Search

Objective: To identify the effects of health literacy levels on health outcomes in patients with diabetes in a type V health center in Western Jamaica. Method: A correlational survey design with a random sampling technique was used. An 18-item questionnaire and the Newest Vital Sign tool were administered to 88 consenting adults with diabetes to assess their health literacy levels. Their health outcomes were evaluated with docket review. Data were analyzed using SPSS version 18. Results: The participants were predominantly female (77.3%), aged 51–70 years, married (44%), employed (46%), and diagnosed with diabetes > 10 years (42%). Only 13.6% of the study population was adequately health literate. The health literacy scores for gender were not significant (P = 0.84). The health literacy scores of the patients with different ages and educational levels were significant (P

Abstract Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age‐appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (

Background: The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited., Objective: We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50%., Methods: We formed a dynamic cohort by linking records of Thai citizens aged ≥18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months., Results: This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82% (95% CI 80.3%-84%) and 86.3% (95% CI 83.6%-84%), respectively., Conclusions: In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries., (©Ponlagrit Kumwichar, Chittawan Poonsiri, Siobhan Botwright, Natchalaikorn Sirichumroonwit, Bootsakorn Loharjun, Supharerk Thawillarp, Nontawit Cheewaruangroj, Amorn Chokchaisiripakdee, Yot Teerawattananon, Virasakdi Chongsuvivatwong. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 05.03.2024.)

Background: Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated., Methods: This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data., Results: Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983-0.9995). Similar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract diseases, and traffic accidents., Conclusion: This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the significance of strengthening primary care in the South Korean healthcare system to improve the overall health and wellbeing.

Background: Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps., Objective: This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers., Methods: Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision., Results: The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis., Conclusions: ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial., Trial Registration: ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404., (©Zhi Yin Kwa, Jinqiu Li, Dale Lincoln Loh, Yang Yang Lee, Guangyu Liu, Lixia Zhu, Minna Pikkarainen, Honggu He, Vidyadhar Padmakar Mali. Originally published in JMIR Formative Research (https://formative.jmir.org), 16.02.2024.)

The literature argues that intense political competition may resultin a nation's potential for increased welfare. We theoretically andempirically examine this proposition by linking political competitionto health outcomes in the Indian context. Theoretical analysissuggests that political competitiveness increases the probabilityof having better health outcomes. This analysis also identifiesthat rural areas benefit from more from political competition thanurban areas. In India, the majority of the population (around 70%)resides in rural areas and, therefore, the diversity of ex-ante viewsabout political parties is higher in rural areas compared to urbanareas. In such situations, as competition intensifies, the governmentallocates greater amounts of resources to rural areas to win theelection. Thus, as political competition increases, the probability ofhaving better health outcomes rise in rural areas at a higher rate ascompared to urban areas. Our empirical analysis also exhibits the same. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated improved outcomes with real‐time patient‐reported outcome questionnaires (PRO questionnaires) using questions adapted for patient use from the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). Outside of the clinical trial setting, limited information exists on factors affecting the completion of PRO questionnaires in routine practice. The primary aim of this prospective cross‐sectional study was to evaluate patient willingness to complete PRO questionnaires on a regular basis and to better understand responder biases to improve patient feedback. Materials and Methods: Patients performing PRO‐CTCAE toxicity and symptom PRO questionnaires in oncology clinics at Princess Margaret Cancer Centre from 2013 to 2016 were assessed for their willingness to complete PRO questionnaires using a nine‐item, tablet‐based acceptability survey. Patient‐reported characteristics (i.e., age, sex, language, marital status, education, occupation, etc.), cancer type, treatment modalities, and health metrics (i.e., Eastern Cooperative Oncology Group) were also collected. Characteristics were evaluated by logistic regression (odds ratios [OR]) using the primary outcome with prespecified levels of significance for univariate (p ≤.10), and additional multivariate (p ≤.05) testing. Results: A total of 1,792 patients (median age 60 years; range 18–97) with various cancer diagnoses were assessed. A greater proportion of female (56%) and white (74%) respondents with an annual household income of <$100,000 (69%) participated. More than half (58%) of respondents were willing to complete PRO questionnaires at every clinic visit, and a high proportion (77%) found utility in reporting physical and emotional feelings to clinicians using PRO questionnaires. In general, patients did not find that PRO questionnaires made clinic visits more difficult (93%). In uni‐ and multivariable testing, patients were more willing to complete sleep‐ and fatigue‐related PRO questionnaires relative to chemotoxicity‐based PRO questionnaires (OR 1.52; p =.012). Patients aged 40–65 versus 18–40 years were also more likely to report high PRO questionnaire acceptability (OR 1.49; p =.025). Additional patient characteristics such as white ethnicity (OR 1.76), Canada as country of birth (OR 1.66), and English language (OR 2.15) relative to other had higher acceptability on uni‐ (p <.001) and multivariable (p <.001) analyses. Patients reporting treatment intent as palliative (OR 0.69; p =.0013) or hematological (OR 0.73; p =.027) were less likely to report high PRO questionnaire acceptability on univariable analysis; however, only palliative patients (OR 0.72) maintained this effect on multivariable testing (p =.012). Patients reporting higher health utility scores (per change in.05) also had significantly increased PRO questionnaire acceptability in uni‐ (OR 1.06; p <.001) and multivariable (OR 1.05; p =.008) analyses. No significant differences in PRO questionnaire acceptability were seen between cancer types, education level, household income, employment status, or treatment modality. Conclusion: Routine assessment using PRO questionnaires is associated with moderate acceptability by patients with cancer. Specific patient characteristics are associated with higher completion willingness. Additional research is necessary to identify factors associated with low acceptability of PRO questionnaires and to develop site‐, ethnicity‐, and treatment‐specific instruments to assess the value of PRO questionnaires for symptom monitoring in clinical practice. Implications for Practice: This study will help to identify the clinical, demographic, and survey characteristics associated with willingness to complete patient‐reported outcome questionnaires regularly in the cancer outpatient setting. regorafenib dosing in patients with metastatic or recurrent gastrointestinal stromal tumors after failure of imatinib and sunitinib. [ABSTRACT FROM AUTHOR]

