搜索结果：International medical education (Basel, Switzerland)

Background/Objectives: Retention of healthcare professionals in the workforce, their employment, and the improvement of working conditions largely depend on identifying the factors that influence their departure and their health. The study was conducted during the period from January to June 2021. This study aimed to examine the association between specific work-related stressors and work ability. The initial hypothesis was that general and specific occupational stressors negatively associate with work ability among healthcare professionals in emergency medical intervention teams. Methods: The study was designed as a cross-sectional comparative study. It was conducted among nurses and physicians in pre-hospital emergency medical services, employed full-time in intervention teams, while the control group consisted of employees from dispatch and call-receiving units. The study was conducted on the 840 participants, representing 43.3% of all healthcare professionals employed in pre-hospital emergency medical services in the Republic of Croatia. In addition to questions on participants' personal characteristics, the following instruments were used: 1. a validated Questionnaire on Workplace Stressors among hospital healthcare professionals; and 2. the international standardized Work Ability Index (WAI) questionnaire for assessing work ability. Participants completed the questionnaires in paper form. Results: On average, the participants demonstrated lower levels of stress compared to reference values, both for overall stress and for individual stress factors, while their work ability, assessed using the Work Ability Index (WAI), ranged from very good to excellent. The control group showed higher levels of stress across all factors and lower work ability. However, the control group was older on average, generally had lower levels of education, and consisted more often of women-personal characteristics that may influence the examined variables. Lower stress levels and better work ability were associated with job satisfaction, ambition, and the fact that participants were working in their desired profession. Frequent sick leave (absenteeism) was highly correlating with both higher stress levels and poorer work ability. Conclusions: Greater job satisfaction and higher motivation have a positive impact on stress levels and employees' work ability. The study results can serve as a starting point for institutional management in designing feasible decisions aimed at improving satisfaction, health, the work environment, and the work ability of emergency medical service personnel, as well as making these institutions more attractive for recruitment and retention of employees both in their positions and within the profession.

The integration of artificial intelligence (AI), particularly large language models (LLMs), into education, marks a profound shift in how knowledge is accessed, processed, and applied. These tools offer clear advantages-including improved efficiency, immediate support, and high productivity-but it may simultaneously weaken foundational skills. This Perspective examines the dual impact of AI on education, arguing that over-reliance on AI may displace essential cognitive processes that reinforce professional competence. Emerging evidence points to troubling associations between frequent AI use and diminished critical reasoning. We propose a model of critical alliance, in which AI augments but does not replace core intellectual processes. Unlike existing AI competency or digital literacy, this model centers on preserving human cognitive agency, judgment, reflection, and intellectual ownership, as primary educational outcomes. This framework not only emphasizes cognitive independence, but also equitable access, ethical vigilance, and faculty development as cornerstones of AI literacy. Addressing these questions is essential to safeguard both intellectual growth and educational equity in an AI-augmented era. Unlike existing digital literacy or AI competency frameworks, the critical alliance explicitly centers on preserving human cognitive agency and intellectual ownership as educational priorities, particularly in environments increasingly shaped by high-performing generative systems.

Diagnostic imaging is central to clinical decision-making across many care pathways, yet the expertise needed to use these images well is unevenly distributed across health systems, with workforce limitations identified as a major barrier to equitable access, particularly in low- and middle-income countries. Digital education has emerged as one response to this gap, offering scalability, asynchronous and just-in-time access, and the cost-efficiency required for global deployment. This paper examines the digital education portfolio of the International Atomic Energy Agency's Nuclear Medicine and Diagnostic Imaging Section, hosted mainly on the open-access Human Health Campus, which in 2025 recorded approximately 45,800 active users and 150,000 views across 159 countries. The portfolio combines structured e-learning courses, interactive webinars, virtual conference access through the Livestream programme, and a broader repository of publications, teaching cases, and reference resources, supported by an internal e-learning framework and learning management system infrastructure. Partnerships with international scientific societies further extend the reach of expert knowledge and professional exchange. The paper argues that these initiatives are best understood not as content delivery alone but as a coordinated strategy to support diagnostic quality at the level of the practising physician, extending access to expertise and strengthening the conditions for better practice, while remaining a complement to, rather than a substitute for, supervised clinical training.

