Low language proficiency (LLP) affects up to 10% of children, depending on how it is defined, and is a known risk factor for academic and social difficulties. Despite growing awareness, there is limited consensus on the long-term consequences of LLP across quality of life domains. This review synthesises evidence from longitudinal cohort studies to evaluate long-term risks associated with LLP identified between ages four and eight, with follow-up from age 12 onwards. To examine the long-term outcomes of children aged four to eight years with low language proficiency (LLP), in terms of language, literacy, and quality of life across five WHO domains (physical, psychological, independence, social relationships, and environment). CENTRAL, MEDLINE, Embase, PsycINFO, ERIC, and 17 other databases were searched without language or date restrictions. In addition, reference lists were checked, citation searching was conducted, and study authors were contacted to identify additional studies. The most recent search was completed in March 2025. We included prospective or retrospective longitudinal cohort studies that identified children with LLP between ages four and eight years and assessed outcomes at age 12 or older. Studies could include comparison groups or single-cohort designs. LLP was defined either using standardised diagnostic criteria (≤ -1 SD on normed language measures, encompassing ~10-15% of the population) or clinical judgement by qualified professionals. We extracted data on language, literacy, and World Health Organization (WHO) quality of life domains and used robust variance estimation (RVE) meta-analysis models, including hierarchical and correlated effects models. Effect sizes were reported as Hedges' g or risk ratios (RR), with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) applied to each outcome domain. We conducted sensitivity and moderator analyses and assessed small-study effects. We included 80 studies; 72 contributed to meta-analyses across 15 independent cohorts (≈ 28,828 participants). Studies were published between 1982 and 2024 and conducted in Europe and North America. Risk of bias, assessed across study participation, attrition, and outcome measurement, varied; only three studies were at low risk across all assessed domains, with study attrition most frequently rated as moderate or high. Language outcomes showed large adverse associations in long-term follow-up (145 effect sizes; 11 cohorts; Hedges' g = -1.36, 95% Confidence Interval (CI) -1.80 to -0.92; moderate certainty). Literacy outcomes were similarly affected (86 effect sizes; 7 cohorts; g = -1.12, 95% CI -1.28 to -0.96; high certainty). Physical outcomes were reported in only one study and could not be meta-analysed; evidence was insufficient to draw conclusions. Psychological outcomes showed moderate adverse associations (91 effect sizes; 7 cohorts; g = -0.50, 95% CI -0.80 to -0.19; moderate certainty), with risk ratio analyses indicating lower probability of favourable psychological outcomes (RR = 0.53, 95% CI 0.42 to 0.67). Independence outcomes showed smaller and more uncertain associations (17 effect sizes; 2 cohorts; g = -0.59, 95% CI -1.35 to 0.18; low certainty). Social relationship outcomes showed moderate adverse associations (35 effect sizes; 6 cohorts; g = -0.64, 95% CI -1.35 to 0.07; moderate certainty). Environmental outcomes showed large but imprecise adverse associations (23 effect sizes; 5 cohorts; g = -1.10, 95% CI -1.47 to -0.73; moderate certainty). Across domains, sensitivity analyses supported the robustness of findings, although degrees of freedom were often low due to the limited number of independent cohorts. Where binary outcome data were available, risk ratio estimates were directionally consistent with continuous outcomes but frequently imprecise. Early low language proficiency (LLP) is consistently associated with substantial long-term language and literacy difficulties. LLP is also associated with poorer psychological well-being and social relationship outcomes later in life, with moderate certainty of evidence. Associations with independence outcomes are smaller and more uncertain, reflecting limited data and low certainty. Environmental outcomes, including education, employment, and societal participation, show large adverse associations, although estimates are imprecise due to the small number of contributing cohorts. Physical health outcomes remain under-researched. Taken together, these findings indicate that childhood LLP is not a transient delay but a marker of enduring developmental vulnerability, underscoring the need for sustained identification and support across developmental stages. Further high-quality longitudinal studies are needed, particularly in under-represented outcome domains. Internal sources Department of Special Needs Education, University of Oslo, Norway, supported the preparation of the protocol and review to be carried out during office hours for ÅMH, KR, and MM-L. Department of Education, University of Oslo, Norway, supported the preparation of the protocol and review to be carried out during office hours for AL. External sources The Research Council of Norway, Norway This review is part of the project, Better Equipped, which is funded by the Research Council of Norway, Grant 324207. Lervåg and Melby-Lervågs participation was founded by The Research Council of Norway, Centres of Excellence, Grant 331640. The funder had no role in the study design, conduct, methods, data analysis, reporting, or publication of this protocol for the review. https://discovery.ucl.ac.uk/id/eprint/10165057/1/Hagen_et_al-2023-Cochrane_Database_of_Systematic_Reviews.pdf.