This study provides new evidence on the predictable validity of grip strength on later life outcomes using a population-based longitudinal survey of middle and older generations in Japan. We show that the level of grip strength contains significant information on health outcome and mortality in the later years although the loss of grip strength does not. Moreover, we confirm that grip strength is associated with socio-economic status, particularly with educational attainment. [ABSTRACT FROM AUTHOR]

Low health literacy is associated with challenges for those living with HIV including medication non-adherence and poorer health outcomes. The aim of this study was to systematically review the literature on health literacy and health outcomes in persons living with HIV. The extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, as well as A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist were utilized to guide the approach to the review. A variety of electronic databases including PubMed, CINAHL, PsychInfo, and Cochrane Library were searched. Additional literature available on U.S. government websites was also included in the search. Search terms were used in a variety of combinations and included HIV, health literacy, adherence, and health outcomes. Forty-eight studies were identified that addressed health literacy and health outcomes in HIV. Although several studies in this review did not provide robust results of statistical significance linking health literacy with health outcomes, all of the studies addressed the key significance of health literacy within the scope of living with HIV disease. The relationship between health literacy and the identified health outcomes requires further research and explication. [ABSTRACT FROM AUTHOR]

Aim: This study describes the reliability and concurrent validity of the Multidimensional Illness Severity Questionnaire (MISQ), a five-item measure for capturing parents' reports of their child's illness severity.Methods: We conducted a cross-sectional survey of parents of children participating in a paediatric research study (n = 20). We assessed parents' perceptions of illness severity using five measures: (i) the MISQ, (ii) the Lansky Play Performance scale, (iii) the Severity of Illness Scale, (iv) subscales of the Parent Experience of Child Illness and (v) general health. We calculated the internal reliability of the MISQ using Cronbach's alpha and assessed concurrent validity through correlations between scores on the MISQ and other measures.Results: MISQ scores ranged from 6/21 to 17/21 (mean = 11.5). The MISQ had adequate internal consistency (Cronbach's α = 0.76) and correlated strongly with other measures.Conclusion: Preliminary evaluation suggests that the MISQ is an easy-to-administer and internally consistent multidimensional assessment of parent-reported illness severity. [ABSTRACT FROM AUTHOR]

Background/purpose: The objectives of this study were to describe epidemiological data, treatment outcomes, and quality of life (QOL) of patients with acromegaly in Taiwan.Methods: From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. After enrollment, each patient was kept on observation for 1 year.Results: The analyzed cohort included 272 acromegalic subjects (117 males, 155 females) with a mean age of 51.4 ± 12.9 years. Their mean age at diagnosis was 41.8 ± 12.1 years. About 83.8% patients presented symptoms of facial changes. Galactorrhea was noted at the earliest age of 32.7 ± 9.1 years. The duration between the onset of symptoms/signs and diagnosis was 6.9 ± 8.1 years. Around 70.3% patients harbored a macroadenoma. At enrollment, percentages of patients ever received surgical intervention, radiotherapy, somatostatin analogs, and dopamine agonists were 94.8%, 27.9%, 64%, and 30%, respectively. At the final following-up visit, the random growth hormone (GH), nadir GH after oral glucose tolerance test, and the insulin-like growth factor 1 levels were 2.7 ± 4.9 μg/L, 2.4 ± 6.1 μg/L, and 291.5 ± 162.4 ng/mL, respectively. The remission rate assessed by random GH level (≦2 μg/L) was 63.8%. The mean AcroQoL scores for the total 22 items were 64.0 ± 19.7. About 42.8% patients never sensed or felt discomfort about their changes in appearance.Conclusion: This study described the profiles of acromegaly in Taiwan. It is important to enhance early diagnosis and timely commencement of treatment to prevent serious complications of acromegaly. [ABSTRACT FROM AUTHOR]