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality globally, with serious implications in Lebanon. Both international and local guidelines advocate for empirical antibiotic treatments by illness severity, yet the extent to which these are followed in Lebanese hospitals is unclear. This research examined the adherence to CAP treatment guidelines and its association with clinical outcomes. Methods: We retrospectively studied adults admitted to two Lebanese referral hospitals (Mount Lebanon University Medical Center and Ain Wazein Medical Village) from April 2011 to March 2025 with CAP. Adherence to empirical antibiotic regimens was determined based on the guidelines from the Lebanese Society of Infectious Diseases and Clinical Microbiology, American Thoracic Society/Infectious Diseases Society of America, and British Thoracic Society/National Institute for Health and Care Excellence. The outcomes assessed were in-hospital mortality, Intensive Care Unit (ICU) admission, and length of hospital stay (LOS). We used logistic and linear regression analyses, adjusting for demographic and clinical variables. Results: A total of 337 patients were included with an average age of 61 years; 53.7% were male, 51.6% were admitted to the ICU, and the in-hospital mortality rate was 27%. In general, 65.6% of the treatment regimens adhered to at least one guideline. The combination of &#x3b2;-lactam and macrolide was the most common, used in 87.8% of cases, while monotherapy was administered in 31.8% of cases and included &#x3b2;-lactam, macrolide, fluoroquinolone, and other antibiotics; most monotherapies were non-adherent to guidelines, except for selected fluoroquinolone monotherapy cases that may be considered guideline-concordant under ATS/IDSA recommendations depending on clinical context. Adherence to guidelines did not significantly affect mortality rates (25.8% vs. 29.3%), ICU admissions (52.5% vs. 50.0%), or length of stay (11.4 vs. 9.3 days). Multivariate analysis revealed that older age (OR 1.025, 95% CI 1.008-1.042) and ICU admission (OR 1.024, 95% CI 1.012-1.039) were independent predictors of adverse outcomes, whereas guideline adherence, comorbidities, and inflammatory markers were not independently linked. Surprisingly, mortality was higher among younger patients (average age 58 vs. 67 years, p < 0.001). Conclusions: Although guideline-concordant empirical therapy was prevalent in this two-center Lebanese retrospective population, it did not independently correlate with length of stay following adjustment, ICU admission, or in-hospital mortality. Patient-related and clinical factors, such as the severity of the illness, may have an impact on observed differences in outcomes, which should be taken as relationships.

Up to one-third of medical inpatients experience clinically relevant mental distress, yet many remain untreated. Stepped and collaborative care (SCC) models may improve access to mental health care, but predictors of service uptake are unclear. We examined patient- and ward-level predictors of psychosomatic-psychiatric consultation (PPC). We analyzed data from SomPsyNet, a stepped-wedge cluster randomized trial targeting SOMatic inpatients across three Swiss tertiary hospitals, to prevent PSYchosocial distress by a care NETwork. Analyses focused on inpatients screening positive for mental distress. Multiple-imputed logistic regressions assessed predictors of four sequential service-use stages: PPC considered, offered, accepted, and received. Among 589 distressed patients, 93.9% were offered PPC, 63.1% accepted, and 83.9% of acceptors received PPC, yielding a 50% overall receipt rate. Patients without Swiss citizenship showed higher odds of acceptance (odds ratio [OR]&#xa0;=&#xa0;1.82 [1.10,&#xa0;3.00]) and eventual receipt (OR&#xa0;=&#xa0;1.62 [1.01,&#xa0;2.62]). Being in a geriatric ward facilitated PCC uptake, while patients from gynecology showed reduced progression through the care pathway. Age, gender, income, education, marital status, and living arrangement showed no statistically robust associations. Almost two-thirds of mentally distressed medical hospital inpatients accepted an offered PPC, indicating high acceptability. About half ultimately received a consultation, highlighting substantial attrition along the SCC pathway. Ward specialty and nationality were key determinants of PPC uptake. These findings suggest that proactive, ward-oriented consultation-liaison models embedded in routine inpatient care may improve timely and equitable access to mental healthcare, including for migrant and minority patients who are otherwise less likely to access such care.

Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences. We conducted an international online survey of ICU doctors and nurses. The 16-question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession. We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10&#x2009;mmol/L. Long-acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM-treatment protocol. Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long-acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol. This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as-needed and long-acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point-of-care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.

Background: Long-term survivors (LTS) after gynecological cancer may be cured but still face physical and psychological challenges. This multicenter study aimed to assess the long-term side effects, the received follow-up care, and the personal perspectives of survivors. Methods: Between 2019 and 2025, LTS from four European countries within the ENGOT (European Network of Gynecological Oncological Trial Groups) and GCIG (Gynecologic Cancer InterGroup) networks were recruited. Long-term survival was defined as surviving at least five years after the first diagnosis. LTS completed a questionnaire with 81 questions (patient's characteristics, oncological history, current health status, lifestyle factors). Analyses were mainly descriptive. Results: A total of 677 LTS were enrolled, with a median age of 64.0 years (range: 26-92) and a median survival time of 7 years (range: 5-38). A total of 46.6% were diagnosed with cervical cancer, 32.9% with endometrial cancer, 4.4% with ovarian cancer, and 16.1% with other types of gynecological cancer. Moreover, 36.9% still suffer from physical and psychological symptoms, most frequently being lymphedema (36.2%), hot flashes (22.4%), difficulties with concentration (21.1%), fatigue (20.9%), vaginal dryness (20.1%), and urinary incontinence (18.9%). Median overall health status was ranked (scale 1-5; 1 = very good, 5 = very poor) as 2, while 13.5% rated their health as poor/very poor. Current symptoms were associated with poorer health status (p < 0.001) and a history of recurrent disease (p = 0.001). In addition, 13.6% reported not receiving follow-up care. CA-125 was determined in 80.8% of ovarian LTS, as well as in 30.7% of cervical and 28.9% of endometrial LTS. Pap smear follow-up was reported by 50.5% of endometrial LTS. A total of 33.7% did not exercise at all or exercised less than an hour per week, 13.4% smoke tobacco, and 51.2% drink alcohol more often than once a month. Conclusions: Our findings highlight the need for patient-centered follow-up care, addressing both long-term side effects and education on lifestyle and prevention. Follow-up procedures that do not follow guidelines should be avoided.

The journal retracts the article titled, "Elastic Nanofibrous Membranes for Medical and Personal Protection Applications: Manufacturing, Anti-COVID-19, and Anti-Colistin Resistant Bacteria Evaluation" [...].

Background/Objectives: Many frontline healthcare professionals had not previously faced a crisis of the magnitude of the COVID-19 pandemic, and prolonged exposure to high-stress clinical environments may adversely affect psychological well-being. This study aimed to assess and compare burnout severity among critical care nurses in two clinical settings-one hospital in Croatia and one in Poland-with particular attention to emotional exhaustion, depersonalization, and personal accomplishment in the post-pandemic period. Methods: A cross-sectional comparative design was conducted across two hospitals (Croatia and Poland). Data were collected from 346 critical care nurses between September and December 2023. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey, analyzed primarily as continuous scores across its three dimensions. Results: No statistically significant differences were observed between the two groups in continuous burnout scores (Emotional Exhaustion p = 0.224, Depersonalization p = 0.852, Personal Accomplishment p = 0.636, total MBI score p = 0.394). Secondary cut-off-based analyses yielded some categorical differences, including a higher proportion classified as having high burnout in the Polish sample (43.2%) than in the Croatian sample (31.5%); however, these findings were exploratory and should not be interpreted as overriding the primary continuous-score results. Regression analyses demonstrated low explanatory power, with education level emerging as a significant predictor only in the Croatian sample (OR = 0.320, 95% CI: 0.125-0.824, p = 0.018). Conclusions: Burnout severity did not differ significantly between the two clinical settings when assessed using continuous measures. These findings suggest that burnout among ICU nurses may be driven primarily by shared occupational and organizational stressors rather than setting-specific differences. Categorical findings should be interpreted as complementary and exploratory.

