWDs in Al-Ahsa, Saudi Arabia. Data were collected using a validated questionnaire covering oral health behaviours, dental care utilisation, and barriers to care. The sample size was determined based on the SWDs population in the region. Data were analysed using descriptive and analytical statistics, with significant associations identified at p < 0.05. Results: Findings revealed that 45.7% of SWDs brushed irregularly, with only 16.8% brushing twice a day or more. Dental flossing was reported by just 4.3% of SWDs. Emergency-based dental visits were common (51.9%), and 29.5% of SWDs had never visited a dentist. Significant associations were found between maternal education and tooth brushing frequency (p = 0.004) and between parental education and the frequency of dental visits (p = 0.035). The most reported barriers included fear of treatment (47.1%), difficulty finding willing dentists (45.5%), and long wait times for appointments (44.7%). Conclusions: The study emphasises the pressing need for targeted interventions to improve oral hygiene practices and enhance accessibility to dental services for SWDs. [ABSTRACT FROM AUTHOR]

Background: Lung cancer screening guidelines prioritize individuals with a history of smoking due to their higher risk of the disease. Methods: Our study examines the awareness and interest in low-dose computed tomography (LDCT) lung cancer screening among different smoking statuses using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) 6 (2022). We analyzed data from HINTS 6, including 3915 participants on smoking status, LDCT screening, and telehealth use. Participants were categorized as current smokers, former smokers, and non-smokers. Results: Current smokers had the highest likelihood of being recommended for LDCT screening (OR: 7.1, aOR: 10.4) compared with non-smokers. Former smokers also had increased odds of screening recommendations (OR: 3.1, aOR: 3.4) than non-smokers. Despite higher screening recommendations, current smokers exhibited significantly lower interest in cancer screening (interest rating score: 2.1) compared with non-smokers (interest rating score: 2.4) and former smokers (interest rating score: 2.5). Current smokers rated their telehealth care experiences more positively in terms of care quality compared with non-smokers. Conclusions: Our findings underscore a gap in cancer screening interest among current smokers despite their higher likelihood of being recommended for LDCT screening. The favorable perception of telehealth among current smokers provides an opportunity to enhance engagement and promote LDCT scan through telehealth care. [ABSTRACT FROM AUTHOR]

Background: Amnestic mild cognitive impairment (aMCI) is an important window of opportunity for early intervention and rehabilitation in dementia. The aim of this study was to investigate the feasibility and effect of delivering transcutaneous electrical acupuncture stimulation (TEAS) intervention to elders with aMCI. Methods: A total of 61 aMCI patients were randomly allocated into the intervention group (receiving a 12-week TEAS) and control group (receiving health education). The feasibility outcomes included recruitment rate, retention rate, adherence rate, and an exploration of patients' views and suggestions on the research. The effective outcomes included cognitive function, sleep quality, and life quality, which were measured by the Montreal cognitive assessment scale (MoCA), auditory verbal learning test—Huashan version (AVLT-H), Pittsburgh sleep quality index (PSQI), and quality of life short-term-12 (QoL SF-12). Results: The recruitment rate, retention rate, and adherence rate were 67.35%, 92.42%, and 85.29%, respectively. Most aspects of the research design and administration of the TEAS intervention were acceptable. The quantitative analysis suggests that compared with the control group, the scores of MoCA, AVLT-H, and SF-12 (mental component summary) were significantly better (p < 0.05); however, the differences were not statistically significant in PSQI and SF-12 (physical component summary) (p > 0.05). Conclusions: The findings demonstrated that the study was feasible. TEAS awas possible for enhancing cognitive function and mental health in people with aMCI. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced cancer often endure a heavy burden of symptoms, both in quantity and intensity. Complementary therapies offer potential relief in this challenging scenario. Increasing the number of randomized controlled trials provides a unique opportunity to generate rigorous data, which can be used to establish causal relationships and evaluate interventions; hence, nurses can strengthen evidence-based practices, leading to better patient outcomes and quality of care. Our study aimed to evaluate the impact of a 7-day pre-recorded music intervention on cancer symptoms and satisfaction in advanced-stage cancer patients receiving palliative care at home. Methods: This multicenter, double-blind, randomized, controlled clinical trial involved 80 Spanish cancer patients receiving palliative care at home, and was conducted from July 2020 to November 2021. The intervention group (n = 40) received self-selected pre-recorded music for 30 min daily over 7 days. The control group (n = 40) received pre-recorded basic health education sessions of equal duration and frequency. Symptoms and patient satisfaction were assessed before and after the intervention using the Edmonton Symptom Assessment System and the Client Satisfaction Questionnaire, respectively. Results: Comparing the intervention with the control group, significant improvements were observed in various symptoms: total symptom burden (p < 0.001), pain (p = 0.001), fatigue (p = 0.007), depression (p = 0.001), anxiety (p = 0.005), drowsiness (p = 0.006), appetite (p = 0.047), well-being (p ≤ 0.001), and sleep (p < 0.001); additionally, patient satisfaction was higher in the intervention group (p < 0.001). Conclusions: The 7-day pre-recorded music intervention reduced both physical and psychological symptoms in advanced-stage cancer patients receiving home-based palliative care, demonstrating significant alleviation of overall symptom burden and increased satisfaction with healthcare. [ABSTRACT FROM AUTHOR]