Chronic pain is a leading global cause of disability. There is evidence supporting the efficacy of virtual reality (VR) interventions for improving pain and function in patients with chronic pain. However, use of VR in physiotherapy practice remains limited. This study examined the pre-implementation barriers and facilitators experienced by physiotherapists working in Germany when implementing VR for chronic pain management in outpatient settings. Physiotherapists participating in a VR implementation study were interviewed using semi-structured interviews. The interviews were transcribed and analyzed using qualitative content analysis. The identified barriers and facilitators were categorized into domains of the Theoretical Domains Framework. Based on the interviews with nine physiotherapists, the pre-implementation key barriers included environmental barriers, such as time limitations and lack of insurance reimbursement, knowledge barriers in relation to chronic pain management and VR content, professional role barriers, such as VR being perceived as outside the scope of physiotherapy and decision-making barriers, such as patient selection. The primary facilitators were environmental opportunities, such as VR being a unique asset of the practice or a dedicated area for VR therapy. Additional facilitators included positive expectations for the rehabilitation process and the belief that VR is an opportunity of growth for physiotherapy as a profession. Physiotherapists recognize the therapeutic potential of VR, but anticipate significant implementation challenges related to environmental restrictions, knowledge gaps, and professional role conflicts. However, they also identified potential facilitators, such as VR's unique assets for practices and its benefits for patient empowerment and professional advancement. Successful adoption requires multifaceted strategies that address reimbursement policies, provide enhanced training in areas such as pain neuroscience and VR applications, and facilitate workflow integration. Future research should validate these findings across diverse healthcare systems to support the integration of VR in chronic pain care. The study was registered with the German Clinical Trials Register on April 14, 2023 (ID: DRKS00030862).
Medical students with chronic diseases constitute a particurarly vulnerable subgroup of young adults, exposed to various health risks, related both to the academic environment and their underlying health condition. Previous findings suggest that medical students with chronic illnesses experience greater deterioration in quality of life (QoL) compared with their healthy peers. The aim of this study was to validate earlier observations from the POLLEK study regarding the relationship between quality of life, health status, and the prevalence of chronic diseases among medical students during a two-year follow-up. This study presents results from the final cohort of Polish medical students' longitudinal study (POLLEK), recruited during the academic years 2020/2021-2022/2023 at the Medical University of Silesia in Katowice. A total of 887 first-year students (T1) participated in the baseline assignment, and 705 were followed up in the second year of studies (T2). The questionnaire included measures of quality of life (WHOQOL-BREF), hazardous alcohol use (AUDIT), general health status (GHQ-28), lifestyle indicators, and sociodemographic characteristics. Students were divided into two groups: those with previously diagnosed chronic diseases (DCD) and those without declared chronic diseases (NDCD). Among first-year students (T1), 219 (24.7%) reported ever having a diagnosed chronic disease. In the second academic year (T2), this proportion increased to 28.9% (N = 204). Higher scores for overall QoL (p < 0.001), and in the somatic (p = 0.009), psychological (0.006), and environmental (p = 0.028) domains were observed among first-year students without chronic diseases. Similar patterns were observed during the second academic year, except for the psychological domain (p = 0.782). Chronic diseases are relatively common among medical students and are associated with poorer quality of life, worse self-rated health, and lower psychological wellbeing in the early years of medical education. Students with chronic diseases report consistently lower quality of life, more somatic complaints, and higher levels of anxiety and depressive symptoms, with these differences persisting over time. These findings highlight the need for systematic monitoring of students' wellbeing and early, tailored support, including health-focused interventions, coping support, and appropriate academic accommodations.
Cystic fibrosis (CF) is a multisystemic disease increasingly affecting adults due to improved survival rates. However, the functional outcomes, participation in daily life, and influence of environmental factors in adults with CF remain underexplored. This study aimed to evaluate the impairments and multidimensional functioning of adults with CF within the International Classification of Functioning, Disability and Health (ICF) framework, based on the perspectives of both patients and healthcare professionals. A qualitative multicenter study was conducted with 101 participants, including 30 adults with CF (≥18 years) and 71 healthcare professionals (27 physicians, 40 physiotherapists, and 4 nurses). Adults with CF participated in in-depth interviews, while healthcare professionals completed an online questionnaire containing six open-ended ICF-based questions. Eighty-three ICF categories were identified: body structures (20.5%), body functions (28.9%), activities and participation (20.5%), and environmental factors (30.1%). Both groups most frequently referred to lungs (s4301), sensations associated with cardiovascular and respiratory functions (b460), socializing (d9205), and immediate family (e310). Adults with CF emphasized environmental influences-such as e310-immediate family (76.67%), e1101-drugs (83.33%), and d9205-socializing (%73)-more than healthcare professionals, who focused primarily on physiological and e580-health services, systems and policies (67.61%). The most prominent ICF categories identified in both groups reflect the physical, psychosocial, and environmental dimensions of CF. Adults with CF placed greater emphasis on environmental and social factors, whereas healthcare professionals focused more on physiological aspects. These findings highlight the importance of the ICF framework, which supports a biopsychosocial, patient-centered, and multidisciplinary approach in the assessment of adults with CF. NCT06128499.