Schistosomiasis remains a public health concern in sub-Saharan Africa, affecting over 250 million people. In endemic settings, schistosomiasis transmission is not always understood exclusively in biomedical terms. Community health workers (CHWs) contribute to schistosomiasis control through mass drug administration and health education, yet limited evidence exists on how they understand schistosomiasis transmission. This study explores how CHWs in C&#xf4;te d'Ivoire, Kenya and Uganda explain schistosomiasis transmission and how these explanations relate to wider disease and training contexts. This paper draws on the CHW component of a larger mixed-methods study conducted in C&#xf4;te d'Ivoire, Kenya and Uganda, with multiple respondent groups. We present findings from interviews and focus group discussions with CHWs. Data were analysed thematically, at both semantic (descriptive) and latent (interpretive) level, employing Kleinman's framework of explanatory models and Good's work on semantic networks to support interpretation. CHWs expressed multiple understandings of schistosomiasis transmission. Most described schistosomiasis transmission in biomedical terms, often emphasising skin contact with contaminated water. Others combined biomedical terms with locally circulating ideas about disease transmission, linking infection to drinking unsafe water, stepping on faeces, flies or other diseases such as trachoma or diarrhoeal illnesses. These understandings emerged in relation to a complex disease landscape in which signs, symptoms and perceived transmission routes overlapped. They were also situated within uneven training experiences, including irregular refresher sessions, variable access to schistosomiasis-specific training and training focused mainly on treatment campaign logistics. CHWs' varying understandings of schistosomiasis reflect not only individual knowledge but also the broader disease landscape and training contexts in which they work. Strengthening schistosomiasis communication therefore requires attention to how CHWs interpret, adapt and combine disease-specific information with other sources of knowledge, and to how training can better prepare them to navigate similarities and differences between disease-specific messages in everyday practice.

Family medicine has attracted increasing policy and institutional support across the Gulf Cooperation Council (GCC) countries through health system reform, expansion of the healthcare workforce, and sustained public investment. Nevertheless, important challenges continue to affect the strength of primary healthcare systems, access to care, and the management of non-communicable diseases. The aim of the narrative review is to identify future trends, directions, perspectives, and opportunities that can strengthen implementation of family medicine across GCC countries and improve healthcare delivery. This review is based on a structured search of major databases such as PubMed, Scopus, and Google Scholar. The focus was evaluation of literature associated with family medicine and primary healthcare development in GCC countries. Regional priorities now include improving medical education and training, expanding the family medicine workforce, strengthening links with communities, promoting more equitable access to healthcare, and managing treatment costs through workforce development and digital health initiatives. Family medicine practice across the GCC is being supported increasingly by electronic health records, telemedicine, and interprofessional education. Policy directions in the region also suggest growing interest in value-based research, international collaboration, multidisciplinary care, and innovation in healthcare delivery. The future of development of family medicine in the GCC will depend on better integration of digital health, more effective use of data in planning and policy, continued investment in training, and broader adoption of patient-centred models of care. In general, strengthening family medicine through sustained investment in workforce development, primary healthcare infrastructure, research capacity, and digital health integration is essential for achieving resilient, equitable, and patient-centered healthcare systems across the GCC.

Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with GDM frequently experience heightened stress, anxiety, and uncertainty, underscoring the need for accessible information, counseling, and ongoing support to navigate glucose monitoring, dietary adjustments, and treatment regimens. Although clinical management has been extensively studied, research has largely focused on metabolic monitoring and therapeutic interventions, often underemphasizing prevention strategies, women's informational needs, and maternal psychological well-being. Emerging evidence and international guidelines increasingly advocate for integrating these components into structured, woman-centered GDM care plans that actively involve families. Such approaches empower women to engage in self-management, enhance health literacy, support adherence to lifestyle and pharmacological interventions, and promote sustainable behavioral changes. This narrative review presents a comprehensive, holistic model of care across the perinatal continuum, emphasizing early risk identification, preventive strategies, and multidisciplinary coordination. Core elements include individualized antenatal education, empathetic communication, and family engagement, fostering self-efficacy, continuity of care, and integration of medical, educational, and psychosocial interventions. Equipping healthcare professionals with the competencies to deliver this holistic, woman-centered framework is essential to optimize maternal and neonatal outcomes and mitigate the long-term health consequences of GDM.

Background/Objectives: Neglect of children's oral health is a major concern at international, national, and regional levels. Of all the health problems that can occur in childhood, dental ones are among the most common. Tooth decay, for example, is a chronic condition in children and can have long-term consequences, especially in otorhinolaryngology and pediatric diseases if not treated properly. Methods: The data collection method was questionnaire. Questionnaires were administered to parents regarding oral hygiene habits and access to dental services; data were collected in dental offices across Timi&#x219; County, encompassing urban, peri-urban, and rural settings. Children enrolled in the study underwent clinical dental examinations to assess their oral health status (dental caries, gingival diseases, developmental anomalies). Results: Parental education level was not significantly associated with the habit of annual dental check-ups (&#x3c7;2, p = 0.092); however, a directional trend was observed. Total monthly family income was significantly associated with the stated reason for not attending dental check-ups (one-way ANOVA, p = 0.043): families with lower incomes more frequently cited financial and logistical barriers, whereas higher-income families cited lack of time or perceived lack of necessity. Parental education level (p < 0.001) and family income (p < 0.001) were both significantly associated with daily tooth-brushing frequency. Conclusions: The efforts of specialists must be increased through coherent policies, adapted education, and real support for vulnerable groups. An informed child, with supported parents, is a child with a real chance at a healthy life. This is not just a professional opinion, but a collective responsibility.

Clinical guidelines for cancer care recognize multidisciplinary tumor boards (MTBs) as a gold standard for providing quality of care for cancer patients. However, the requirements and workflow for MTBs varies across countries, influencing their roles in decision making, care efficiency, and medical education. This study compares validity and performance of MDT evaluation tools, Measure of case-Discussion Complexity (MeDiC) and Metric for the Observation of Decision-Making (MODe) in the UK versus US. MeDiC, developed to assess case complexity, and MODe, designed to evaluate decision-making quality, were applied to 555 cases and 104 MTB meetings from urological and gynecological tumor boards at an academic cancer center between December 2021 and June 2024. MeDiC was used to assess clinical complexity through pathology, patient, and treatment factors, while MODe evaluated decision-making quality based on patient information and team contributions. All assessors underwent formal training. Data analysis included reliability testing using intraclass correlation coefficients (ICCs), Kappa, Cronbach's alpha, and bootstrapping was used to estimate confidence intervals for correlation estimates. MeDiC demonstrated good reliability (ICC&#x2009;=&#x2009;0.849) in the US MDT and identified key factors contributing to complexity, such as malignancy and significant comorbidities. The tool also revealed that case discussion duration was not significantly associated with complexity levels. MODe similarly showed moderate reliability (ICC&#x2009;=&#x2009;0.628), with high correlations between decision-making quality and contributions from core specialties such as medical oncologists. The validity of MeDiC and MODe in the US was similar to the tools' performance in the UK settings. However, case complexity metrics demonstrated significant selection of more complex cases for US MDT presentation compared to UK MDTs.