The aim of our study is to evaluate the relationship between sociodemographic and clinical characteristics of individuals with Colorectal Cancer (CRC), tumour-intrinsic characteristics and treatment received with health-related quality of life (HRQoL). Methods: Cross-sectional analysis of data from 805 survivors from the MCC study was conducted. HRQoL was assessed through a general and specific questionnaire, SF-12 and FCSI (Colorectal Symptom Index). Statistical analyses were performed with linear regression with adjustment for sociodemographic variables, stage at diagnosis and histological grade. Results: Participants had survived a median of 7.9 years from diagnosis (IQR 7.1–8.5 years). Age at diagnosis, sex and area showed a clear association with HRQoL in both physical and mental dimensions of the SF-12 questionnaire. A direct association between CRC recurrence was also found in the PCS-12 and MCS-12 dimensions and radical surgery in the PCS-12. Regarding the scores in FCSI questionnaire, statistically significant differences were observed by sex, age and area, with older women being the most impaired (p < 0.001). Conclusions: Age, sex and area was associated with lower scores of HRQoL among CRC survivors. Knowing the determinants related to HRQoL would allow us to lay the groundwork to develop strategies that help reduce morbidity and mortality, relapses and increase HRQoL. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated workplace violence (WPV) toward frontline health workers under comprehensive interventions to improve the occupational safety and health management system in a Chinese infectious disease hospital. Methods: The risk assessment of WPV using an international questionnaire was conducted in 2018 and 2021 to compare the perceived levels of exposure to WPV and intervention measures before and after the intensification of anti-violence measures in the hospital context. Additionally, qualitative data were collected in 2021 through semi-structured and unstructured interviews, providing complementary information about WPV toward frontline health workers (HWs). Results: After establishing the occupational safety and health management system (OSHMS), the total incidence rate of WPV decreased from 60.90% in 2018 to 34.44% in 2021. Psychological violence declined significantly from 60.90% in 2018 to 33.89% in 2021. The endorsement of precautionary measures increased significantly from 2018 to 2021, including patient screening recognition, patient protocol, shift or rota changes, etc. A thematic analysis of several subthemes shows that HWs had an in-depth understanding of WPV, recognizing its multifaceted consequences in the context of complex risk factors. Conclusions: This study demonstrates a significant decrease in WPV, psychological violence, verbal abuse, bullying/mobbing, and ethnic discrimination after implementing the comprehensive OSHMS. [ABSTRACT FROM AUTHOR]

Background: Effective prevention and treatment of pelvic floor dysfunction (PFD) necessitates the identification of lesions within the complex pelvic floor muscle (PFM) groups associated with various symptoms. Here, we developed a multi-region pelvic floor muscle functional diagnosis system (MPDS) based on an inflatable stretchable electrode array, which aids in accurately locating areas related to PFD. Methods: Clinical diagnostic experiments were conducted on 56 patients with postpartum stress urinary incontinence (PSUI) and 73 postpartum asymptomatic controls. MPDS collects pelvic floor electromyography from all participants. By assessing EMG parameters such as activation time differences (ATD) and using Jensen–Shannon (JS) divergence to verify, with the aim of locating target muscle groups with functional abnormalities. Results: Clinical test results showed that by observing the AT sequence of the PSUI group and the control group, muscle groups with functional abnormalities in the Pubococcygeus muscle (PC) and Puborectalis muscle (PR) regions could be preliminarily diagnosed. In the assessment of regional muscle contribution values based on JS divergence, it was verified that the contribution values of rapid contraction in the PC and PR regions of the PSUI group were relatively lower compared to those of the control group, which correlated with urinary control dysfunction. Conclusions: These experiments demonstrate that the MPDS helps in accurately locating target muscle groups with functional abnormalities, showcasing its potential in precise assessment of complex muscle groups such as PFM, which may improve diagnostic precision and reliability. [ABSTRACT FROM AUTHOR]

