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Gender dysphoria (GD) involves a marked incongruence between an individual's experienced gender and their sex assigned at birth. Individuals with GD often experience a strong desire to be treated as another gender and frequently face significant health disparities, including limited access to care, higher risks of depression, and suicide. These challenges are often exacerbated by healthcare providers' knowledge gaps and discriminatory attitudes. This study's objective is to assess the knowledge, attitudes, and practices (KAP) of healthcare providers in Saudi Arabia regarding GD and to identify gaps that could inform targeted educational interventions. A cross-sectional online survey was conducted with healthcare providers in Saudi Arabia (Nov 2024-Jun 2025). A total of 156 responses were gathered. The questionnaire included domains of knowledge (9 items), attitude (11 items), and practice (4 items) on a 7-point Likert scale. Missing responses, including "I don't know," were imputed. Descriptive statistics were used to summarize participant responses. Associations among knowledge, attitude, and practice scores were examined using Spearman's rank-order correlation, with additional subgroup analyses conducted to explore variations by demographic characteristics. Participants demonstrated moderate to strong knowledge and generally positive attitudes toward individuals with GD, particularly regarding pronoun use, mental health assessment, and awareness of health disparities. However, practical engagement was limited, with only 19% reporting direct clinical experience and a few having received GD-related training. Scores varied by age, training level, and specialty, as respondents aged 24-39 years showed the strongest knowledge and attitude scores, and practice scores were highest among those aged 40-49 years, while senior registrars demonstrated the highest overall KAP scores, and psychiatry showed the strongest overall specialty profile. Healthcare providers demonstrate foundational knowledge and supportive attitudes but limited practical experience in managing GD. Targeted training and structured clinical exposure are recommended to improve culturally competent and inclusive care.

The Facial drooping, Arm weakness, Speech difficulty, Time to call 911 (FAST) mnemonic raises awareness of common stroke signs and symptoms and reinforces the urgency of activating emergency services. We examined the prevalence of knowledge of appropriate action for FAST-related stroke signs and symptoms among US adults aged ≥18 years. Cross-sectional, national survey data from the National Center for Health Statistics' Rapid Survey System were collected in February-March 2025. Respondents were asked about the best action for: face drooping, arm weakness, speech difficulty, and suspected stroke. For each outcome by select sociodemographic covariates, we calculated prevalence and adjusted prevalence ratios using survey-weighted quasi-Poisson regression. Among US adults, knowledge of appropriate action for four stroke signs and symptoms ranged from 70.8% to 83.9%. However, only 56.3% (95% CI, 54.8-57.8) identified the appropriate action for all assessed signs and symptoms. Overall, 44.6% (95% CI, 43.2-46.0) reported having heard of FAST. Compared with adults who had not heard of FAST, those who had were 31% more likely to know the appropriate action for all 4 signs and symptoms (adjusted prevalence ratio, 1.31 [95% CI, 1.24-1.39]). Knowledge of appropriate action for stroke signs and symptoms was high. However, only about half of adults identified the appropriate action for all signs and symptoms, suggesting gaps in stroke knowledge. Amplifying messaging, especially among adults at risk of stroke and their families, may improve knowledge of stroke signs and symptoms and the importance of calling 911, enabling early recognition and potentially decreasing morbidity and mortality.

Zoonotic diseases are common threats to global health. A large number of infectious diseases are transmitted from animals to humans. The current study aimed to assess the community's knowledge, attitudes, and practices (KAP) regarding common zoonotic diseases in the Arbaminch district. A cross-sectional survey was carried out between November 2024 and June 2025. A total of 384 participants were interviewed in the study. Participants residing in these areas were randomly chosen. Data were collected using a structured questionnaire. The collected data were analyzed using Stata 17, and the results were reported using descriptive statistics and the chi-square test. The findings of this study revealed that a majority (55%) of participants had good knowledge about zoonotic diseases. Respondents know several modes of transmission for zoonotic diseases, with animal bites (32.5%) being the most recognized, followed by direct contact (15.5%), ingestion of raw products (10%), and inhalation (10%). Regarding attitudes, 63.2% of respondents exhibited a positive attitude towards the importance of zoonotic disease prevention and control, and 67.4% of respondents followed relatively good hygiene and preventive behaviors. However, risky practices were still common. Knowledge score showed a significant association with age. Attitudes of participants were significantly associated with education, age, occupation, and income. Similarly, practices were significantly associated with gender, education level, occupation, and income, with all associations being statistically significant (p&#x2009;<&#x2009;0.05). The overall community knowledge, attitudes, and practices regarding zoonotic diseases were relatively good.