Hidradenitis suppurativa (HS) is a chronic, systemic, immune-mediated disease requiring multimodal care, which is crucial for raising awareness and advancing treatment. This project aimed to establish consensus among HS experts to define HS Competence Centers (HSCC) criteria using the Delphi consensus method. Overall, 22 global HS experts (3 patient representatives and 19 healthcare professionals [HCPs]) from 16 countries across 5 continents were invited to participate. Subsequently, a three-step Delphi polling was conducted among the HS experts from 20 May 2024 to 8 July 2024. A 50% agreement was required to reach consensus. Consensus levels included strong consensus (&#x2265;&#x2009;95%), consensus (&#x2265;&#x2009;75%), majority agreement (&#x2265;&#x2009;50%) and no majority agreement (<&#x2009;50%). In the prepolling step, 22 participants proposed 26 criteria. In step 1, 23 criteria were selected, of which 6 (23.1%) reached strong consensus, 11 (42.3%) reached consensus, and 6 (23.1%) majority agreement. The remaining 3 (11.5%) criteria proposed were rejected. In step 2, 13 of the 23 criteria (56.5%) were proposed for wording modifications. Of these, four (30.8%) retained initial wording and nine (69.2%) were modified. In step 3, 21 of the 23 criteria were identified as very important (91.3%), while 2 (8.7%) were considered less important. Among the 21 very important criteria, 2 (9.5%) reached strong consensus, i.e., essential, 12 (57.1%) reached consensus, and 7 (33.4%) had majority agreement. Overall, a set of 23 criteria (2 essential, 12 required-1st grade, 7 required-2nd grade, and 2 potential) was recommended to establish HSCC. This article reveals a consensus among an international group of HCPs and patients on a series of evidence-based criteria for HSCC. Standardized care, a hub and spoke model, multidisciplinary teams, specialized treatments, well-defined protocols, patient education, medical training, and robust referral systems were identified as essential/very important criteria for HSCC.

Systematic approaches to studying pharmacist-patient communication are relevant to support the development of communication practices to improve identification and resolvement of patient medication-related problems. However, there is currently no established gold standard for systematically coding pharmacist-patient communication, making it relevant to explore whether existing Systematic Coding of Observed Human Behavior (SCOBe) systems from other healthcare professions could be transferable to pharmacy practice. Therefore, this commentary explores the opportunities and challenges of applying existing SCOBe systems, originally developed in other healthcare professions, to pharmacist-patient communication research, education, and practice. A group of pharmacy researchers carried out a screening and assessment process of already validated SCOBe systems, developed for other health settings, with regard to degree of need for adaptation to a pharmacy practice context. While many SCOBe systems appear potentially transferable to pharmacy practice, it is currently unclear what degree of adaptation is required. Some tools may need only limited revisions, whereas others would require major structural changes or complete re-validation to fit the pharmacist-patient context, a process that is both important and resource-intensive. The outcomes were discussed according to the need for pharmacy researchers to strategically select communication domains and prioritize validated instruments that can enhance comparability and strengthen collective knowledge. Collaborative efforts within international pharmacy networks may support the development of a recommended core set of coding tools. Moreover, SCOBe systems hold value not only for research but also for pharmacist education, contributing to a more humanistic and person-centered professional identity.

This study presents the development and psychometric validation of a Career Identity Questionnaire for vocational school students aged 15-19 years. Career identity was conceptualized as comprising career exploration and career commitment, based on theories of identity development and career guidance. Two studies were conducted. In Study 1 (N = 188), principal component analysis (PCA) was used to determine the final structure of the questionnaire. From an initial pool of 20 items, 14 items were retained: 8 items for career exploration and 6 items for career commitment. The two scales were positively correlated (r = 0.48, p < 0.01), with Cronbach's alpha coefficients of 0.78 and 0.88, respectively. In Study 2 (N = 293), convergent and structural validity were examined using correlation analysis, canonical correlation, ANOVA, and confirmatory factor analysis (CFA). The CFA supported a three-factor structure consisting of exploration within the educational profile, exploration outside the educational profile, and career commitment. Career exploration correlated with school satisfaction (r = 0.31), subjective well-being (r = 0.26), and school success (r = 0.14), while career commitment showed stronger associations with the same variables (r = 0.56, 0.27, and 0.15, all p < 0.01). Canonical correlation analysis indicated significant relationships between career identity dimensions and mental health, with the strongest weights observed for career commitment (rs = -0.96) and career exploration (rs = -0.60), explaining 14% of the variance in mental health, while mental health explained 23% of the variance in career identity. Students with below-average values of commitment and exploration reported lower school success, satisfaction, and well-being. The findings provide evidence for the reliability and validity of the questionnaire, supporting its use in both research and practice in educational settings.

