Healthcare systems operate within a VUCA (Volatile, Uncertain, Complex, and Ambiguous) environment, shaped by economic, demographic, and systemic transformations. These rapid and unpredictable changes create ethical challenges, resource constraints, and heightened emotional and moral distress for healthcare professionals. The increasing complexity of care delivery, shifting institutional priorities, and external pressures contribute to moral injury, impacting professionals' ability to provide patient-centered care while maintaining their ethical and professional integrity. This qualitative study aimed to explore how healthcare professionals experience and cope with moral injury in a VUCA healthcare ecosystem. Through 35 semi-structured interviews, the study explores how healthcare professionals experience and cope with moral injury in such a dynamic healthcare ecosystem. The research uses an abductive analysis guided by the VUCA framework to examine the systemic roots of moral conflict. The analysis identified six themes highlighting how instability, unpredictability, ambiguity, and systemic overload shape clinical decision-making, emotional burden, and ethical distress. Participants described moral injury as emerging from the misalignment between professional values and institutional demands, intensified by resource shortages, role ambiguity, and crisis normalization. These pressures affect professionals' well-being, compromise ethical integrity, and contribute to long-term psychological consequences. The findings emphasize the need to move beyond individual-level resilience strategies and focus on systemic reforms. Strengthening institutional support structures-including ethical leadership, reflective spaces, and alignment between organizational policy and professional ethics-is essential for protecting both clinicians' integrity and care quality in today's complex healthcare landscape.
PurposeTo examine the relationship between fall-related mortality, disability-adjusted life years (DALY), healthcare expenditures, and research funding and determine whether fall prevention funding is proportional to fall-related public health impact.DesignCross-sectional.SettingUnited States.SampleNot applicable.MeasuresMortality rates (2018-2022) for leading causes of death were obtained from CDC WONDER. Disability-adjusted life-year (DALY) rates (2021) were obtained from the World Health Organization. Healthcare expenditures (2016) were obtained from the Institute for Health Metrics and Evaluation. Research funding data (2018-2022) were obtained from NIH ExPORTER and linked to causes of death using MeSH term searches.AnalysisLinear regression models were used with log-transformed research funding as the dependent variable and log-transformed mortality rates, DALY rates, and healthcare expenditures as predictors.ResultsFall mortality rate was 13.1 deaths per 100 000 individuals, fall-related DALY rate was 713.2 per 100 000, and fall-related healthcare expenditures were $106.6 billion. Falls ranked 12th in mortality, 8th in DALY, and 5th in healthcare costs but 20th in research funding, receiving $489 million over 5 years. Falls received significantly less funding than expected based on mortality rates (predicted $1.95 billion), DALY rates (predicted $3.27 billion) and healthcare expenditures (predicted $5.63 billion).ConclusionAlthough falls have a significant impact on older adults' health and mortality, fall research funding is disproportionately low. To reduce mortality and mitigate rising healthcare costs associated with falls, federal investment in fall prevention research should be a higher priority.
Type 2 diabetes mellitus (T2DM) and degenerative or mechanical spinal disorders frequently co-occur and amplify one another's clinical and socioeconomic burden. T2DM has been associated with greater pain severity, prolonged disability, and higher reported risks of surgery and opioid use, although the underlying mechanisms remain hypothesized rather than established. In South Korea's dual healthcare system, patients may access both Western medicine (WM) and Korean medicine (KM), yet national-level evidence on spine-T2DM multimorbidity care patterns is limited. This study examined 10-year healthcare utilization, expenditures, and medication use among patients with coexisting T2DM and degenerative or mechanical spinal disorders. We conducted a retrospective study using the Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) from 2010 to 2019. Patients with both T2DM (E11) and at least one degenerative spinal diagnosis (M47, M48, M51, M54, S33) were included. KM users were defined as those with ≥ 1 KM claim per year. Outcomes included annual claim counts, expenditures, service categories, medication use, and facility type. Annual percent change (APC) was estimated using log-linear regression, and baseline characteristics were compared using standardized mean differences (SMDs). A total of 188,716 patients generated 9,590,400 claims over 10 years; 62.9% were KM users. KM users were more often female and slightly older; back pain (M54) showed the largest imbalance (SMD = 0.26). Total claims increased from 715,279 (2010) to 1,157,475 (2019). KM users had substantially more annual claims; yet per-patient expenditures were similar, reflecting reliance on lower-cost outpatient KM services, notably acupuncture. Medication use peaked in 2012 and declined thereafter following national drug pricing reforms. Non-users received fewer but higher-cost prescriptions, particularly for pain and inflammatory medications. Adults with coexisting T2DM and degenerative spinal disorders demonstrate increasing and complex healthcare needs driven primarily by chronic pain rather than glycemic management alone. KM users engage in high-frequency, multimodal outpatient care at lower unit cost, whereas non-users rely more heavily on tertiary WM services and higher-cost pharmaceuticals. Korea's dual healthcare system appears to support differentiated care pathways in this multimorbidity population. Findings underscore the need for integrated, longitudinal chronic care models that combine conservative pain management with diabetes care to reduce disability and long-term healthcare burden.