This study examined the direct and indirect associations among health literacy (HL), its determinants, and health-related quality of life (HRQoL) in individuals with physical disabilities based on the Integrated Model of Health Literacy (IMHL). This cross-sectional study analyzed data from 441 adults with physical disabilities obtained from the 2021 Korea Health Panel Survey. Based on the IMHL, path analysis was conducted to examine the direct and indirect associations of situational determinants (usual source of care, need for care) and societal and environmental determinants (employment status, unmet healthcare needs) on HL and HRQoL. Among the participants, 44.0% were classified as having inadequate HL and 22.3% as problematic. Need for care was negatively associated with both HL (β = - 0.12, p = .002) and HRQoL (β = - 0.33, p < .001). Unmet healthcare needs also had a significant negative direct association with HRQoL (β = - 0.17, p < .001). Employment status (β = 0.15, p < .001) and HL (β = 0.13, p = .005) were positively associated with HRQoL. HL partially mediated the relationship between need for care and HRQoL (β = - 0.02, p = .044). These findings highlight the role of HL in relation to HRQoL among individuals with physical disabilities. Improving HRQoL in this population may require approaches that go beyond individual-level HL promotion and also address support for care-dependent individuals and structural factors, including healthcare accessibility and employment opportunities. Individuals with physical disabilities often experience worse health and lower quality of life than the general population. This study examined whether health literacy affects health-related quality of life among individuals with physical disabilities in South Korea. It also explored how determinants of health literacy are linked to health literacy and health-related quality of life. The main finding is that health literacy plays an important role in health-related quality of life. The results showed that many participants had low health literacy. Those who needed more care or could not receive the healthcare they needed reported lower health-related quality of life. In contrast, individuals who had jobs and better health literacy reported better health-related quality of life. Health literacy helped explain why the need for care was linked to health-related quality of life. These findings suggest that helping individuals with physical disabilities better understand health information, making healthcare easier to access, and supporting employment opportunities may improve their health-related quality of life and reduce health inequalities.
Mothers of children with physical disabilities often experience caregiving-related stress that may negatively affect their psychological well-being and quality of life. Mindfulness-based interventions may help reduce stress by improving awareness and emotional regulation. This study aimed to examine the effect of a mindfulness-based stress reduction (MBSR) program on parental stress, mindfulness, and quality of life in mothers of children with physical disabilities. This single-blind randomized controlled trial included 62 mothers randomly assigned to either the MBSR group (n = 32) or the control group (n = 30). The intervention group received an 8-week MBSR program with weekly 60-90 minute sessions, while the control group received no intervention. Outcomes were assessed at baseline and post-intervention using the Parent Stress Scale (PSS), Mindful Attention Awareness Scale (MAAS), and World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF). Data were analyzed using repeated measures two-way analysis of variance in SPSS version 25. Compared with the control group, the MBSR group showed a significant reduction in parental stress and a significant increase in mindfulness (p < 0.05). Significant improvements were also observed in the psychological and environmental domains of quality of life (p < 0.05), whereas no significant between-group differences were found in the physical and social domains (p > 0.05). The MBSR program increases the level of mindfulness in parents of physically disabled children, reduces perceived stress, and significantly improves the quality of life, particularly in terms of psychological and environmental dimensions. Mindfulness-based interventions may be considered as a supportive approach within family-centered rehabilitation programs.