Background/Objectives: Operating room (OR) efficiency is a critical factor in healthcare delivery, influenced by various components including surgical duration, room turnover, staff availability, and equipment preparation. Optimizing surgical start times through systematic strategies such as computational algorithms can significantly enhance OR utilization and management. This study aimed to improve OR efficiency by effectively managing and optimizing surgical start times using a computational algorithm designed to allocate resources more efficiently. Methods: A comparative analysis was conducted over two six-month periods from January to June 2023 and January to June 2024, with an improvement phase implemented between July and December 2023. Results: These measures encompassed training surgical personnel, strengthening the medical team, revising work procedures and hospital regulations, and the integration of a computational algorithm to better schedule and manage surgical interventions. Following the implementation of these comprehensive measures, enhanced management of surgical start times was observed. A statistically significant increase in surgical interventions between 8 and 10 a.m. was noted for the entire OR, rising from 28.65% to 32.13%. While OR occupancy between 8 and 12 a.m. increased from 63.91% to 73.30%, this difference was not statistically significant. However, a notable improvement in average occupancy between 9 and 11 a.m. was observed, rising from 87.53% to 98.07%. Conclusions: The introduction of computational algorithms significantly improved operating room efficiency, particularly in managing surgical start times. Additionally, team coordination improved as a result of more structured scheduling processes. The results indicate that effective management of surgical start times, especially when enhanced by computational algorithms, can positively impact OR utilization, particularly within specific time blocks. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the psychological wellbeing, life satisfaction, and perceived social support in Chinese older immigrants living in Canada between the early (i.e., Wave 1: September–November 2020) and late (i.e., Wave 2: January–February 2023) stages of the COVID-19 pandemic. Additionally, it assessed perceived social support from family, friends, or others as predictors for psychological wellbeing and life satisfaction in this population. Methods: These questions were addressed with a cross-sectional survey design with two independent samples at Wave 1 (n = 171) and Wave 2 (n = 191), respectively. Results: The results revealed lower levels of psychological wellbeing, life satisfaction, and perceived social support in Wave 2 compared to Wave 1. The hierarchical regression models identified social support from friends (but not from family or others) as a significant predictor for psychological wellbeing and life satisfaction. Additionally, a higher level of income and being a male predicted better psychological wellbeing. A higher level of income and a lower level of education predicted greater life satisfaction. Conclusions: The findings suggest a deterioration in psychological wellbeing and life satisfaction from the early to late stages of the pandemic and highlight the protective effect of social support from friends among Chinese older immigrants. [ABSTRACT FROM AUTHOR]

Background: Communication skills (CSs) and evidence-based practice (EBP) are key foundations for offering personalized and quality nursing care. CS that results in open communication is fundamental for applying EBP. Objectives: The objective of the study was to assess the relationship between the acquisition of EBP competencies and learning CS after taking an EBP course in the nursing degree. Methods: Pre-test-post-test quasi-experimental study without a control group. The study population comprised fourth-year undergraduate nursing students. Before and after an EBP course, students completed a questionnaire on CS competence (HP-CSS) and EBP competence (EBP-COQ). The EBP course lasts for 15 weeks, with 150 h of work for the student. Out of these 150 h, 60 are conducted in person, while the remaining 90 h are for independent or group work, utilizing the flipped classroom methodology. Bivariate, correlational, pairwise Student's t-test, and linear regression multivariate analyses were performed. Results: The sample was composed of 153 students. After completing the EBP course, there was a statistically significant improvement in informative communication (p = 0.046) and assertiveness (p = 0.018). However, there were no observed changes in empathy, respect, and the total score of the CS competence. The results from the multivariate analysis showed that the dimensions of attitude towards EBP and EBP knowledge had a positive relation to three of the four dimensions of the CS and overall competence. Regarding the students' variables and characteristics, admission through special programs for athletes and older students (p < 0.001) and being female (p = 0.004) were positively statistically associated with empathy. Conclusions: EBP training positively affects the development of CS in nursing students, as shown by significant improvements in the total scores of the CS and the dimensions of informative communication and assertiveness after the intervention. This study demonstrates the initial applicability and usefulness of an EBP training program for the development of CS in nursing students. [ABSTRACT FROM AUTHOR]