Health literacy is a core competency in nursing education and an essential component of person-centered care. Its association extends beyond clinical communication to shaping attitudes that support sustainable, ethical, and environmentally responsible healthcare. However, this relationship remains under examined among nursing students in Middle Eastern settings. To investigate the relationship between health literacy dimensions and sustainable healthcare attitudes among Saudi nursing students and to determine whether health literacy predicts sustainability-related awareness, values, and behavioral intentions. A cross-sectional design was conducted using three independent samples: exploratory factor analysis (n = 385), confirmatory factor analysis (n = 514), and hypothesis-testing correlational analysis (n = 652). This multi-sample validation design represents a key methodological strength ensuring robust psychometric evaluation. Participants completed validated Arabic measures assessing health literacy (information literacy, communication and navigation, self-management and promotion) and sustainable healthcare attitudes (awareness/knowledge, attitudes/values, behavior/action). Correlation analysis, multiple regression, and two-way ANOVA were performed. Ethical approval and informed consent were obtained. Strong positive correlations were observed between all health literacy and sustainable healthcare dimensions (r = .776, p < .001). Regression analysis showed that health literacy collectively predicted 60.3% of the variance in sustainable healthcare attitudes (F(3,648) = 328.147, p < .001), with information literacy representing the strongest predictor (β = 0.349). Residence demonstrated a significant effect favoring urban students (p < .001), while gender showed no significant influence. Findings highlight that students with stronger meaning-making capacities, reflective awareness, and ability to interpret information demonstrated more developed sustainability attitudes and intentions, with the behavioral dimension reflecting self-reported intentions rather than observed behaviors. Health literacy is strongly associated with sustainability attitudes among future nurses. Integrating literacy-enhancing pedagogies may strengthen environmental stewardship, ethical responsibility, and holistic care orientations within nursing curricula.
This study aimed to describe and compare patient-reported outcome measures (PROMs) and objective clinical outcome measures (CROMs) in the treatment of age-related macular degeneration (AMD), exploring the concordance between these measures within a value-based healthcare (VBH) framework. This prospective, multicenter, observational, real-world study was conducted at three tertiary referral hospitals specializing in the treatment of neovascular AMD. Clinical outcomes (CROMs) and patient-reported outcomes (PROMs) were analyzed using the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) questionnaire as a functional assessment tool. Data were collected at baseline and at three, six, and 12 months following initiation of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Statistical analysis was primarily descriptive. The comparison between baseline and 12 months in the global NEI VFQ-25 score was performed using the Wilcoxon signed-rank test for paired samples. Concordance between CROMs and PROMs was assessed using the intraclass correlation coefficient (ICC). A total of 235 eyes were included, receiving 2338 intravitreal injections. The mean age of participants was 81 years (SD = 8.57), and 55.8% were female. The mean baseline NEI VFQ-25 score was 67.83 (SD = 10.39). The median best-corrected visual acuity was 63 ETDRS letters (interquartile range [P25 - P75]: 41 - 75) at baseline, increasing to 65 letters at three months and remaining stable through 12 months of follow-up. The comparison between baseline and 12 months revealed a statistically significant difference in visual acuity (Wilcoxon signed-rank test, Z = 4.2; p < 0.001). A reduction in the proportion of patients classified as legally blind was observed, together with an increase in the proportion of patients in the reading-vision and driving-vision categories. At 12 months, 58.7% of patients reported stabilization or improvement in visual function on the NEI VFQ-25 questionnaire. Concordance between the variation in visual acuity and the variation in the global NEI VFQ-25 score showed good agreement between CROMs and PROMs (ICC = 0.76; p < 0.001). The integrated analysis of CROMs and PROMs suggests that anti-VEGF treatment for neovascular AMD is associated with stabilization or improvement in visual acuity and patients' perceived visual function. The implementation of the VBH-AMD model proved feasible in a real-world clinical setting, reinforcing the importance of integrating patient-centered measures into the evaluation of therapeutic outcomes. Introdução: O objetivo deste estudo foi descrever e comparar os resultados reportados