Aim: Globally, burns remain a significant public health issue that disproportionately affect young children. The current study examines the 10-year epidemiological profile of burn hospitalisations, hospital treatment cost and health outcomes by age group for children ≤16 years in Australia.Methods: National, population-based, linked hospital and mortality data from 1 July 2002 to 30 June 2012 were used to identify burn-related hospitalisations. Age-standardised hospitalisation rates and hospital treatment costs were estimated.Results: There were 25 098 children aged ≤16 years hospitalised after sustaining a burn. The age-standardised hospitalisation rate was 54.4 per 100 000 (95% confidence interval (CI): 53.7-55.1). Children aged 1-5 years had the highest burn hospitalisation rate (105.6 per 100 000; 95% CI: 103.8-107.3). The burn hospitalisation rate of infants <1 year declined by 3.1% per annum (95% CI: -4.84, -1.37, P < 0.001). Contact with heat and other substances, hot drinks, food, fats and cooking oils was the most common burn mechanism, and the home was the most common place of occurrence for children ≤10 years. Exposure to the ignition of highly flammable material was the most common burn mechanism for children aged 11-16 years. There were 7260 hospital readmissions within 28 days and 11 deaths within 30 days of the index burn hospitalisation. Total hospital treatment costs were estimated at $168 million.Conclusions: Childhood burns continue to account for a large proportion of hospitalised morbidity. To assist in reducing burn hospitalisations, the development, implementation and resourcing of national multi-sectorial childhood injury prevention is needed in Australia. [ABSTRACT FROM AUTHOR]

Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs. [ABSTRACT FROM AUTHOR]

Background: Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population.Objective: Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI.Methods: A systematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach.Results: Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacist-led medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence.Conclusion: Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI. [ABSTRACT FROM AUTHOR]

Background and Objective: Environmental burden of disease (EBD) studies are one of the most important needs for determining the current situation, increasing the effectiveness of health policies and programs and prioritizing environmental health interventions. This review article was evaluated the status of the EBD in Iran based on the results of the latest Global Burden of Disease (GBD) Study, other international studies and national estimates in the country. Materials and Methods: In this study, the researches on the EBD in Iran were identified by searching in the international and national scientific databases and the search results were studied and analyzed. Results: The review of the EBD studies showed that based on the results of the GBD study, the share of environmental risk factors in the total burden of diseases in the country in 2017 according to the disability-adjusted life years (DALYs) and deaths were about 8 and 13%, respectively. According to the results of the GBD study, the contributions of environmental risk factors in the attributable DALYs in the country in 2017 (a total value of 1,648,329) were as follows: ambient air PM2.5 for 45.0%, occupational risk factors for 25.1%, exposure to lead for 19.4%, unsafe water source for 5.0%, tropospheric ozone for 1.7%, lack of access to handwashing facility for 1.5%, unsafe sanitation for 1.4%, residential radon for 0.6%, and household air pollution from solid fuels for 0.3%. The total DALY rate and death rate attributable to solar ultraviolet radiation in Iran in 2000 were estimated to be 46.2 and 0.7, respectively. The DALY and the DALY rate attributable to elevated levels of fluoride in drinking water due to dental fluorosis in the country in 2017 were 3,443 and 4.14, respectively. The evaluation of the effect of water fluoridation as an environmental protective factor showed that the intervention by reducing the risk of dental caries could fall the DALY and DALY rates in the country by 14,971 and 18.73, respectively. In the period of 2005-2017, the DALY rate (per 100,000 people) attributable to ambient air PM2.5, tropospheric ozone, residential radon, and occupational risk factors rose that the result increases the importance of the preventive measures and controls of these risk factors. Conclusion: There was a considerable difference in the burden of disease attributed to each risk factor in various international studies as well as between national and international studies. The results of national studies on the burden of diseases attributable to environmental risk factors are considered to be more reliable and practical due to the application of more detailed data and conducting subnational evaluations; therefore, the strengthening and continuing these studies at the national and sub-national levels with regard to priorities, needs, and spatiotemporal trends using domestic reliable data and information are necessary and strictly recommended. [ABSTRACT FROM AUTHOR]

Purpose: This article aimed to examine the causal relationships of hours of work with health behaviors and health outcomes.Method: The data were derived from Japan Household Panel Survey/Keio Household Panel Survey. In total, data from 2677 men and 2170 women were analyzed to show the effects of hours of work on body mass index, smoking, and sleeping hours. To deal with the potential endogeneity of decisions about hours of work, the instrumental variable approach was used.Results: Hours of work had a negative impact on hours of sleep among men (coefficient [coef.], -0.371; 95% confidence interval [CI], -0.519 to -0.223). Longer hours of work also increased the probability of men being obese (coef., 1.108; 95% CI, 0.234-1.981) and the number of cigarettes they smoked each day (coef., 1.007; 95% CI, 0.037-1.978). For women, longer hours of work increased the probability of being obese (coef., 0.029; 95% CI, 0.009-0.050) and decreased the hours of sleep (coef., -0.416; 95% CI, -0.618 to -0.214).Conclusions: This article suggests that the health consequences of long hours of work include health behaviors and health outcomes that can lead to higher risks of morbidity and mortality. [ABSTRACT FROM AUTHOR]

The multitude of comorbidities and disabilities that are prevalent among diabetic patients make their care very challenging for providers. This, in turn, may have a negative effect on measures of patient satisfaction, quality, and outcomes. This study examines the correlation between diabetes ratio as a primary diagnosis in home health agencies (HHAs) with the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey and the Outcome and Assessment Information Set (OASIS) star ratings. Our result indicates that HHAs with a higher proportion of patients with diabetes have lower ratings in health outcomes (bathing, breathing, moving from the bed, moving around, and controlling pain). The association was stronger in the case of diabetic cases with complications. [ABSTRACT FROM AUTHOR]