Mental health research aims to improve people&#x2019;s well-being, but it does not always fully include the voices of those with direct experience of mental health difficulties. This is especially important in countries like Nepal, where experiences of distress are shaped by family relationships, social expectations, culture, and stigma. When these realities are not included, research may miss what people are actually going through. This paper is based on my personal journey working with Youth Advisory Boards (YABs) and Community Advisory Boards (CABs) in mental health research. Over time, I have been involved in different roles: first as a young advisory member, then as a research coordinator and study manager, and now as a doctoral researcher. These boards included young people and community members with lived experience of mental health challenges and suicidality. My experiences show that advisory boards can play an important role at every stage of research. They help shape research questions, improve study tools, guide ethical decisions, and ensure that sensitive topics like suicide are discussed in safe and culturally appropriate ways. They also help researchers better understand what participants really mean. For example, in my study, advisory members explained that a common Nepali word for &#x201c;difficulty&#x201d; actually reflects many combined pressures, such as family expectations and financial stress, rather than a single problem. The paper also shows that advisory boards are most valuable when they are treated as partners, not just consulted occasionally. When they are meaningfully involved throughout the research process, they help produce knowledge that is more accurate, culturally relevant, and ethically sound. At the same time, working with advisory boards can be challenging. It requires time, resources, careful planning, and attention to power differences and emotional safety. Overall, this paper argues that listening to people with lived experience is not only the right thing to do, but also improves the quality of research. Advisory boards can help make mental health research more inclusive, grounded in real life, and useful for communities.

Menopause can affect women's psychological well-being and cognitive function. We adopted phenomenology to explore women's experiences of menopause symptoms. Four women self-identifying as peri-menopausal, menopausal or post-menopausal completed an autophotography task and semi-structured online interviews. Interpretative Phenomenological Analysis generated four themes: Adrift on a sea of confusion summarized women's worries and uncertainty about change; Planning for uncharted waters recounted unfamiliar symptoms and "relief" of "diagnosis"; Going with the flow describes acceptance of change; and Toward calmer currents revealed an emerging coherent identity. Women's menopause experiences were both positive and challenging. Epistemic injustice, experienced through poor services and healthcare professional knowledge, delayed help-seeking. Phenomenological theory explained coexisting incommensurate feelings of psychological distress and growing resilience. Reconstructing menopause as opportunity for growth in older womanhood would benefit women's quality of life. To facilitate earlier help-seeking and access to treatment, societal and professional education needs strengthening to include the breadth of menopause symptoms.

Chronic enteropathies characterized by multiple superficial ulcers of the small intestine have long been under-recognized, particularly in their early stage. However, the occurrence of refractory occult bleeding and episodes of partial bowel obstruction in this disease severely impacts quality of life, while targeted therapeutic options remain limited. Although dysfunction of the prostaglandin metabolic pathway has been associated with mucosal damage, the underlying molecular mechanisms and potential therapeutic targets remain unclear. In recent years, in-depth investigations of nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy, along with the discovery of rare monogenic disorders affecting the prostaglandin metabolic pathway, have helped bridge this knowledge gap. A broader concept, termed "prostaglandin-associated enteropathy (PGAE)", has since emerged, representing a monumental breakthrough in the differential diagnosis of nonspecific small intestinal ulcers. This narrative review focuses on prostaglandin metabolism and chronic intestinal ulcers, including NSAID-induced enteropathy and chronic enteropathies associated with solute carrier organic anion transporter family member 2A1 (SLCO2A1) and phospholipase A2 group IVA (PLA2G4A). By unraveling molecular connections and highlighting innovative therapeutic avenues, we aim to advance clinical management and improve the well-being and quality of life for patients with PGAE.