pelos doentes (patient-reported outcome measures, PROM) e os resultados clínicos objetivos (clinical-reported outcome measures, CROM) no tratamento da degenerescência macular da idade (DMI), explorando a concordância entre estas medidas no contexto de um modelo de cuidados de saúde baseados em valor (value-based healthcare, VBH). Métodos: Conduziu-se um estudo prospetivo, multicêntrico e observacional, da prática clínica, realizado em três hospitais terciários de referência no tratamento da neovascularização macular secundária à DMI. Foram analisados os resultados clínicos e os resultados reportados pelos doentes, utilizando o questionário National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) como instrumento de avaliação funcional. Os dados foram recolhidos no início do tratamento e aos três, seis e 12 meses após o início da terapêutica com injeções intra-vítreas de agentes anti-fator de crescimento endotelial vascular (anti-VEGF). A análise estatística baseou-se em estatística descritiva. A comparação entre o baseline e os 12 meses do score global do NEI VFQ- 25 foi realizada através do teste de Wilcoxon para amostras emparelhadas. A concordância entre os CROM e os PROM foi avaliada através do intraclass correlation coefficient (ICC). Resultados: Foram incluídos 235 olhos, tratados com 2338 injeções intravítreas. Na amostra, a idade média dos participantes foi de 81 anos (DP = 8,57), sendo 55,8% do sexo feminino. Relativamente ao questionário, o score médio na avaliação basal foi de 67,83 (DP = 10,39). A mediana da melhor acuidade visual corrigida foi de 63 letras ETDRS (intervalo interquartil [P25 - P75]: 41 - 75) na baseline, aumentando para 65 letras aos três meses e mantendo-se estável até aos 12 meses de seguimento. A comparação entre a baseline e os 12 meses revelou uma diferença estatisticamente significativa na acuidade visual (Wilcoxon signed-rank test, Z = 4,2; p < 0,001). Observou-se uma redução da proporção de doentes classificados como cegueira legal e um aumento das proporções de doentes nas categorias de visão de leitura e visão de condução. Aos 12 meses, 58,7% dos doentes reportaram estabilização ou melhoria da funcionalidade visual no questionário NEI VFQ-25. A concordância entre a variação da acuidade visual e a variação do score global do NEI VFQ-25 revelou boa concordância entre CROM e PROM (ICC = 0,76; p < 0,001). Conclusão: A análise integrada de CROM e PROM sugere que o tratamento da neovascularização macular secundária à DMI com anti-VEGF se associa a uma estabilização ou melhoria da acuidade visual e da perceção funcional da visão. A implementação do modelo VBH-DMI demonstrou ser aplicável em contexto de prática clínica real, reforçando a importância de integrar medidas centradas no doente na avaliação dos resultados terapêuticos.
Virtual interventions for patients with substance use disorders (SUDs), including intensive outpatient treatment, were developed during the COVID-19 pandemic and later maintained in some clinical settings. However, the effectiveness of this type of intervention in healthcare professionals (HPs) has not been studied so far. This is a quasi-experimental cohort study with both retrospective and prospective data comparing the main treatment outcomes of HPs in treatment for SUDs: (1) 29 patients following a 40-hour synchronous virtual group intervention; and, (2) 31 patients following a an 80-hour in-person group psychotherapy. They both underwent in-person psychiatric and psychological individual treatment as well as addictive drug use monitoring. Logistic regression analyses were performed to find predictors of abstinence from addictive substances and of working status. A Cox proportional hazards regression was used to compare time to first lapse (positive addictive drug use monitoring). Satisfaction rates at the end of each intervention were also compared in both groups using a non-parametric test. The sample consisted of 60 HPs, with a mean age of 49.5 years (range: 30-67). Of these, 53.3% (n = 32) were women. Physicians represented 53.3% of all patients. Patients in the virtual group were more likely to be working during the intervention compared with those in the in-person group. At one-year follow-up, 55% of the sample remained abstinent from addictive substances. After multivariate analysis, the type of intervention did not predict abstinence when controlling for other variables, although having dual diagnosis was inversely correlated with remaining abstinent (OR: 0.24; 95% CI: 0.07-0.85). HPs receiving in-person intervention were more likely to be working one year after the treatment (OR = 8.3; 95% CI: 2.1-33.3). Time to first lapse was similar between groups, although the in-person sample showed a more heterogeneous distribution. Satisfaction rates were similar in both groups. Virtual interventions may be an effective alternative to in-person interventions for HPs with SUDs. More studies are needed to more deeply analyze these preliminary findings.