Social determinants play a critical role in shaping mental health (MH) outcomes. The World Health Organization emphasizes the importance of addressing such factors to reduce MH disparities. This scoping review aims to assess the landscape of research on social determinants of MH in Germany, focusing on frequently studied social determinants, MH outcomes, and underlying theoretical frameworks and explanatory mechanisms, particularly the consideration of the framework of intersectionality. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, a systematic literature search was conducted in PubMed and Web of Science. Studies that specifically addressed social determinants of MH in Germany were targeted, and data were charted to map key research trends. A total of 73 studies were included in the data analysis and synthesis, and outcomes were grouped into eight social determinants of health domains. The most frequently examined domains were demographics (in 96.0% of included studies), interpersonal/community/cultural influences (89.3%), economic stability (72.0%), and education (57.3%). Less frequently addressed domains included neighborhood and built environment (25.3%), environmental events (16.0%), other health-related determinants (16.0%), and healthcare access and quality (5.3%). We observed substantial heterogeneity within and between domains. MH outcomes were more often studied in terms of mental illness than positively defined MH, with depression and anxiety being the most frequently assessed outcomes. Theoretical frameworks such as the biopsychosocial model, social-ecological perspectives, and resilience theory were commonly applied, while intersectionality was rarely explicitly analyzed. This scoping review delineates the research landscape on social determinants of MH in Germany. The findings point towards a predominant focus on individual-level determinants, with comparatively limited attention to systemic and structural factors. Moreover, an emphasis on mental illness rather than MH, alongside substantial heterogeneity in measured constructs, may constrain the understanding of MH disparities. These gaps highlight the need for more comprehensive, intersectional approaches that account for the diversity of individuals, contexts, and outcomes.
Hemodialysis is the primary form of treatment for patients with chronic renal failure. The lengthy dialysis process and rigid treatment schedule often lead to poor patient adherence. This study aims to explore the effects of interdisciplinary collaborative nursing and routine nursing on hemodialysis compliance in patients with chronic renal failure. This retrospective analysis included clinical data of 136 patients with chronic renal failure who underwent hemodialysis in Zibo Central Hospital from April 2021 to January 2022. The patients were divided into a control group and an observation group according to the type of nursing care given. The control group received routine nursing, whereas the observation group received nursing intervention based on an interdisciplinary collaborative nursing model. Hemodialysis compliance, anxiety, awareness of disease, and health-related quality of life among the patients were evaluated. Compared to the control group, the observation group exhibited significantly higher levels of hemodialysis compliance and disease knowledge (p < 0.05). The anxiety level of the observation group was significantly lower than that of the control group (8.04 ± 5.06 vs. 12.49 ± 4.87; p < 0.001). In terms of quality of life, the observation group scored higher than the control group in physical, psychological, social, and environmental domains (p < 0.05). The interdisciplinary collaborative nursing enhances hemodialysis compliance in patients with chronic renal failure, ameliorates their anxiety, and improves their health-related quality of life. This research provides a theoretical basis for the design and selection of clinical management plans in the future.
This study aimed to examine the relationship between nurses' perceptions of the green organizational climate, perceptions of green team climate, and awareness of consequences, are related to their green behavior in hospitals. Healthcare is a resource-intensive sector where everyday employee green behavior can meaningfully reduce environmental impacts. Nurses, who work at points of concentrated resource use and waste generation, are pivotal for sustainability in hospitals. Yet, factors associated with nurses' green behavior remain underexplored. This study adopted a correlational, cross-sectional design and is reported in accordance with the STROBE guidelines. Data were collected from 649 nurses working in six hospitals in South Korea through an online survey conducted in January and February 2025. Multiple linear regression estimated associations between the three predictors and green behavior, controlling for age, conscientiousness, and direct care provision of nurses. Green team climate emerged as the strongest predictor of nurses' green behavior, followed by awareness of consequences and green organizational climate. Team-level environmental norms may have a stronger influence on nurses' green behavior than broader organizational climate. Awareness of environmental consequences also contributes to green behavior. Nurses' green behavior was positively associated with both contextual climates and individual cognitions. Promoting pro-environmental team norms, enhancing consequence awareness, and aligning organizational practices with sustainability priorities may encourage green behavior. Peer-led environmental initiatives at the unit-level and consequence-awareness training can strengthen shared norms among the team and promote green behavior. Hospitals should embed environmental sustainability in policies, performance management, and operating procedures, including procurement and waste management. At the larger systems level, environmental metrics could be tied to accreditation and funding.