Objective: The aim of this study was to explore how healthcare professionals in the Republic of Ecuador perceive violence against women, its underlying social determinants, and their role in prevention and response within the healthcare setting. Methodology: A qualitative descriptive study was conducted using purposive sampling. Ten healthcare professionals with experience in managing cases of violence against women participated. Data were collected through semi-structured interviews and analysed using Braun and Clarke's reflective thematic analysis. The ATLAS.ti software was used throughout the analysis process. Results: The participants emphasised the normalisation of microaggressions, institutional shortcomings in prevention systems, and the need for gender-sensitive professional training. Three main themes emerged from the data analysis: (1) the characteristics and identification of violence against women, (2) the social dimensions of violence against women, and (3) combating violence against women in clinical and educational settings. Conclusions: The healthcare professionals highlighted the need to recognise normalised and less visible forms of violence reflected in everyday attitudes and behaviours. They emphasised the importance of early identification, multidisciplinary care and sex education as preventive strategies. The social context and deep-rooted power dynamics favour the perpetuation of violence against women. Healthcare professionals can play an important role in the prevention of violence against women by improving care for survivors, identifying areas for improvement within existing prevention systems, and promoting sex education.

Rural-urban disparities are well documented in pediatric healthcare, influencing access, service organization, and outcomes. However, whether these differences extend to the domain of nursing care remains unclear. This study examined the association between degree of urbanization and nursing complexity among children admitted to a single tertiary-care pediatric hospital, comparing clinical, organizational, and nursing characteristics across geographic groups. Routinely collected electronic nursing documentation and hospital administrative records were retrospectively examined in a tertiary-care pediatric hospital in Rome, Italy. Children aged 2 to <18 years were consecutively included. Degree of urbanization was defined using the ISTAT-derived DEGURBA classification. The study outcome for nursing complexity corresponded to the number of nursing diagnoses documented at hospital admission. Descriptive analyses and a multivariable negative binomial regression model assessed the association between urbanization and nursing complexity, adjusting for age, sex, DRG weight, number of medical diagnoses, and chronic conditions. Among 1652 pediatric hospitalizations, those from rural areas showed a higher clinical burden, with significantly higher DRG weight and more chronic conditions, but nursing complexity did not differ significantly across geographic groups. In the multivariable model, degree of urbanization was not independently associated with nursing complexity for admissions from towns and suburbs (IRR = 0.93, 95% CI 0.82-1.04, p = 0.211) or rural areas (IRR = 1.00, 95% CI 0.84-1.20, p = 0.966), compared with those from cities. Higher DRG weight (IRR = 1.11, 95% CI 1.05-1.17) and a greater number of medical diagnoses (IRR = 1.17, 95% CI 1.11-1.25) were positively associated with nursing complexity, whereas the number of chronic conditions showed an inverse association (IRR = 0.90, 95% CI 0.84-0.96). In this single-center sample, rural-urban differences in clinical burden are not accompanied by statistically detectable differences in nursing complexity at hospital admission. Despite a higher clinical burden among children admitted from less urbanized areas, nursing complexity does not appear to differ significantly across geographic groups. Standardized nursing data enhance the ability to compare admission-level care needs across geographic contexts, enabling more precise and stratified population and public health analyses.