暂无摘要（点击查看详情）
Somalia has one of the lowest childhood immunization coverage rates globally, with only 34.8% of children aged 0-59 months having received at least one vaccine and a high burden of zero-dose children. Immunization uptake is influenced by socioeconomic, maternal, healthcare access, and geographic factors. This study examined determinants of childhood immunization coverage in Somalia to inform equity-focused strategies. A cross-sectional analysis was conducted using nationally representative data from the 2020 Somalia Demographic and Health Survey (SDHS), including 7,373 mother-child pairs. bivariate and multivariable logistic regression models assessed associations between sociodemographic, economic, maternal, healthcare access, and geographic characteristics and child vaccination status, accounting for survey design and confounders. Overall vaccination coverage was 34.8%. Health facility delivery was the strongest independent predictor (AOR = 1.93; 95% CI:1.68-2.22; p < 0.001). Children from the highest household wealth quintile had higher odds than the poorest (AOR = 2.45; 95% CI:2.00-3.00; p < 0.001). Maternal primary and secondary education were positively associated with vaccination (AOR = 1.58; 95% CI:1.34-1.87 and AOR = 1.94; 95% CI:1.40-2.67; respectively; p < 0.001). Nomadic residence was associated with higher odds compared with rural residence (AOR = 1.69; 95% CI:1.46-1.96; p < 0.001). Compared with infants aged 0-11 months, children aged 12-23 months (AOR = 1.36; 95% CI:1.10-1.69; p = 0.005) and 24-59 months (AOR = 1.33; 95% CI:1.12-1.59; p = 0.001) were more likely to be vaccinated. Lack of radio exposure was associated with lower vaccination odds (AOR = 0.64; 95% CI:0.50-0.82; p < 0.001). Children living in Gedo region had markedly lower odds of vaccination than those in Awdal region (AOR = 0.26; 95% CI:0.17-0.39; p < 0.001). Childhood immunization coverage in Somalia remains critically low, reflecting socioeconomic, maternal, healthcare access, and geographic inequalities that require strategies targeting disadvantaged populations and regions.
Hospitalizations among older adults differ by dementia status, gender, and living arrangements. Understanding these differences, particularly in advanced age (age 85 and above), can inform appropriate healthcare strategies. Using health claims data for Germany, we followed the 1918 to 1923 birth cohort (n = 4,065 men and 13,302 women), who reached age 85 between 2004 and 2009 until death or age 95. Two-level mixed-effects linear probability models with repeated observations were conducted, adjusting for age, gender, dementia status, nursing home residency, dependency on long-term care, comorbidities, and quarter of death. Men consistently exhibited higher probabilities of hospitalization compared to women, and individuals with dementia (PwD) had a greater probability of hospitalization than those without dementia (non-PwD). Specifically, when compared to male non-PwD, the probability of hospitalization increased by 0.10 (p ≤ 0.001) for male PwD; female non-PwD demonstrated a 0.02 (p ≤ 0.001) lower probability of hospitalization, while female PwD had an increased probability of 0.06 (p ≤ 0.001). Hospitalization probabilities increased with age among non-PwD (men: +0.052 from p85=0.14 [95%CI = 0.13-0.14] to p95=0.19 [95%CI = 0.18-0.20]), women: +0.021 from p85=0.12 [95%CI = 0.12-0.13] to p95=0.14 [95%CI = 0.14-0.15]), remained almost stable among male PwD (+ 0.018 from p85=0. 24 [95%CI = 0.23-0.26] to p95=0.26 [95%CI = 0.24-0.28]), but declined among female PwD (-0.023 from p85=0.22 [95%CI = 0.21-0.22] to p95=0.20 [95%CI = 0.19-0.20). The quarter of death strongly elevated hospitalization probabilities for all groups, though less so among women with dementia who had a lower probability than women without dementia (-0.04; pnon-PwD=0.58 [0.58-0.59], pPwD=0.54 [0.53-0.55]). Dependence on long-term care significantly reduced hospitalization risk among women, especially those with dementia (-0.5; pno long-term care=0.21 [0.21-0.21], plong-term care =0.16 [0.16-0.17]), but showed no substantial effect for men. Nursing home residency increased hospitalization probabilities mainly for women without dementia (+ 0.02), but slightly decreased probabilities for women with dementia (-0.01). Higher comorbidity was consistently associated with greater hospitalization risk. Gender and dementia status significantly modulate hospitalization risks in advanced age. A gender-sensitive healthcare approach that accounts for dementia status and care needs is crucial for ensuring adequate hospital care in advanced age.