Bovine tuberculosis (bTB) remains one of the most significant challenges for the animal health industry in the United Kingdom, costing millions of pounds annually with associated trade implications. The Bovine Tuberculosis Advisory Service (TBAS) is a government-funded initiative in England assisting private veterinarians to provide tailored advice to farmers to help implement preventive measures to reduce the risk of bTB on their farms. However, limited understanding persists regarding factors influencing preventive measure implementation. The aim of this study were to identify the barriers and facilitators influencing preventive medicine implementation from the perspective of TBAS advisors and farmers who participated in the initiative. Thirteen semi-structured interviews were conducted with six farmers and seven TBAS advisors. Transcripts were analysed using inductive thematic analysis, followed by deductive mapping to the Capability, Opportunity, and Motivation Behaviour (COM-B) model of behaviour change. Opportunity and motivation emerged as the primary drivers of decision-making. Key barriers included a lack of time, expense, and the perceived feasibility of implementing a recommended measure (physical opportunity). Policy-related factors linked to the policy-farm disconnect (social opportunity) and farmers' perceived control over bTB (reflective motivation) also acted as a barrier. Facilitators included a good farmer-advisor relationship (social opportunity), involving farmers in decision-making processes (reflective motivation) and a clear understanding of the rationale and benefits of the recommendations (psychological capability). Integrating this knowledge into the TBAS programme, including strategies to overcome barriers and utilise facilitators, could improve the implementation of bTB preventive measures, and enhance its contribution to the goal of eradicating bTB.

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Despite substantial advances in interventional cardiology, profound disparities in access to care and clinical outcomes remain across racial/ethnic and sex groups. These inequities arise from a complex interplay of biological differences, structural barriers, and sociocultural determinants that shape disease recognition, treatment allocation, procedural decision-making, and long-term follow-up. A further driver is the limited understanding of cardiovascular disease in female patients and racial/ethnical minorities, largely attributable to their persistent underrepresentation in clinical research, thereby restricting the external validity of evidence and perpetuating gaps in practice. This review explores how social and biological dimensions intersect to influence risk profiles, clinical presentation, procedural strategies, and secondary prevention in contemporary practice, focusing on the 2 most widely performed interventions in cardiology: percutaneous coronary intervention and transcatheter aortic valve replacement. It also highlights how such differences are often not integrated into standardized pathways of care, allowing inequities to persist even in the era of advanced cardiovascular technologies. Ultimately, it may serve as a call to action: advancing equity in interventional cardiology requires more than representative trial enrollment. It demands reform in study design, systematic stratification of outcomes, and structural change in care delivery to ensure that innovations in cardiovascular medicine benefit all patients.

Spatial neglect-a multifaceted neuropsychological (NP) syndrome-has been studied extensively after stroke. Yet its prevalence, trajectory, and anatomical underpinnings in parietal glioma remain poorly defined. We performed a systematic literature review to synthesize current evidence on neglect in this population, highlighting its temporal course, the white-matter networks implicated, and the NP assessment. A systematic literature search was conducted following PRISMA guidelines, using keywords related to parietal gliomas and visuospatial deficits. Eligible studies included adult patients with parietal gliomas assessed with NP assessment. Only nine heterogeneous studies met inclusion criteria. Overall, across 86 parietal glioma cases, neglect was documented in 12% pre-operatively and in 23% post-operatively. Long-term follow-up (reported for just five patients) suggested an 80% recovery rate. Most cases recovered within five days, indicating that neglect may be transient or under-detected. Low-grade gliomas (LGGs) were associated with a lower risk then high-grade gliomas (HGGs), despite the limited sample size. Diffusion-tensor imaging (DTI) and direct electrical stimulation (DES) consistently implicated the second branch of the superior longitudinal fasciculus (SLF&#x202f;II), while pointing to a broader fronto-parietal network involved in both onset and recovery. Comprehensive NP batteries proved critical for delineating neglect occurrence and evolution, and co-existing visuospatial or global cognitive deficits. Neglect frequency rises after resection of parietal gliomas, though current evidence is limited by small, heterogeneous samples.&#xa0;While most patients recover within three months, these findings rely on low-quality data often limited to single-task assessments.&#xa0;Multimodal evaluation via DTI, DES, and comprehensive NP batteries is essential for tracking recovery. Larger, prospective studies are needed to clarify the network dynamics that govern neglect emergence and resolution, and to refine evidence-based management strategies.