Self-perceptions of ageing have an important influence on the physical function in later life, yet little is known about how these perceptions relate to foot and lower limb health. Exploring how self-perceptions of ageing interact with subjective reports of foot health as well as objective measures such as lower limb joint movement, muscle strength and functional mobility may provide important insights to support more person-centred and responsive models of care. This study aimed to determine the association between self-perceptions of ageing and subjective and objective measures of foot and lower limb health in older adults. This cross-sectional study included 40 community-dwelling adults ≥ 65 years who completed the five subscales of the Brief Ageing Perceptions Questionnaire (B-APQ) alongside patient-reported outcomes (100 mm Visual Analogue Scale [VAS] for foot pain, Manchester Foot Pain and Disability Index [MFPDI] and Lower Limb Task Questionnaire [LLTQ]). Objective assessments of joint range of motion, foot and ankle muscle strength and functional mobility tasks (timed up and go [TUG] and Short Physical Performance Battery [SPPB]) were also conducted. B-APQ subscale scores were direction-aligned so that higher scores reflect more negative ageing perceptions. Relationships between B-APQ subscales and foot and lower limb outcomes were modelled using linear regression. All models were adjusted for key clinical and demographic confounders. Omnibus block tests evaluated the joint contribution of the five B-APQ subscales. The B-APQ dimension block showed no evidence of association with foot pain (VAS, MFPDI). The B-APQ block was associated with plantarflexion and inversion strength, with more adverse beliefs about consequences/low control (consequences-control negative) and lower perceived control (control-positive) associated with weaker strength. Consequences-control negative was also associated with slower TUG, whereas SPPB total and joint motion showed no evidence of association. Associations between self-perceptions of ageing and lower limb function and mobility appear dimension-specific with beliefs about adverse consequences and perceived control most consistently related to neuromuscular strength and mobility, rather than pain. Interventions combining progressive strengthening with strategies addressing specific ageing-belief dimensions, may support mobility in older adults.
To enhance the competency of clinical medicine students in evaluating the severity of genetic disorders, this study first modularized an assessment of genetic diseases severity based on the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Then, this modular teaching framework was applied in teaching instruction. During the Medical Genetics course, the 2024 clinical medicine cohort at Hunan University of Medicine were clustered into a experimental group (6 classes, 203 students) and a control group (7 classes, 235 students) randomly. The experimental group engaged in the ICF-based module in the case analysis of genetic diseases, while students in the control group followed the traditional teaching methods. Learning outcomes were evaluated by analyzing the student-written genetic disease severity evaluation reports. Results demonstrated that students in the experimental group achieved significantly higher scores on their assessment reports (73.33±7.16) compared to the control group (64.79±5.45), with a statistically significant difference (t=13.87, P<0.001). Furthermore, textual analysis further revealed that reports from the experimental group contained a significantly higher frequency of keywords related to patient psychology, social functioning, and environmental factors, indicating a broader focus on the patients and more comprehensive and in-depth understanding of the patient's situation. These findings suggest that the ICF-based modular teaching framework significantly improves medical students' ability to conduct individualized assessments of genetic diseases and effectively fosters their humanistic care. This study provides an actionable and scalable teaching practice pathway for cultivating clinical genetic counseling professionals. 为提升临床医学生遗传病严重性的评估能力，本文首先基于世卫组织国际功能、残疾和健康分类(International Classification of Functioning, Disability and Health，ICF)框架，对遗传病严重性评估进行模块化整合，形成评估模型。继而在湖南医药学院2024级临床医学班级中随机抽取班级作为实验组(6个班级，203名学生)和对照组(7个班级，235名学生)，实验组学生在遗传病案例讲解中接受基于ICF框架的遗传学教学，对照组学生采用传统教学方式。通过评估学生撰写的遗传病严重性评估报告来检验学习效果。结果表明，实验组学生评估报告得分(73.33±7.16)显著高于对照组(64.79±5.45)，差异具有统计学意义(t=13.87，P<0.001)，并且实验组学生撰写的报告在结构上更具系统性。此外，实验组学生提及患者心理、社会功能及环境因素等关键词的频次显著高于对照组，表明实验组学生对患者的关注面显著拓宽，对患者处境的理解更为全面和深入。上述结果提示，基于ICF框架的模块化教学整合可显著提升临床医学生对遗传病的个体化评估能力，并有效培养其人文关怀精神。本文为临床遗传咨询人才培养提供了可操作、可推广的教学实践路径。.
Research has shown that the sense of agency depends on various sources of information and can influence other cognitive processes such as visual attention and memory. This study examines whether stimulus variability is another factor that either influences or is influenced by the sense of agency. Stimulus variability reflects environmental uncertainty, which is closely linked to the sense of agency. We hypothesized that a reduced sense of agency increases perceived variability and that higher stimulus variability diminishes the sense of agency. Participants in four experiments moved 40 circle stimuli for 3 s, with a 1 s delay introduced in half the trials to reduce the sense of agency. In Experiments 1-3, color variability was manipulated. Participants reported the perceived color variability (Experiment 1), their sense of agency (Experiment 3), or both (Experiment 2). While the delay manipulation did not influence perceived color variability, color variability reduced the agency ratings. Notably, the effect of color variability emerged only when participants reported both perceived color variability and their agency ratings (Experiment 2), and it disappeared when the color variability was task-irrelevant (Experiment 3). Experiment 4 extended this design to motion-direction variability, and a similar pattern was observed where direction variability reduced the agency ratings but the delay had no effect on perceived direction variability. Together, these results suggest that stimulus variability can influence the sense of agency in a unidirectional manner and that this effect is modulated by the task relevancy of variability information.