The utilization of breast and cervical cancer screening services among women remains low in Turkiye, despite their importance for early diagnosis. Therefore, this study examines the influences of financial and physical barriers in accessing healthcare and socio-economic and demographic factors on Turkish women's participation in mammography and Pap smear screenings. The microdata from the Turkey Health Survey (TSA) conducted by the Turkish Statistical Institute (TURKSTAT) in 2014, 2016, 2019, and 2022 were pooled. A total of 26,931 women aged 35 and over were included. To analyze the factors affecting the likelihood of undergoing mammography and Pap smear tests, separate binary logistic regression (logit) models were estimated for each dependent variable. In the first stage, the effects of the variables were reported as odds ratios, and in the second stage, average marginal effects (AME) were calculated and presented through graphs. Participation rates were 43.73% for breast cancer screening and 43.06% for cervical cancer screening. 20% of women faced financial barriers in accessing healthcare services, while 34% faced physical barriers. Encountering financial barriers, education and income levels, having access to a physician, and performing self-breast examinations were related to the level of mammography and Pap smear screening. To increase the effectiveness of screening programs, health policies must prioritize reducing financial barriers, promoting healthy behaviors, and improving physician services. Furthermore, strengthening the role of primary care services in this regard would also be a significant contribution. Not applicable.
Understanding the supply-demand relationship of medical services is essential for regional planning. Existing city-scale studies typically exclude cross-city flows, whereas national-scale studies often overlook intra-city heterogeneity. In urban agglomerations, healthcare resources and transport infrastructure are usually planned by cities, although patients may cross city boundaries to seek care. The implications of cross-city trips for regional medical services remain insufficiently understood. Taking the Pearl River Delta as a case, this study investigates cross-city hospital visiting trips and their implications for medical service evaluation. Using 91.2 million automobile navigation records collected in 2019, 1.37 million hospital visiting trips to Grade 3 hospitals were identified through a modified spatial join method. A population-hospital bipartite network and a multi-scale analytical framework were constructed. Cross-city demand and supply indices were developed at the city, subdistrict, and hospital scales to characterize cross-city medical service patterns and influencing factors. Accessibility and Gini coefficients were computed under intra-city and regional evaluation scenarios to assess how incorporating cross-city hospital visiting trips affects medical service evaluation. Based on automobile navigation data, 9.1% of identified hospital visiting trips crossed city boundaries. Guangzhou and Shenzhen served as dominant regional suppliers, with cross-city supply indices of 55.9% and 21.8%, respectively. Cross-city demand was negatively associated with distance to boundary, GDP per capita, and hospital beds. Cross-city service share was negatively associated with distance to boundary, whereas contributions to regional cross-city service provision were positively associated with hospital size and hospital grade. Incorporating cross-city flows increased accessibility in most peripheral areas and reduced the regional population-weighted Gini coefficient from 0.596 to 0.522. Based on automobile navigation data, cross-city hospital visiting trips constitute an important component of medical service utilization in urban agglomerations. At the subdistrict scale, cross-city demand was jointly associated with boundary proximity and local economic and medical conditions. At the hospital scale, the cross-city service share was higher among hospitals closer to city boundaries, whereas contributions to regional cross-city medical service provision were greater among larger and higher-grade hospitals. Evaluation frameworks relying solely on intra-city data tend to underestimate accessibility in boundary areas and, in most cases, overestimate the Gini coefficient.
PurposeTo examine the relationship between political county-level partisanship and COVID-19 and flu vaccination uptake in the United States following the 2020 and 2024 presidential elections.DesignEcological, cross-sectional analysis utilizing public datasets.SettingAll 3224 US counties and county equivalents.SampleData includes 3224 counties; 3192 had complete COVID-19 vaccination data, and 3125 had complete flu vaccination data.MeasuresDependent variables were county-level flu and full COVID-19 vaccination rates. Independent variables included 2020 and 2024 GOP vote share, median household income, education, healthcare access, and county-level health indicators.AnalysisSpearman correlation, independent t-tests, and multivariate linear regressions.ResultsGOP vote share is strongly negatively correlated with COVID-19 vaccination (r = -.699, P < .001) and moderately with flu vaccination (r = -.427, P < .001). Counties in the highest GOP quartile had significantly lower vaccination rates than Democratic quartile counties (COVID-19: 45% vs 60%, t = -39.64, P < .001; flu: 35% vs 46%, t = -23.10, P < .001). Each percentage-point increase in GOP vote share is associated with a 0.45% decrease in COVID-19 uptake in 2024 (β = -.449, P < .001) and a 0.13% decrease in flu uptake (β = -.128, P < .001), independent of socioeconomic controls.ConclusionsPartisan alignment has become a significant determinant of vaccination, with the divide persisting between 2020 and 2024. Findings underscore the need for localized, depoliticized public health strategies.