Background: The avoidable mortality rate is a key indicator of overall health and health care utilization. However, the avoidable mortality rate may differ by the relative remoteness of a community. Avoidable mortality rates specific to remote areas cannot be investigated unless there is a clear geographic classification of remoteness. Therefore, this research uses a newly developed remoteness index to explore the geographic variability of avoidable mortality in Canada. Data and methods: The remoteness index, Canadian Vital Statistics--Death Database (2011 to 2015), and the 2016 Census of Population are used to understand the geographic variability of preventable and treatable mortality rates in Canada. Descriptive and multivariate data analysis techniques are used to test the hypothesis that remoteness is one of the statistically significant predictors of avoidable mortality rates in Canada. Results: There is a clear gradient of preventable and treatable mortality rates by relative remoteness. The preventable and treatable mortality rates are significantly higher in more remote areas than in easily accessible areas. The remoteness index is a good predictor of both preventable and treatable causes of mortality for low-Aboriginal census subdivisions but not for high-Aboriginal census subdivisions in Canada. Interpretation: Both preventable and treatable mortality rates vary significantly by remoteness, despite Canada's universal health care system. The remoteness of Canadian communities may have affected health care delivery and utilization. [ABSTRACT FROM AUTHOR]

Objectives. To explore the interaction between surgeon volumes (SVs) and hospital volumes (HVs) on health outcomes. Materials and Methods. We searched MEDLINE, Embase, CINAHL, Web of Science as of May 2017. We included studies investigating the interaction between high or low SVs operating in high or low HVs. Review process follows the PRISMA guidelines. We assessed the methodological quality of the included studies using validated critical appraisal checklists. Results. Sixteen studies were included. Due to the heterogeneity of studies, it was not possible to perform a quantitative analysis. Heath outcome are worse when high SV operating in low HV vs high HV, for the majority of the conditions (colorectal cancer, cystectomy, liver resection, mitral valve surgery, pancreatico-duodenectomy). Results for low SV are better when operating in high HV vs low HV for patients undergoing pancreatic-duodenectomy for mortality, 30 days complications and length of stay. Results for low SV are worse vs high SV when operating in high HV for most considered conditions. Results were in favour of higher SV vs low SV when operating in low HV for digital replantation success after injuries, 30 days mortality and complications after pancreatic-duodenectomy. Conclusion. The available evidence is limited. It is necessary to increase the monitoring of the association between surgeons volumes and hospitals volumes in which they operate, to ensure fairness and accuracy of care for better health outcomes. [ABSTRACT FROM AUTHOR]

Abstract Introduction There are relatively few studies addressing the relationship between the patient's expectation and the short and long-term response to treatment with acupuncture. The aim of this study was to assess the association between pre- and post-treatment expectation of acupuncture and post-treatment and post-follow-up patient outcomes. Methods This was an open-label, randomized controlled clinical trial conducted at the Czech-Chinese Centre for Traditional Chinese Medicine at the University Hospital Hradec Kralove between October 2015 and April 2017. Non-specific factors were examined in the intervention arm using regression analysis. Results Post-treatment positive expectation concerning the success of the treatment, as well as the affective status of the patient, is one of the most significant nonspecific factors contributing to an increased post-treatment effectiveness of acupuncture; however, this positive expectation decreased with time. On the other hand, the post-follow-up effect of acupuncture was significantly improved by the patients' positive perception of the TCM practitioner. Conclusions Correct calibration of a patient's expectation, good mental status, and patients' perceptions of an acupuncturist's skills reduced the number of migraine days in patients treated with acupuncture. Understanding non-specific treatment effects can potentially help clinicians to integrate them in to practice and thus optimise treatment effectiveness. Future research is needed to clarify whether interventions targeting modifiable non-specific factors prior to and during acupuncture treatment can result in better patient outcomes and future cost-savings. [ABSTRACT FROM AUTHOR]

Participation in regular physical activity yields numerous psychological and physical health benefits. Despite this, a large proportion of the global population is increasingly becoming inactive and sedentary, which has been linked to various causes of morbidity and mortality. One practice that has been found to encourage healthy participation in physical activity and associated health behaviours is mindfulness. Mindfulness practices have been consistently linked to higher levels of physical activity participation. However, the relationship between mindfulness practices and physical activity remains ambiguous. This present paper comments on the role of mindfulness practice in physical activity and health behaviours. Implications for future research and practice have also been addressed.

The literature in Intensive Care Units (ICUs) data analysis focuses on predictions of length-of-stay (LOS) and mortality based on patient acuity scores such as Acute Physiology and Chronic Health Evaluation (APACHE), Sequential Organ Failure Assessment (SOFA), to name a few. Unlike ICUs in other areas around the world, ICUs in Ontario, Canada, collect two primary intensive care scoring scales, a therapeutic acuity score called the "Multiple Organs Dysfunctional Score" (MODS) and a nursing workload score called the "Nine Equivalents Nursing Manpower Use Score" (NEMS). The dataset analyzed in this study contains patients' NEMS and MODS scores measured upon patient admission into the ICU and other characteristics commonly found in the literature. Data were collected between January 1st, 2015 and May 31st, 2021, at two teaching hospital ICUs in Ontario, Canada. In this work, we developed logistic regression, random forests (RF) and neural networks (NN) models for mortality (discharged or deceased) and LOS (short or long stay) predictions. Considering the effect of mortality outcome on LOS, we also combined mortality and LOS to create a new categorical health outcome called LMClass (short stay & discharged, short stay & deceased, or long stay without specifying mortality outcomes), and then applied multinomial regression, RF and NN for its prediction. Among the models evaluated, logistic regression for mortality prediction results in the highest area under the curve (AUC) of 0.795 and also for LMClass prediction the highest accuracy of 0.630. In contrast, in LOS prediction, RF outperforms the other methods with the highest AUC of 0.689. This study also demonstrates that MODS and NEMS, as well as their components measured upon patient arrival, significantly contribute to health outcome prediction in ICUs. [ABSTRACT FROM AUTHOR]