AI integration into medical education and practice has its benefits and risks. This national web-based cross-sectional survey on Egyptian medical staff and students aimed to assess knowledge, attitudes, and concerns regarding the use of AI. This study comprised 2765 medical students and 500 medical staff, with a mean age of 20.8 and 29.9 years, respectively, and higher percentages of females among both groups. Medical students demonstrated satisfactory knowledge of AI compared to medical staff (p < 0.001). Unfortunately, the majority of both groups (80.4% of staff and 81.6% of students) expressed negative attitudes toward AI use. Male participants had significantly higher attitude scores than females in both groups. Knowledge score and gender were significant predictors of attitude towards AI among medical staff (p<0.005), while gender was a significant predictor of attitude scores among medical students (p < 0.001). The total AI usage score in this study was higher among students than staff, particularly for idea generation. Medical staff demonstrated a slightly higher total concern score regarding the use of AI in medical education and practice compared with students. The results emphasize the necessity of engagement, focused education and training, compatible solutions, uniform standards, guidelines, and the smooth incorporation of AI into medical education and clinical practice.
Tuberculosis (TB) remains a critical global health concern, with India contributing nearly one-fourth of the total global burden. Although significant progress has been made in diagnostic innovations and therapeutic strategies, the rising incidence of multidrug-resistant TB (MDR-TB), coupled with treatment-associated adverse effects, continues to hinder effective disease management. These challenges not only complicate therapeutic outcomes but also pose a substantial threat to global TB elimination efforts. These factors substantially impair health-related quality of life (HRQoL), affecting physical, psychological, social, and environmental domains. Yet, evidence from Indian tertiary care settings using standardized QoL tools remains limited. A holistic assessment that combines clinical, radiological, and microbiological findings with psychological and QoL measures is essential for capturing the full impact of TB on patients' lives. This study was designed to comprehensively evaluate the QoL among patients with TB by employing the WHOQOL-BREF instrument within a tertiary care hospital setting. Furthermore, it aimed to investigate the influence of key determinants, including sociodemographic characteristics, treatment regimens, therapy-induced adverse events, and drug resistance patterns on QoL across the physical, psychological, social, and environmental domains. A six-month observational study was performed at a tertiary care hospital, enrolling 220 TB patients aged 20 years and above. QoL was assessed using the WHOQOL-BREF questionnaire, which evaluates four domains: physical, psychological, social, and environmental. Data were collected and analyzed using SPSS version 26, applying descriptive statistical methods to summarize the findings. The Physical Health domain demonstrated the greatest impairment (mean score: 36.35 ± 5.34), followed by the Psychological (44.49 ± 9.30), Environmental (48.17 ± 9.59), and Social (52.95 ± 19.61) domains. QoL varied significantly across sociodemographic and clinical factors, including education, occupation, and income. While adverse drug reactions (ADRs) were commonly reported, they did not show a significant association with diminished QoL (p > 0.05). Conversely, patients with drug-resistant TB demonstrated markedly lower scores in the environmental domain (p = 0.024) as well as overall QoL (p = 0.001) when compared to individuals with drug-sensitive TB. TB profoundly affects patients' QoL, with the greatest burden observed in the physical and psychological domains. Lower socioeconomic status, limited education, and drug-resistant TB are key determinants of poorer QoL. Incorporating patient-centred care with integrated psychological support alongside routine clinical management may improve overall treatment outcomes and well-being.
Breathlessness is a common and potentially life-threatening symptom among patients and constitutes a frequent reason for ambulance dispatches. Within ambulance care, ambulance clinicians (ACs) are often required to make rapid clinical assessments and decisions under complex and unpredictable conditions. Despite this, there is limited knowledge of how ACs experience their working conditions in ambulance care when caring for patients with breathlessness. Little is known about how these working conditions influence their ability to balance clinical responsibility, patient needs, and environmental constraints in the ambulance care setting. This study aimed to explore how ACs experience their working conditions in connection with the care of patients with breathlessness. This qualitative exploratory sub-study included a sample of 16 ACs from southwestern Sweden, all with at least one year of clinical experience. Data were collected through semi-structured dyadic interviews following a simulation exercise and analyzed using reflexive thematic analysis. The ACs experiences of their working conditions in connection with the care of patients with breathlessness is captured in three main higher-order themes: navigating constraints of the care environment, navigating professional judgment within institutional boundaries, and navigating responsibility in uncertain and distant care situations. ACs highlighted situations in which high-acuity care is delivered in environments that do not consistently ensure clinician safety. Clinical guidelines support decision-making in high-stress situations but may become restrictive when patients' conditions fall outside standard recommendations or when interventions are contraindicated. To address these constraints, ACs develop adaptive strategies. Non-conveyance decisions involving patients with breathlessness are described as particularly complex and burdensome, a challenge intensified by a shift toward selective transport and increased reliance on individual clinical judgment under uncertainty. The findings show that working conditions in ambulance services influence how care for patients with breathlessness is provided and experienced. Care is delivered in contexts marked by urgency, uncertainty, and constrained resources, requiring ACs to navigate patient needs, safety considerations, and organizational expectations. While acceptance of limitations functions as a professional strategy, it carries ethical implications for patients' safety, dignity, and care.