Ethnic and social diversity in contemporary societies is not adequately reflected among medical residents and medical specialists, and this disparity may also exist within hospital pharmacy. Although at least 35% of pharmacy students have a Turkish, African, Latin American or Asian (TALA) background, it remains unclear whether this extends to hospital pharmacy residents. This study examined the diversity among hospital pharmacy residents in the Netherlands, in terms of gender, age, ethnic background and social background. In addition, the extent to which diversity is considered in selection procedures was explored. A quantitative cross-sectional national study was conducted using questionnaires delivered to hospital pharmacy residents, who started their residency between 2018 and 2023, and their supervisors in the Netherlands. Residents reported their gender, age, ethnic and social background. Ethnic background of residents was compared with that of young adults (aged 20-30 years) in the general population and pharmacy students. Supervisors indicated whether diversity, considering gender, ethnic background and their combination with previous experience and interests, was considered during selection and rated importance hereof (scale 1 "unimportant" to 5 "very important"). In total, 131 of 169 (78%) invited residents and 32 of 37 (87%) supervisors were included. Among residents 30% were male and 18% had a Turkish, African, Latin American or Asian (TALA) background, compared to 20% of young adults in the general population and 35% of students. Compared to other residents, TALA residents were less likely to have a parent with at least a bachelor's degree (44% versus 76%, p=0.004) or a parent registered as healthcare professional (4% versus 26%, p=0.043). Most supervisors reported considering gender balance (73%), ethnic diversity (69%), and the combined diversity factors (90%) during selection. Gender and ethnic diversity were rated fairly important (median 3); while the combined diversity factors were rated as important (median 4). The ethnic diversity of hospital pharmacy residents in the Netherlands is comparable to that of young adults in the general population but appears to decline in the transition from student to resident. Future research should focus on this transition, including career choices and the residency selection procedures.
Breast cancer is the most prevalent and costly cancer. Oral endocrine therapy (OET) improves survival rates and quality of life while reducing recurrence, mortality, morbidity, and medical costs. However, adherence to OET is challenging because OET is prescribed for 5-10 years. Determinants of OET nonadherence (NA) among women aged 65 and older remain poorly characterized. Existing studies are limited, often focusing on small, single-site samples and focusing on patient-level rather than multi-level determinants. Despite the unique needs of older women, research on OET-NA remains scarce. This study identified multi-level determinants of OET-NA in older women using ecological systems theory and the World Health Organization's five-dimension model. A descriptive, correlational secondary data analysis was conducted using the 2019 Surveillance-Epidemiology-End-Results (SEER) Medicare database, which includes more than 9 million cancer cases in the United States. OET-NA was significantly affected by (a) patient-related factors of ethnicity (i.e., Black [AOR 1.55; 95% CI 1.34-1.78; p < 0.001]) and psychological issues (i.e., depression [OR 1.40; 95% CI 1.27-1.54; p < 0.001]), (b) socioeconomic-related factors of marital status (i.e., divorced [OR 1.17; 95% CI 1.04-1.32; p ≤ 0.01]), and lifestyle (i.e., tobacco use [OR 1.41; 95% CI 1.22-1.63; p < 0.001]), (c) therapy-related factors of switching OET medications (OR 2.72; 95% CI 2.41-3.07; p < 0.001), (d) condition-related factors of comorbidities (i.e., obesity [OR 1.13; 95% CI 1.03-1.23; p < 0.01]), and (e) characteristics of the healthcare team and health system-related factors (i.e., group practice type [OR 1.26; 95% CI 1.01-1.56; p < 0.05]). OET-NA was associated with multi-level determinants, including being Black, having depression, being divorced, using tobacco, switching OET medications, having obesity, and receiving care in group practices. Identifying these determinants is a critical first step toward developing and testing interventions to improve OET-NA and enhance survival and quality of life.
Persistent negative symptoms (PNS) often emerge early in the course of schizophrenia spectrum disorders, significantly impair long-term functional outcomes, and remain difficult to treat, with no consistently effective interventions available. The manifestation of PNS in individuals with first-episode psychosis (FEP) engaged in coordinated specialty care (CSC) in the United States remains largely unknown. This study characterizes negative symptoms in routine clinical care using data from the Early Psychosis Intervention Network's Connection Learning Healthcare System, with a focus on a subcohort of individuals with PNS. Practice-based data were collected every 6 months over a 2-year period from 1289 participants across 23 CSC programs using a Core Assessment Battery (CAB) comprised of clinician-rated and self-report measures. Negative symptoms were quantified across CAB items, allowing for categorization of participants into PNS (n = 79) and non-PNS groups (n = 455). Group comparisons examined outcomes across CAB items, and exploratory mediation analyses focused on the role of engagement in outcomes relative to PNS. Individuals with PNS had higher rates of schizophrenia and lower social and role functioning compared to those in the non-PNS group. Exploratory analyses indicated that service engagement at 6 months mediated the negative relationship between PNS and 12-month social and role functioning. These findings highlight the challenge of PNS in individuals with FEP receiving CSC, the importance of early service engagement, and an opportunity to develop targeted interventions and refine treatment approaches to improve outcomes in this unique subgroup.