Policies can influence health of a population in various ways. Numerous epidemiological studies supported by toxicological investigations demonstrate a positive association between ambient concentrations of airborne particulate matter and increased adverse cardio-respiratory events, including morbidity and mortality. The aim of this paper was to present the concept of the top-down health policy risk assessment approach model developed to estimate the expected health risk reduction associated with policy aiming at attaining the new particulate matter ≤ 10 μm in diameter (PM10) standards in Poland. The top-down approach guides the analysis of causal chains from the policy to health outcomes. In this case study we tried to estimate the predicted health effects of the policy change over the past 20 years. Since Polish annual standard for PM10 changed from 50 μg/m3 in 1990 to 40 μg/m3 in 2010, we calculated the relative risk associated with decreasing PM10 in diameter to 10 μg/m3 in the annual level of PM10 for 6 adverse health effects. The relative risk slightly decreased for almost all adverse health effects, which means that the relative decrease in the incidence of health effects from the baseline incidence should range from about 0.5–0.6% for heart disease admissions to > 1% for respiratory admissions. The obtained results indicate that implementation of the new ambient air standards could influence improvement of the health status of Polish population. A top-down policy health risk assessment model can be one of the main tools in this process, providing harmonized guidance how to seek evidence-based information, which could serve policy-makers.

Technology has been evolving at an exponential speed in the past decade and the evidence of a dramatic change is all around us such as self-driving cars, artificial intelligence, robotics, and many more. The fusion of physical, digital and biological worlds, the so-called 4th industrial revolution, has impacted all industries and disciplines including healthcare. It has changed the way we live, work, and interacts with people around the globe. Despite its numerous benefits it also brings several concerns such as organisations failing to adapt to this shift at an equal or adequate pace. It is imperative that we grab the opportunities it presents and together shapes a sustainable and highly productive future. The field of rehabilitation has begun to adapt to these changes and became known as Telerehabilitation (TR). A promising field can be instrumental in aiding healthcare delivery, enhancing compliance, and improving health outcomes and quality of life of patients. However, the development of TR has been at a much slower pace than expected in both developing and developed countries. This article is a review of status and trends in TR and will mainly deal with identifying challenges faced by its users, gaps and propose means for rectifying issues and for establishing cost-effectiveness. It is thus concluded that there should be future studies of high quality, analysing its cost effectiveness and cost benefit. Also, the challenges could be overcome by a combination of face to face delivery and TR.

Background: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected., Objective: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model., Methods: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios., Results: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties., Conclusions: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins., (©Shikha Modi, Sue S Feldman, Eta S Berner, Benjamin Schooley, Allen Johnston. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 24.01.2024.)

Established in 2008 and comprising over 60 researchers, the IPD-Work (individual-participant data meta-analysis in working populations) consortium is a collaborative research project that uses pre-defined meta-analyses of individual-participant data from multiple cohort studies representing a range of countries. The aim of the consortium is to estimate reliably the associations of work-related psychosocial factors with chronic diseases, disability, and mortality. Our findings are highly cited by the occupational health, epidemiology, and clinical medicine research community. However, some of the IPD-Work’s findings have also generated disagreement as they challenge the importance of job strain as a major target for coronary heart disease (CHD) prevention, this is reflected in the critical discussion paper by Choi et al (1). In this invited reply to Choi et al, we aim to (i) describe how IPD-Work seeks to advance research on associations between work-related psychosocial risk factors and health; (ii) demonstrate as unfounded Choi et al’s assertion that IPD-Work has underestimated associations between job strain and health endpoints; these include the dichotomous measurement of job strain, potential underestimation of the population attributable risk (PAR) of job strain for CHD, and policy implications arising from the findings of the IPD-Work consortium; and (iii) outline general principles for designing evidence-based policy and prevention from good-quality evidence, including future directions for research on psychosocial factors at work and health. In addition, we highlight some problems with Choi et al’s approach.

