Romania has a poor uptake of COVID-19 vaccination in its population. The study objectives were to evaluate the differences between vaccinated and unvaccinated hospitalized COVID-19 patients with regard to disease severity, intensive care need, and mortality during the fourth and the fifth wave of the pandemic associated with the Delta and Omicron variants of concern. A retrospective study on a cohort of hospitalized COVID-19 patients was performed in a Romanian tertiary hospital for infectious diseases. Multivariate logistic regression models were built predicting severe/critical COVID-19, intensive care need, and death as a function of vaccination status and adjusted for age, comorbidities, and wave of the pandemic. 2235 COVID-19 patients were included, and vaccination status, as a primary vaccination or a booster dose, was described in 750 (33.5%). Unvaccinated patients were older, with more cardiovascular and endocrine diseases, a longer duration of hospitalization, a higher percentage of severe/critical COVID-19, need for intensive care, and death (p < 0.05). The multivariate logistic regression models adjusted for age and comorbidities showed higher odds ratio for severe/critical COVID-19, intensive care need, and mortality in unvaccinated versus vaccinated patients. Our results support vaccination to prevent severe outcomes associated with COVID-19 due to both variants of concern. Full article

This study aimed to characterize the pre-attentional effects on global precedence processing in children with autism spectrum disorder (ASD) and those with typical development (TD). A sample of 17 participants, comprising eight children with ASD and nine TD children, were recruited for the study. A tablet-based assessment utilizing a global and local visual processing paradigm task was developed to investigate the participant’s abilities. The task consisted of verbal instructions to locate and touch either a global or local figure, presented in five conditions: neutral, congruent, and incongruent. The percentage of correct answers and reaction time (RT) for each task were measured and analyzed statistically. Results revealed that children with ASD exhibited statistically significant differences in both the percentage of correct scores and RT among various conditions, while TD children displayed differences in RT but not in the percentage of correct answers. These findings suggest that conflicting processes affect both behavioral and cognitive processes in children with ASD, and that cognitive effort is still involved for children with TD, but does not affect behavioral processes. In children with ASD, the RT was the shortest in the congruent (report local figure) condition; in children with TD, the RT was the shortest in the congruent (report global figure) condition. This implies that children with TD exhibit a pre-attentive effect on global precedence processing, while children with ASD do not. These visual-processing-function characteristics may aid in screening for visual perception problems in children with ASD. Full article

(1) Background: Colorectal cancer (CRC) is a serious health problem in Poland as well as many European Union countries. The study aimed to describe factors that, from the patient’s perspective, could increase the attendance rate and regularity of participation in the colorectal cancer screening programme (SP); (2) Methods: The qualitative approach was applied. The study involved six focus interviews conducted with 24 respondents (12 women and 12 men) aged 40–49, who had at least one first-degree family member diagnosed with CRC and persons aged 50–65, living in five selected voivodships (provinces) of Poland. The collected data were thematically coded. Further, a comparative analysis was conducted, and aggregated statements were formulated; (3) Results: The inclusion of primary care clinics within the CRC SP organization was reported as a key factor in improving the attendance rate and regularity of patient participation in the programme. Particularly important factors included an invitation in the form of a personal letter or a phone call made by staff from primary care clinics; (4) Conclusions: Patients were confirmed to have clear expectations and preferences for the organizational conditions of the CRC SP. Preferences nature allows them to be treated as one of the potential criteria for selecting critical parameters of CRC SPs. Full article

Background: Nowadays, health organizations seek to bring innovations to their services to stand out in competition with their rivals by improving service quality (SQ), encouraging patients to always make the same organizational choices, and enhance the behavior of patient citizenship. Objective: This study aims to determine the mediating role of patient satisfaction (PS), patient loyalty (PL), and employee responsiveness (ER) between the service quality and patient citizenship behaviors (PCB). Methods: In order to test the proposed hypotheses, quantitative research methods were utilized; cross-sectional data was collected using scales between December 2021 and March 2022. Results were obtained from 422 participants. The data were analyzed using descriptive statistics, correlation, confirmatory factor analysis, and structural equation modeling methods, using AMOS 21. Results: SQ was found to have a significant and positive effect on PL, PS, and ER. PL, PS, and ER were found to have a significant and positive effect on PCB. The indirect effect of SQ on PCB was found to be positive. Discussion: The findings demonstrate that SQ does not directly affect or create PCB, but it is affected by the mediators in order to create PCB via satisfaction, loyalty, and employee responsiveness. Full article