Background: Nowadays, Thoracic Surgery is technologically advanced; therefore, it also focuses its attention on nursing care. The aim of the study is to evaluate the effect of the assessment of a dedicated team of nurses (DTN) in all onco-hematological patients undergoing VATS lobectomy for lung cancer on the outcome of the patient, preventing pressure injuries, reducing perioperative stress, duration of operations, complications, and hospital stay times. Methods: We performed a single-center observational retrospective study, including 31 DTN and 760 onco-hematological patients who underwent thoracic surgery between 30 October 2018 and 30 June 2023 at "Vanvitelli" University of Naples. Results: DTN ensures good nursing care before, during, and after surgery. Operative time was reduced by approximately 20 min, decreasing hospital infections in the DNT period and reducing intraoperative complications such as bleeding and hospital costs (p < 0.05). Conclusions: Thoracic surgery nurses require more specialized training to adapt to the development of sophisticated. [ABSTRACT FROM AUTHOR]

An analysis of patient satisfaction in the context of healthcare reflects the patient's perception of actual care through the prism of their expectations of ideal care. A study was conducted to investigate patient satisfaction with postoperative care in the context of improvements in hospital medical services (renovations and modernization of operating rooms and wards with beds, endowments in medical equipment for investigation and treatment, new work procedures, and revisions of existing procedures). Statistical analysis was performed based on the questionnaires distributed to patients hospitalized in the surgical wards of the Bihor County Emergency Clinical Hospital, between 2019 and 2023. A total of 4018 questionnaires were collected, and after the elimination of questionnaires with incomplete or incorrect data, 3985 remained in the analysis. Of the total of 2994 people who reported having undergone surgery, a total of 2090 responded to the questions that focused on postoperative care and overall impression of the hospital. No statistically significant differences in patient satisfaction by sociodemographic factors were found. A statistically significant increase in patient satisfaction with postoperative care and overall impression of the hospital was observed over the last 5 years. Correlation testing between postoperative care responses and overall impression, using the Sperman method, shows a directly proportional relationship between the two variables. In the future, it is necessary to extend the patient satisfaction questionnaire to comprehensively analyze the surgical component in order to identify gaps in postoperative care, helping decision makers to improve the medical services provided to patients. [ABSTRACT FROM AUTHOR]

(1) Background/Objective: California has one of the highest rates of pediatric dental caries in the nation. One way to combat this problem is through non-dental provider training programs that focus on prevention. However, there are limited data on healthcare provider training program integration and evaluation of oral health curricula focused on prevention of early childhood caries. This study will assess the change in healthcare providers' attitudes, knowledge, and skills by implementing an interprofessional educational (IPE) oral health curriculum in medicine and nurse practitioner programs at one university in Southern California. (2) Methods: A mixed method design was employed using a pre- and post-educational survey, and end-of-program focus group interviews. Descriptive statistics and paired t-tests were used to assess group differences and thematic analyses for the focus groups. (3) Results: A total of 81 students (14 pediatric medicine residents, 18 pediatric, and 49 family nurse practitioners) completed the curriculum and surveys. Attitudes related to oral hygiene remained unchanged, with the nurse practitioner group showing improved clinical skills (all questions; p < 0.021). Knowledge scores significantly improved across all groups (paired t-test; p < 0.001). All focus groups expressed the helpfulness of the educational modules, the usefulness of the skills learned, and the benefits of IPE activities. (4) Conclusion: Healthcare providers showed improved oral health knowledge and clinical skills acquired through the oral health program and can serve as a model to educate across disciplines on the prevention of early childhood caries. [ABSTRACT FROM AUTHOR]

Myasthenia gravis (MG) patients often require long-term glucocorticoid therapy, which may affect bone health. This study aimed to assess long-term changes in bone mineral density (BMD), evaluate osteoporotic fracture incidence, and examine the relationship between MG-specific factors and bone health outcomes over a 10-year period. This single-center, prospective cohort study included 28 MG patients. BMD, T-scores, Z-scores, and bone turnover markers were measured at baseline. FRAX® scores were calculated and adjusted for glucocorticoid dose. Fracture occurrence was monitored for over 10 years. Five (17.9%) patients experienced major osteoporotic fractures during follow-up. The fracture group had significantly lower baseline BMD and T-scores than the no-fracture group. Baseline FRAX® scores for major osteoporotic fracture risk were significantly higher in the fracture group (median 19.0% vs. 5.7%, p = 0.001). The fracture group progressed from osteopenia at baseline to osteoporosis by the end of this study. This study highlights the importance of early and regular bone health assessments in MG patients, particularly those receiving long-term glucocorticoid therapy. The FRAX® tool may be valuable for fracture risk stratification in this population. These findings can inform clinical practice and improve long-term management strategies for MG patients who are at risk of osteoporotic fractures. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users. Methods: The scale's structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined. Results: EFA revealed a two-factor structure comprising eight items (χ2 = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ2 = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ2 = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors. Conclusions: This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment. [ABSTRACT FROM AUTHOR]