The IPD-Work (individual-participant data meta-analysis of working populations) Consortium has published several papers on job strain (the combination of low job control and high job demands) based on Karasek’s demand–control model (1) and health-related outcomes including cardiovascular disease (CVD), cancer, obesity, diabetes as well as health-related behaviors, utilizing meta-analyses of a pooled database of study participants from 17 European cohorts. An IPD approach has some advantages over typical meta-analyses, eg, having access to all the data for each individual allows for additional analyses, compared to typical meta-analyses. However, such an approach, like other meta-analyses, is not free from errors and biases (2–6) when it is not conducted appropriately. In our review of the IPD-Work Consortium’s (hereafter called the Consortium) publications of the last two years, we have identified and pointed out several conceptual and methodological errors, as well as unsubstantiated conclusions and inappropriate recommendations for worksite public health policies (6–15). However, the Consortium has not yet appropriately addressed many of the issues we have raised. Also several major errors and biases underlying the Consortium IPD meta-analysis publications have not been presented in a comprehensive way, nor have they been discussed widely among work stress researchers. We are concerned that the same errors and biases could be repeated in future IPD Consortium meta-analysis publications as well as by other researchers who are interested in meta-analyses on work stressors and health outcomes. It is possible that the inappropriate interpretations in the Consortium publications, which remained uncorrected to date, may have a negative impact on the international efforts of the work stress research community to improve the health of working populations. Recently, Dr. Töres Theorell, a principal investigator of the Consortium, responded in this journal (16) to some of our criticisms on the Consortium papers (17, 18). The purpose of this article is to discuss the methodological and substantive issues that remain to be resolved and how they could be addressed in future analyses. We provide recommendations for future IPD or typical meta-analyses on work stressors and health outcomes. Finally, we discuss the inappropriate conclusions and recommendations in the Consortium publications and provide alternative recommendations, including a comprehensive perspective on worksite intervention studies.

Background: Web-based learning has transformed education. Its ability to overcome physical barriers and deliver knowledge at the click of a button has made web-based learning popular and ensured that it will continue to be used in the future. The involvement of parents in web-based learning is fundamental to the success of the educational process, but limited attention has been paid to the impact of web-based learning on parents., Objective: This study examined parental experiences with school-aged children receiving web-based learning in Jeddah, Saudi Arabia., Methods: We sent cross-sectional, anonymous web-based questionnaires to school-aged children's parents. A total of 184 parents completed the survey., Results: Parents' negative experiences of web-based learning (mean 4.13, SD 0.62) exceeded their positive experiences (mean 3.52, SD 0.65). The most negative experience reported by parents was their child's boredom due to prolonged sitting in front of a device (mean 4.56, SD 0.69). The most positive experience was their child's technological skill enhancement (mean 3.98, SD 88). Their child's lack of social interaction and friendship building promoted stress among parents (r=-0.190; P=.01). At the same time, their child's technological skill enhancement reduced stress among parents (r=0.261; P=.001). The most reported (63/184, 34.2%) obstacle to web-based learning was having multiple learners in the same household., Conclusions: Web-based learning is a fundamental learning method and will continue to be used in the future because of its ability to overcome many barriers to education. Parental involvement in the continuity and success of the web-based learning process is crucial. However, the findings of this study illustrated that parents' experiences of web-based learning were more negative than positive. Parents who reported negative experiences reported an increase in stress and faced more obstacles due to web-based learning. Thus, more attention and intervention are needed to promote positive web-based learning experiences among parents., (© Samaa Al Anazi, Eman Bajamal, Neama Hantira, Ola Esheaba. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org).)

This Viewpoint presents a case study that explored the effects of using a performance-based Memorandum of Understanding (MoU) in public health donor programs to enhance health metrics, program efficiency, and accountability. The MoU between Kebbi State Government in Nigeria and the United States Agency for International Development (USAID) focused on strengthening primary healthcare. It covered Health Systems Strengthening (HSS) indicators, overseen by an Operations Committee (OC) and a high-level Steering Committee (SC). Quarterly and biannual reviews tracked indicators through a dashboard developed by the Integrated Health Program (IHP). Results suggest that the MoU led to better monitoring of primary healthcare (PHC) revitalization, health sector work plan harmonization, and data quality. Dashboard tracking showed improved health facility financing, immunization, antenatal care, and skilled attendants at births. The use of the MoU demonstrated potential for boosting program efficiency, cost-effectiveness, and political commitment for resource mobilization in public health initiatives. Results support recommending MoUs as valuable tools for effective outcome-driven public health funding., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: TikTok is a popular social media platform that allows users to create and share content through short videos. It has become a place for everyday users, especially Generation Z users, to share experiences about their reproductive health. Owing to its growing popularity and easy accessibility, TikTok can help raise awareness for reproductive health issues as well as help destigmatize these conversations., Objective: We aimed to identify and understand the visual, audio, and written components of content that TikTok users create about their reproductive health experiences., Methods: A sampling framework was implemented to narrow down the analytic data set. The top 6 videos from each targeted hashtag (eg, #BirthControl, #MyBodyMyChoice, and #LoveYourself) were extracted biweekly for 16 weeks (July-November 2020). During data collection, we noted video characteristics such as captioning, music, likes, and cited sources. Qualitative content analysis was performed on the extracted videos., Results: The top videos in each hashtag were consistent over time; for example, only 11 videos appeared in the top 6 category for #BirthControl throughout the data collection. Most videos fell into 2 primary categories: personal experiences and informational content. Among the personal experiences, people shared stories (eg, intrauterine device removal experiences), crafts (eg, painting their pill case), or humor (eg, celebrations of the arrival of their period). Dancing and demonstrations were commonly used in informational content., Conclusions: TikTok is used to share messages on myriad reproductive health topics. Understanding users' exposure provides important insights into their beliefs and knowledge of sexual and reproductive health. The study findings can be used to generate valuable information for teenagers and young adults, their health care providers, and their communities. Producing health messages that are both meaningful and accessible will contribute to the cocreation of critical health information for professional and personal use., (©Isha Nair, Sophia P Patel, Ashley Bolen, Samantha Roger, Kayla Bucci, Laura Schwab-Reese, Andrea L DeMaria. Originally published in JMIR Infodemiology (https://infodemiology.jmir.org), 13.11.2023.)