Ethiopian people possess deep knowledge of how to use plant resources and are dependent on plant values mainly for traditional medicine. However, most ethnobotanical studies are restricted to rural areas, leaving urban centers poorly documented, which implies the need for further study. Thus, this study was conducted in Gondar City Administration, aimed at investigating medicinal plants to fill the traditional knowledge documentation gap. The study was conducted from February 2024 to January 2025 in 12 kebeles selected purposively based on vegetation cover, availability of knowledgeable practitioners and representation of both urban and rural settings. Data were collected using interviews, focus group discussions, guided field walks, and market surveys with 120 randomly selected general informants and 60 purposively selected key informants. Descriptive statistics were used to analyze the basic ethnobotanical data. An independent sample t-test and two-way ANOVA were used to analyze socio-demographic effects of informants on their indigenous knowledge. Different ethnobotanical ranking and clustering methods, Rahman's similarity index (RSI) and Jaccard's coefficient of similarity were also used. A total of 109 medicinal plants distributed across 95 genera and 54 families were recorded to treat 76 ailment types. Asteraceae was the foremost family with 9 (8.26%) species. Shrub was the dominant habit (39.45%) and leaves were the most valuable plant parts used for 33.80% of remedy preparations. Remedies were prepared mainly from fresh forms (76.39%) by crushing (20.37%) and administered through the dermal route (41.20%). Significant knowledge variation on medicinal plants was observed between key and general informants (P = 0.000), rural and urban kebeles (P = 0.001), and between age groups (P = 0.013). Informant type (general vs. key informant) and age had a highly significant interaction effect on the medicinal plant knowledge (P = 0.000). About 14.68% of all recorded species were reported to treat hepatitis. From those, Clutia lanceolata was the most preferred. The highest informant consensus factor value (98%) was associated with respiratory conditions. The RSI ranged from 0.5 to 13.79%, and the JSI ranged from 3.5 to 36%. After a systematic search was performed across various reputable databases (Scopus, PubMed, EMBASE, Web of Science, and Google Scholar), unique ethnobotanical information on the therapeutic roles of 12 medicinal plant species that have not been reported previously was documented. This finding indicates that the rich diversity of medicinal plants in Gondar City, along with unique ethnomedicinal findings, is an indicator of alternative use of traditional medicine by urban inhabitants for their healthcare system. However, urban ethnobotany is a distinct field in which is expected to evolve knowledge systems influenced by migration. So, these knowledge systems could experience an accelerated loss due to urbanization-related factors unless prior documentation is made.
Hospitalization often imposes significant psychological and physiological demands on patients. Mandala coloring may help reduce these challenges. This meta-analysis aimed to evaluate the effectiveness of mandala coloring interventions across psychological and physiological symptoms in adult hospitalized patients. A comprehensive search was conducted using nine databases. Randomized controlled and controlled studies comparing mandala coloring with control groups were included. Data extraction was performed independently by two authors, and risk of bias was assessed using the Cochrane RoB tool. GRADE Pro software was used to assess the quality of the evidence. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were pooled using RevMan (version 5.4). Subgroup analyses were performed by session frequency and duration. Seventeen studies with a total of 987 participants were included. Mandala coloring significantly reduced anxiety (SMD = - 2.16, 95% CI [-3.38, - 0.95]) and stress (SMD = - 2.45, 95% CI [-3.06, - 1.85]). Improvements were also observed in well-being (SMD = 4.51, 95% CI [0.81, 8.21]) and hope (SMD = 0.42, 95% CI [0.09, 0.75]). No significant effects were found for resilience, pain, fatigue, nausea, comfort, or vital parameters. Subgroup analyses indicated that brief (≤ 30 min) and multiple-session interventions were especially effective in alleviating anxiety. The level of evidence, as assessed using GRADE, was, however, low. Mandala coloring provides nurses and healthcare professionals with an inexpensive, low-resource, and patient-friendly method to enhance psychological well-being during hospitalization. Incorporating short, repeated sessions into routine care may strengthen resilience and patient comfort. Further large-scale and high-quality trials are required to establish standardized protocols and clarify effects on physiological symptoms. PROSPERO meta-analysis registration: CRD420251130565.