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5's capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched questions related to OSA were entered into Google Search and ChatGPT-3.5. The responses were assessed by two independent researchers using the Global Quality Score (GQS), Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, CLEAR tool, and readability scores (Flesch Reading Ease and Flesch–Kincaid Grade Level). ChatGPT-3.5 significantly outperformed Google Search in terms of GQS (5.00 vs. 2.50, p < 0.0001), DISCERN reliability (35.00 vs. 29.50, p = 0.001), and quality (11.50 vs. 7.00, p = 0.02). The CLEAR tool scores indicated that ChatGPT-3.5 provided excellent content (25.00 vs. 15.50, p < 0.001). PEMAT scores showed higher understandability (60–91% vs. 44–80%) and actionability for ChatGPT-3.5 (0–40% vs. 0%). Readability analysis revealed that Google Search responses were easier to read (FRE: 56.05 vs. 22.00; FKGL: 9.00 vs. 14.00, p < 0.0001). ChatGPT-3.5 delivers higher quality and more comprehensive OSA information compared to Google Search, although its responses are less readable. This suggests that while ChatGPT-3.5 can be a valuable tool for patient education, efforts to improve readability are necessary to ensure accessibility and utility for all patients. Healthcare providers should be aware of the strengths and weaknesses of various healthcare information resources and emphasize the importance of critically evaluating online health information, advising patients on its reliability and relevance. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is the gold standard in infant nutrition. Successful breastfeeding depends on many factors, including the help of medical personnel in teaching breastfeeding, the need for professional work, and breastfeeding-friendly places in public spaces. The main goal was to identify various barriers among mothers to breastfeeding. Methods: This study used a quantitative descriptive research design. We recruited 419 mothers aged at least 18 years old through social media. Results were analysed using Pearson's chi-squared and Fisher's tests of independence for pairs of dependent and independent variables. Results: Most often, women gave birth at the age of 25–30, had one or two children, and attended higher education. Almost half of them lived in a large city and gave birth to a child by caesarean section. A total of 83.1% of mothers planned to breastfeed, but not all of them were able to do so for various reasons. One-third of them felt sorry for themselves that they had to change their feeding method. The majority of mothers did not receive sufficient help in the hospital in terms of learning how to breastfeed (61%), did not use the help of a lactation consultant (67%), and answered that there was no lactation consultant in their place of residence (65%). Only 43.2% of mothers returned to work without ceasing breastfeeding. A total of 42% of mothers experienced feelings of embarrassment when breastfeeding in a public place. The most frequently indicated barrier to breastfeeding in a public place was the lack of a suitable location where a woman would feel comfortable, calm, and intimate. Conclusion: There are various barriers towards breastfeeding: too few lactation consultants, problems with breastfeeding when the mother wants to return to work, and unfriendly places for breastfeeding in public spaces. Efforts must be made to support mothers in breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC. Methods: The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study. Results: The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly—switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%). Conclusions: Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly. [ABSTRACT FROM AUTHOR]

(1) Background: During and after the pandemic, individuals with type 1 and type 2 diabetes struggled to maintain a healthy lifestyle due to psychological distress and the struggle to accommodate contextual challenges and changes in their family and work obligations and expectations. This study aims to explore the long-term impacts of the pandemic on proactive self-management behaviors and outcomes that consider contextual and environmental factors, such as family and work dynamics. (2) Methods: In this mixed-method study, data were collected from 418 participants using the Hospital Anxiety and Depression Scale (HADS) and the Insomnia Severity Index (ISI), followed by 16 individual interviews. (3) Results: The prevalence of depression was 37.1%, that of anxiety was 59.1%, and that of insomnia was 66.3%. Significant differences were observed in anxiety by age (p = 0.02), while individuals with other comorbidities were more likely to report insomnia (p = 0.3). Overall, various challenges during the pandemic have exacerbated emotional distress and complicated self-care routines and adherence to healthy lifestyles. (5) Conclusions: The COVID-19 pandemic has prompted individuals with type 1 and 2 diabetes to adopt alternative health-management methods, such as self-care, proactive initiatives, and daily challenges. Enhancing proactiveness, awareness, and an understanding of individuals' needs is crucial for alleviating stress, controlling disease, and preparing for potential future health crises in the wake of the pandemic's long-term effects. [ABSTRACT FROM AUTHOR]