How does the generosity of social insurance coverage affect the demand for healthcare and health outcomes of elderly people? This paper presents an examination of the effects of insurance coverage on long-term care (LTC) utilization and its health consequences using administrative data of the public long-term care insurance (LTCI) system in Japan. In LTCI, a recipient's health score determines their insurance coverage limit, and thresholds of the score generate discontinuous changes in the level of coverage limits. I implement a regression discontinuity design and find that coverage expansion increases recipients' LTC utilization considerably irrespective of their health status. When more generous insurance coverage is available, recipients with low care needs increase day care and rehabilitation services, whereas those with high care needs increase home care services. Moreover, using more LTC has little effect on health outcomes such as the health score and the entry into nursing homes. Together, these results suggest that generous LTCI coverage can induce excessive LTC utilization without having health benefits., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Technology has been evolving at an exponential speed in the past decade and the evidence of a dramatic change is all around us such as self-driving cars, artificial intelligence, robotics, and many more. The fusion of physical, digital and biological worlds, the so-called 4th industrial revolution, has impacted all industries and disciplines including healthcare. It has changed the way we live, work, and interacts with people around the globe. Despite its numerous benefits it also brings several concerns such as organisations failing to adapt to this shift at an equal or adequate pace. It is imperative that we grab the opportunities it presents and together shapes a sustainable and highly productive future. The field of rehabilitation has begun to adapt to these changes and became known as Telerehabilitation (TR). A promising field can be instrumental in aiding healthcare delivery, enhancing compliance, and improving health outcomes and quality of life of patients. However, the development of TR has been at a much slower pace than expected in both developing and developed countries. This article is a review of status and trends in TR and will mainly deal with identifying challenges faced by its users, gaps and propose means for rectifying issues and for establishing cost-effectiveness. It is thus concluded that there should be future studies of high quality, analysing its cost effectiveness and cost benefit. Also, the challenges could be overcome by a combination of face to face delivery and TR. [ABSTRACT FROM AUTHOR]

Highlights • Inpatients with severe mental disorder are quite heterogenic regarding their perception of health services. • Personality factors are more important than clinical symptomatology to a satisfaction level. • Satisfaction with hospital health care is associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia. • Improving knowledge of the determinants of inpatient satisfaction is a way to improve their care experience and to achieve better outcomes. Abstract Background Patients' perception of psychiatric healthcare is a critical indicator in measuring service quality. The aim of the study was to determine patient's level of satisfaction with the quality of health care delivered at the inpatient departments, and to identify the service quality factors that were important to patients. Method The Satisfaction with Psychiatry Care Questionnaire-22 was administered to 125 consecutive inpatients with schizophrenia or schizoaffective disorder in a stable condition. Sociodemographic and background variables, illness and symptom severity, insight, social anhedonia, self-esteem, perceived social support, and satisfaction with quality of life were collected. Results Although the participants generally expressed satisfaction with the inpatient services, they indicated that the weakest aspects of the service were in the domains of 'personal experience', 'information' and 'activity'. Women were significantly more dissatisfied than men with 'staff', 'care', and by general satisfaction. Multiple regression analysis revealed that satisfaction with hospital health care was associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia. Conclusion Personality related factors rather than psychopathological symptoms were associated with a satisfaction with care of admitted patients with severe mental illness. These factors could be targets for interventions aimed to improve treatment and hospital services. [ABSTRACT FROM AUTHOR]

Food insecurity (FI) has been recognized as a public challenge not only for developing countries but also for the U.S. population. The present study was designed to identify the prevalence of FI and the association of household FI with the health status of pediatric patients seen at a Federally Qualified Health Center in New Jersey which provides health care mainly for Latino patients. Patients were included if they were screened for FI at their well visits during a 4-month period following implementation of the 2-item screening tool recommended by American Academy of Pediatrics. We compared demographic and morbidity data of children with FI to those living in food-secure households. The results are presented as the distribution of frequency (%) and odds ratios (OR) with 95% confidence interval (95% CI). FI was detected in 15.8% (95% CI 14.2-17.5%) of 486 studied children. We recorded higher rates of anemia (10.4 vs. 3.2%, p < 0.005), hypercholesterolemia (10.4 vs. 3.4%, p < 0.01), and any morbidity (24.7 vs. 9.3%, p < 0.02) in children living in FI households. Multivariate logistic regression analysis revealed an association of household FI with at least one recorded morbidity independent of the patient’s age, gender, and body mass index (OR 1.79, 95% CI 1.31-2.43). No one was diagnosed with diabetes, and only a few with asthma and hypertension. We have concluded that living in households with FI increased the risk for unfavorable health outcomes in a predominantly economically disadvantage community of children within the U.S. population. [ABSTRACT FROM AUTHOR]