Ethical risks of medical artificial intelligence (AI) are a global concern, but existing understanding remains fragmented without an integrated framework, and physicians' awareness of these ethical risks is unclear. This study aimed to construct a multidimensional ethical risk framework for medical AI in the Chinese context, assess physicians' perceptions of these risks, and provide theoretical support for AI risk governance. In the first phase, we conducted semistructured interviews with 36 experts (102,000-word transcript), analyzed via grounded theory (NVivo 11 [Lumivero]), yielding 5 main risk categories and 15 subcategories. In the second phase, a 21-item questionnaire based on this framework was administered to 600 physicians across 19 Chinese provinces. After the reliability and validity of the questionnaire, descriptive statistics, and multiple linear regression identified risk perceptions and influencing factors. The framework includes physiological risks (eg, diagnostic error and improper treatment), psychological risks (eg, physicians' technical anxiety and patient's psychological anxiety), data and privacy risks (eg, privacy leakage and data security), social risks (eg, trust crisis, occupational impact, unclear liability, and autonomy erosion), and economic and sustainability risks (eg, increased financial burden, resource waste, environmental pollution, and energy consumption). Physicians (n=600) showed the highest concern for data and privacy risks, ambiguous accountability, and a physician-patient trust crisis. Economic and sustainability risks received the lowest agreement. Multiple linear regression identified significant predictors for risk perception. Specialized AI training was positively associated with perceptions of misdiagnosis risks (β=0.230, 95% CI 0.031-0.429; P=.02), privacy leaks (β=0.220, 95% CI 0.041-0.399; P=.02), and unclear liability (β=0.285, 95% CI 0.110-0.460; P=.002). The establishment of medical institution AI ethics review procedures was positively associated with perceptions of diagnostic errors (β=0.355, 95% CI 0.141-0.569; P=.001) and unclear liability (β=0.390, 95% CI 0.200-0.580; P<.001), while AI unfamiliarity was negatively associated with trust crisis (β=-0.260, 95% CI -0.450 to -0.070, P=.006). This study proposes a contextualized ethical risk framework for medical AI in China to guide targeted governance. It is recommended that future efforts should focus on enhancing the ethical training of medical professionals, improving the ethical review mechanisms for AI in health care institutions, and clarifying the division of liabilities and accountability. These measures will promote the robust development of medical AI within an ethically compliant framework.
This study aimed to explore nurses' experiences with the implementation of infection control measures, with a particular focus on perceived barriers, compliance practices, and organizational support mechanisms. While infection control is a critical component of patient safety, the practical implementation of infection control protocols often encounters systemic and environmental barriers, particularly in inpatient care settings. A qualitative study was conducted using the interpretative phenomenological analysis (IPA) approach. Semistructured interviews were conducted online via Zoom with 15 nurses working in internal medicine units at a university hospital in Türkiye between September and December 2024. Each participant had at least 2 years of professional experience. Data were analyzed inductively in line with IPA principles to identify recurring themes and meaning structures. Four main themes emerged: (1) Awareness and Compliance, reflecting nurses' knowledge and routine practices related to infection control; (2) Challenges in Implementation, including workload pressures, staffing shortages, and physical environment limitations; (3) The Role of Training, emphasizing the perceived value of interactive and practice-based education; and (4) Monitoring and Continuous Improvement, highlighting the need for regular audits and constructive feedback mechanisms. Notably, the barriers identified were predominantly organizational and systemic rather than individual, underscoring the importance of institutional support. Although nurses demonstrated strong awareness and commitment to infection prevention, structural and managerial challenges appeared to limit the consistent implementation of infection control measures. Strengthening institutional support, revising audit mechanisms, and enhancing staff engagement may help support sustainable infection control practices. Nurse leaders and healthcare administrators may consider addressing workforce capacity, supporting practice-oriented training approaches, and implementing constructive supervision and feedback systems to enhance adherence to infection control standards and promote a culture of safety in clinical practice.