Immunoglobulin replacement therapy is an essential approach for treating patients with inborn errors of immunity that impair humoral response. The main goal of immunoglobulin replacement treatment is to provide antibodies passively, preventing severe or recurrent infections, as well as medium/long-term complications. Currently, there are different administration routes: intravenous, conventional subcutaneous, and facilitated subcutaneous with recombinant hyaluronidase. Therefore, the choice of the administration route should be individualized, with the active participation of the patient and guidance from healthcare professionals regarding the advantages and limitations of each option. This guideline aims to clarify the available immunoglobulin treatment modalities, provide practical guidance for their selection, and thereby promote better treatment adherence and effectiveness, leading to improved clinical stability for patients. A terapêutica substitutiva com imunoglobulina é parte essencial do tratamento dos erros inatos da imunidade que comprometem a resposta humoral. O seu principal objetivo é fornecer anticorpos de forma passiva, prevenindo infeções graves ou recorrentes, bem como as suas complicações a médio e longo prazo. Atualmente, existem diferentes vias de administração: endovenosa, subcutânea convencional, e subcutânea facilitada com hialuronidase recombinante. A escolha da via de administração deve ser feita de forma individualizada, com participação ativa do doente e orientação pelos profissionais de saúde quanto às vantagens e limitações de cada alternativa. Este protocolo pretende esclarecer sobre as modalidades disponíveis de tratamento com imunoglobulina, propor orientações práticas para a sua escolha e, com isso, favorecer uma maior adesão e eficácia terapêutica, promovendo maior estabilidade clínica dos doentes.
To translate, culturally adapt, and validate the short version of the Parenting Styles and Dimensions Questionnaire for use in Spanish populations. A cross-sectional study was conducted with parents of children aged 3-14 years attending private dental clinics, primary healthcare centers, and a university dental clinic. The adaptation process included forward translation, reconciliation, back-translation, expert review, and pilot testing. Psychometric evaluation of 334 valid responses was performed. Exploratory factor analyses examined the seven parenting dimensions and Baumrind's three parenting styles, and internal consistency was assessed using Cronbach's alpha. The Spanish version showed satisfactory structural validity, replicating the three parenting styles (authoritative, authoritarian, permissive) and a coherent seven-dimension structure after removing three items (25, 26, 28) to improve reliability. Subscale internal consistency was acceptable (α = 0.84 authoritative; 0.74 authoritarian; 0.63 permissive). The authoritative style was most prevalent (M = 4.35, SD = 0.45). The final instrument included 29 items and showed improved reliability (α = 0.548). The short PSDQ was successfully translated and culturally adapted for Spanish-speaking parents, demonstrating adequate validity and reliability. The validated instrument provides a practical and culturally appropriate tool for assessing parenting behaviors, with applications in research, clinical practice, and pediatric dentistry.
Opioid Use Disorder (OUD) has emerged as a critical public health issue among pregnant and postpartum individuals. To address this concern, it is of utmost importance that healthcare institutions, community-based programs, and other agencies collaborate to improve the support offered to the concerned population in their OUD recovery journey. A social network analysis was conducted to understand collaborations among multisectoral agencies serving or having potential to serve pregnant and postpartum individuals with OUD. Collaborations among agencies (n = 79), including three Continuous And Data-drivEN CarE (CADENCE) program clinics, in a large Florida county were mapped. A cross-sectional web-based survey was distributed to these agencies to capture inter-agency collaborations, including services provided (e.g., housing, transportation, etc.), interaction frequency, and perceptions of partner agency confidence, dependence, and value. Open-ended questions identified champion agencies and needs of agencies to better serve the population. Network maps of the agencies were generated to characterize the nature of existing collaborations and identify opportunities for strengthening interagency coordination. Twenty-six out of 79 enlisted agencies (33%) responded, describing connections with 72 enlisted agencies. The social network analysis of total 376 ties among these agencies demonstrated low density (0.108) but high clustering (0.637), indicating a connected core with tightly knit subgroups and cross-sector bridges especially through social services. CADENCE clinics were inter-linked; CADENCE Co-located pediatric/ psychiatric/Maternal-Fetal Medicine clinic was most connected (38 ties), followed by CADENCE Outpatient Prenatal Care clinic (16 ties), and CADENCE Addiction Medicine (9 ties). Collaboration frequency varied, with 34% of referral ties used only once a year or less, 13% used daily, and 17% never used. Agencies reported having confidence in 82% of collaborations, yet more than half (56%) were considered non-essential (no or little dependency) to achieving patient care goals. Qualitative insights emphasized integrated, trauma-informed care, standardized referral pathways and shared data; destigmatization, and harm reduction; simpler resource navigation and supports for housing and transportation. Overall, the county possesses a multisector perinatal OUD network that is yet underutilized. Strengthening structured referrals, interoperability, and wraparound, stigma-free services leveraging CADENCE could reduce fragmentation and improve maternal-infant outcomes. ClinicalTrails.gov (NCT05609669). November 02, 2022.