Apparent neural encoding of future words may arise from the statistical structure of language itself, rather than from predictive computations in the brain.

The authors sought to identify barriers to participation in psychiatric research, especially for members of racial-ethnic minority groups, and applied a community engagement model to identify strategies to improve trust in science and research participation among individuals with psychiatric or substance use disorders. Using the Bridging Research, Accurate Information, and Dialogue (BRAID) model as a framework, the authors conducted 10 cofacilitated conversation circles with 15 adults with psychiatric or substance use disorder diagnoses across three clinical and community-based sites in New York. Thematic analysis was used to identify key barriers to research participation and community-informed strategies for engagement. Participants described a deep mistrust of psychiatric research and behavioral health care that was rooted in histories of harm, a lack of shared decision making, and provider stigma. Stigma and discrimination-particularly during emergency and pain-related visits-were pervasive and compounded by participants' racial-ethnic, economic, and diagnostic groups. Participants endorsed the conversation circles as safe, empowering spaces. Lack of trust, stigma, and discrimination continue to deter minoritized patients' engagement in psychiatric research. Community-driven models, such as BRAID, offer a promising pathway to rebuild trust; amplify patients' voices; and promote ethical, equitable research and services.

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Common shoulder disorders are a major source of pain and disability worldwide. Although mechanical overload, degeneration, and trauma are well-recognized contributors, substantial variability in disease onset, severity, and response to treatment suggests that biological and inherited factors may also influence disease susceptibility and progression. In recent years, advances in genomic and molecular research have provided new insights into the mechanisms underlying common shoulder pathologies. Evidence from family-based studies, genome-wide association studies, transcriptomic analyses, and causal inference approaches indicates that several common shoulder conditions demonstrate a measurable genetic component. Rotator cuff disease and adhesive capsulitis show the strongest evidence for inherited susceptibility, involving pathways related to extracellular matrix remodeling, inflammation, and fibrosis. Glenohumeral osteoarthritis is primarily characterized by altered gene expression within diseased cartilage and periarticular tissues, although shoulder-specific inherited risk data remain limited. Shoulder instability has been associated with variation in genes involved in collagen synthesis and capsular remodeling, though the distinction between inherited predisposition and secondary molecular responses to injury remains incompletely defined. These findings support the concept that common shoulder pathologies are multifactorial disorders influenced by both genetic susceptibility and disease-specific molecular processes. This narrative review aims to synthesize and contextualize current evidence on the role of genetics in 4 prevalent shoulder conditions: rotator cuff tears, adhesive capsulitis, glenohumeral osteoarthritis, and shoulder instability, with the goal of providing an accessible overview for practicing orthopedic surgeons.

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Acute traumatic aortic injury (ATAI) is a rare but life-threatening consequence of blunt trauma that requires prompt diagnosis and accurate imaging assessment. This review presents an imaging-based approach to ATAI, with emphasis on computed tomography angiography (CTA) as the first-line modality for diagnosis, grading, treatment planning, and follow-up. CTA enables the detection of both direct and indirect signs while also allowing for the assessment of lesion severity, extent, and associated findings that may influence management. Familiarity with common mimics and anatomic variants improves diagnostic confidence and helps avoid false positive interpretations. Careful protocol optimization, including multiphasic acquisition, bolus timing, and postprocessing reconstructions, can further enhance image quality and diagnostic performance. Recognition of patient-related and technical CTA artifacts, along with strategies to reduce them, including the selective use of ECG-gated CTA, may further decrease diagnostic uncertainty. We also discuss the complementary roles of emerging CT technologies and magnetic resonance angiography in selected patients. Finally, we review current classification systems, imaging-guided management, post-treatment surveillance, and potential complications. Awareness of ATAI imaging findings, protocol optimization, and diagnostic pitfalls is essential for accurate interpretation and effective multidisciplinary care.

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