This study aims to identify factors associated with life satisfaction among older adults with disabilities living alone using an analytic framework informed by the International Classification of Functioning, Disability and Health (ICF). Data were analyzed from 536 older adults (aged 60 years and older) with disabilities using the fourth wave of the Disability and Life Dynamics Panel conducted by the Korea Disability Development Institute. Factors associated with life satisfaction were categorized into personal factors (sex, education level, employment status, subjective economic hardship, self-esteem, and disability acceptance), environmental factors (number of close persons and frequency of contact with them), health-related characteristics (subjective health status, primary disability type, and disability severity), and activities and participation (needs for assistance with activities of daily living, social activity participation, online social interaction, and leisure activity participation). Statistical analyses included descriptive statistics, t-tests, analysis of variance, Pearson's correlation coefficients, and hierarchical regression analysis. Subjective economic hardship was negatively associated with life satisfaction (β = -0.151, p < 0.001), whereas employment status (β = 0.326, p < 0.001), self-esteem (β = 0.114, p = 0.002), and disability acceptance (β = 0.101, p = 0.006) were positively associated with life satisfaction within the personal factors domain. Among environmental factors, rare contact with close persons was negatively associated with life satisfaction (β = -0.121, p = 0.001). Regarding health-related characteristics, subjective health status was positively associated with life satisfaction (β = 0.256, p < 0.001). For activities and participation, unmet needs for assistance with activities of daily living (β = -0.078, p = 0.013) and non-participation in leisure activities (β = -0.073, p = 0.016) were negatively associated with life satisfaction. This study highlights the multidimensional nature of life satisfaction among older adults with disabilities living alone, demonstrating that both individual and environmental factors are significantly associated with life satisfaction. Future initiatives should focus on expanding job programs, promoting social and leisure activities, and developing integrated health and social support interventions that consider both individual and community contexts, along with improving age-friendly environments.
This study aimed to explore Irish anaesthesiologists' attitudes toward environmentally sustainable anaesthesia, including perceptions of safety, efficacy, and policy influences on anaesthetic choice. A cross-sectional online survey was distributed to anaesthesiologists across Ireland between March and June 2025. The questionnaire assessed demographic factors, preferences for intravenous versus inhalational anaesthesia, environmental awareness, and institutional support. Descriptive and comparative statistical analyses were performed. A total of 98 responses were received. Patient factors and ease of administration were the primary determinants of anaesthetic choice, while cost was less influential. Environmental considerations were common, with 71 (72%) reporting they consider environmental impact when selecting an anaesthetic technique. Most respondents (n=86, 88%) were willing to modify their practice to reduce environmental harm, yet 55 (56%) felt their institution did not provide adequate environmental education or guidance. Irish anaesthesiologists demonstrate strong awareness and willingness to engage in sustainable practice, but institutional training and policy support remain limited. Targeted education and system-level initiatives may enhance environmentally responsible anaesthetic care.
Human papillomavirus (HPV) infection is a major public health concern and a leading cause of cervical cancer worldwide. Despite the availability of effective vaccines, awareness and vaccine acceptance remain limited in many developing countries. This study aimed to assess awareness, acceptance, barriers, and determinants of HPV vaccination among medical students in Egypt. A web-based multicentre cross-sectional study was conducted among undergraduate medical students from governmental, national, and private medical faculties across Egypt using a non-probability sampling approach (convenience and snowball sampling). Data were collected using a validated structured questionnaire. A total of 601 students participated in the study. 31.4% were unaware that HPV is available for both males and females, and half of them expressed negative attitudes and concerns regarding the novelty (44%), safety (56%), efficacy (59%), and cost of the vaccine (51.7%). Nearly half (48.3%) of them were unaware that the "HPV vaccine" is available in Egypt. Seventy-three students (12.1%) received the vaccine, and among vaccinated participants, 39 were males. In addition, 44.3% of students reported hesitancy toward HPV vaccination, while 58.9% indicated willingness to receive the vaccine if it was provided free of charge. Family history of cervical cancer, total knowledge, and attitude scores were significant predictors of participants' HPV vaccine uptake (p < 0.05). Nearly half of the participants had not taken the vaccine because they were not sexually active or they lacked knowledge. Unfortunately, about one-third of the participants didn't take the vaccine because of cultural and parental objections. Male participants were less likely to recommend the vaccine to others. In spite of being medical students, their knowledge and attitudes were less than expected, giving an idea about the public situation. Findings underscore the importance of educational campaigns to raise knowledge and change faulty beliefs, focusing on the target groups and their parents. Also, the national health authorities should allocate resources to make the HPV vaccine available, accessible, and affordable.