Background: Despite the substantial increase in the number of probiotic products available in the U.S. during the last decade and the potential for millennials to be a large market for probiotics, there is a lack of understanding about millennials' awareness, use, and preference for probiotics. In this study, we examine the relationship between the millennials' health and diet perceptions and health outcomes, estimate awareness and use levels of probiotics among the millennials, and identify the drivers of use of probiotics. Methods: An online Opt-in Internet panel is used to collect national-level survey data on awareness, and use of probiotics from the U.S. population in the age group of 21 to 37 years old. Results: The study discovered divergence in millennials' perceptions about their health and diet and health outcomes. Awareness about probiotics is high. Moreover, the use of probiotics is common among millennials. Demographic, socio-economic, and lifestyle-related attributes are influential in millennials' decision on the use of probiotics. Shakes and yogurt are the most preferred carrier forms of probiotics among millennials. The study also found that income constraints and perception of good health status are major factors hindering the use of probiotics among the millennials. Conclusion: The study demonstrates how millennials are already an important market for probiotics and there is substantial scope for expanding that market. The ability of probiotics to address public health concerns will depend greatly on how health care providers and probiotic industry will leverage these high levels of awareness and use by the millennials. Findings from our study provide insights helpful for the probiotics product and market development and outreach efforts that will result in increased use of probiotics among the millennials with positive implications for public health and the overall economy. [ABSTRACT FROM AUTHOR]

This research aimed to evaluate whether a self-management program promoted healthy lifestyle behaviors (HLBs) and improved health outcomes among Thai elderly with hypertension. Participants were randomly allocated to either an intervention group (n= 20), that received an 8-week selfmanagement program that included home visits, or a control group (n=20). The data were analyzed by a chi-square analysis, a mixed-model repeated measure MANOVA, and MANCOVAs. There were significant differences in the mean scores of healthy lifestyle behaviors at posttest and follow-up between the two groups (p <0.01) . Moreover, the experimental participants showed statistically significant decrease in BMI as compared to the control group participants in posttest and follow-up ( p <0. 001) . There was a statistically significant reduction in blood pressure in the experimental participants, compared with the control participants at follow-up (p <0.001). Furthermore, healthy lifestyle behaviors increased significantly in the experimental participants compared with the control participants and baseline ( p < 0. 001) . In addition, BMI and blood pressure decreased in the experimental participants compared with the control participants and baseline ( p < 0. 001) . The self-management program resulted in improved healthy lifestyle behaviors, and health outcomes among the elderly with hypertension, and has implications for health promotion. [ABSTRACT FROM AUTHOR]

The aim of this paper is to introduce the FunctionalMastery of Health Ownership (FMHO) model and to develop an operational definition of functional mastery as it applies to a positive health outcome for patients with chronic illness or an altered life situation. Daily functioning within the negative disease burden of chronic illness is the goal of individuals living within the constraints of morbidity. Functional mastery fosters health ownership and helps to predict successful control over life circumstances for optimum wellness within the parameters of the limitations of the effects of illness. Significant to nursing, the FMHO conceptual framework uses four foundational influences to assess a patient's ability to not only master function within the disease process, but also to sustain function and best health over time. The FMHO model provides a tool for practitioners to enable individualized care as patients move through the disease process and adapt to changes over time. [ABSTRACT FROM AUTHOR]

The cost of healthcare is a burden in most developing countries, and this is exponentially increasing in the context of population growth, pandemics, and rapidly evolving medical necessities. A customized healthcare typology should rely on data collection and architectural requirements, before moving to aesthetically compelling designs, so hospitals in low-resource or developing countries will not mimic their Western counterparts. The greatest bearing that improves the patient's outcome and well-being would engage a productive interaction between the hospital designers and the medical practitioners, this will also allow for evidence-based hospital planning. As the author of this short report, I use the best of my experience as a physician and healthcare planner to translate a successful interaction with multinational designers building hospitals in Rivers State, Nigeria. [ABSTRACT FROM AUTHOR]

BackgroundPeople with multiple sclerosis (MS) often experience pain, which can interfere with mobility, employment, and quality of life (QOL).MethodsThis cross-sectional study explored associations between pain, demographic, disease, and modifiable lifestyle factors in an international sample of people with MS recruited online.ResultsSubstantial pain, of moderate/severe intensity and interfering at least moderately with work/household or enjoyment of life in the past 4 weeks, was reported by 682/2,362 (28.9%). Substantial pain was associated with fatigue (odds ratio (OR): 6.7, 95% confidence interval (CI): 4.9,9.3), depression (OR:4.0, 95% CI:3.2,5.1), anxiety (OR:2.4, 95% CI:1.9,2.9), and lower mental health QOL (Mean Difference: −14.7, 95% CI:−16.6,−12.8). Regression analyses showed that smoking (OR: 2.0, 95% CI:1.35,2.87) and obesity (OR:2.1, 95% CI: 1.5,2.8), moderate alcohol use (OR: 0.7, 95% CI:0.5,0.9), moderate (OR 0.7, 95% CI: 0.55,0.98) or high (OR 0.6, 95% CI: 0.4,0.8) physical activity level, and healthy diet (OR 0.8, 95% CI: 0.75,0.95, per 10 points) were associated with substantial pain.ConclusionOur results show clear associations with modifiable lifestyle factors and substantial pain in MS. These factors are already considered in the prevention and management of pain in other populations but have not previously been considered in MS. Conversely, pain and associated common MS comorbidities, such as depression, anxiety, and fatigue, may hamper efforts to start or maintain healthy behaviors. Strategies to overcome these barriers need to be considered. Further research should clarify the direction of these associations.