Stoma bag filter-related issues, such as ballooning (the bag filling with gas), remain highly prevalent among users. The full-circle filter was purposely designed to reduce ballooning through the inclusion of a unique, full-circle pre-filter. Two similar randomized crossover trials were conducted to compare the performance of the full-circle filter with a dual filter in adults with a colostomy (n = 20) or an ileostomy (n = 20). The frequency of ballooning was significantly lower with the full-circle filter versus the dual filter in participants with a colostomy (p < 0.0007) and in participants with an ileostomy (p < 0.0001). No significant differences were observed in the frequency of other issues (pancaking, odor problems, and ostomy solution discretion) between the filters. On average, participants with an ileostomy wore ostomy solutions with the full-circle filter for 3.3 h longer than ostomy solutions with the dual filter (p < 0.0001); wear-time in users with a colostomy was comparable between the filters. Considering the lack of published research on stoma bag filters and the high prevalence of filter-related issues, these data provide important information for health care practitioners who support people living with a stoma. Full article

Previous studies have revealed various factors related to nurses’ resilience and predictors of resilience. However, there are no studies analysing the association of three variables—mental well-being, coping strategies, and stress—with resilience. This study aims to assess the impact of mental well-being, levels of stress, and coping strategies on resilience using path analysis. This study used a cross-sectional approach that involved 763 nurses from 16 major hospitals in the eastern and northern regions of Saudi Arabia during the COVID-19 pandemic. The data gathering was conducted from August to November 2022. The staff nurses possessed positive mental wellness (3.75 ± 1.08), moderate stress levels (3.06 ± 1.21), adequate coping skills (3.33 ± 1.23), and a low level of resilience (2.90 ± 1.040). Age had a small effect on resilience (β = 0.040; p < 0.001) but work experience (β = −0.019; p > 0.139) and marital status (β = 0.019; p > 0.072) were not significant. Conversely, mental well-being (β = 0.043; p < 0.001) and stress (β = −0.089; p < 0.001) had a small effect on resilience, but coping strategies (β = 0.561; p < 0.001) had a large effect on resilience. Therefore, coping strategies must be reinforced at all times to assist nurses and other healthcare professionals in identifying contributing elements that maintain these workers’ resilience in the face of unforeseen and protracted pandemics and other life events. Full article

The coronavirus pandemic (COVID-19) is a global health crisis with a particular emotional and physical impact on health professionals, especially nurses. The aim of this study was to investigate the prevalence of anxiety, depression and fatigue and their possible relationships among nurses during the pandemic. The study population consisted of nurses from five tertiary-level public hospitals in Athens who completed the Fatigue Assessment Scale (FAS), Beck Depression Inventory (BDI) and State–Trait Anxiety Inventory (STAI) questionnaires. Gender, age and years of work experience were recorded. The study was conducted from mid-November to mid-December 2021. The sample included 404 nurses (69 males and 335 females) with a mean age of 42.88 years (SD = 10.90) and 17.96 (SD = 12.00) years of work experience. Symptoms of fatigue were noted in 60.4% of participants, while 39.7% had symptoms of depression, 60.1% had abnormal scores on state anxiety and 46.8% on trait anxiety, with females showing higher scores on all scales (p < 0.05). High positive correlations (p < 0.01) were found between the FAS, BDI, State Anxiety and Trait Anxiety scales. Regression analysis showed that 51.7% of the variance in FAS scores can be explained by trait anxiety, an additional 6.2% by the BDI and 1.2% by state anxiety. Mediation analysis showed that state anxiety and BDI mediate the relationship between trait anxiety and FAS. Finally, BDI was found to exert a moderating role in the relationship between trait anxiety and fatigue. In conclusion, our study showed that nurses continue to experience high rates of anxiety, depression and fatigue. The variation in fatigue appears to be significantly dependent on trait anxiety. Depressive symptomatology and state anxiety exert a parallel positive mediation on the relationship between trait anxiety and fatigue, with depression exhibiting a moderating role in this relationship. Full article

(1) Background: Long-term caregiving for patients receiving hemodialysis (HD), is associated with physical and psychological stress, which may impact on the well-being and quality of life of caregivers. Due to a lack of understanding of the experiences of informal caregivers of patients receiving HD, especially in Saudi Arabia, this study aimed to measure burden in informal caregivers of patients receiving HD, examine the factors that predict caregiver burden (CB), and explore the experience of burden in caregivers of patients receiving HD. (2) Methods: This study used a mixed-methods, sequential, explanatory design, which consisted of two phases. Phase 1 involved a cross-sectional study design, with a convenience sample of 61 caregivers of patients on maintenance HD for at least 3 months. All caregivers in the study completed the Arabic version of the Zarit Burden Interview to identify caregiver burden. Phase 2 of the study involved a qualitative descriptive design involving semi-structured interviews with nine caregivers. (3) Results: Study findings indicate that caregivers did not experience severe burden. Being older, a female caregiver and having comorbidities was positively associated with increased levels of caregiver burden. In the qualitative phase of the study, a number of important factors emerged that may contribute to a reduction in caregiver burden, including social support, cultural acceptance, and religious influences. (4) Conclusion and impact: CB was found to be low when a comparison was made with other studies using similar populations. Understanding the factors that influence caregiver burden will contribute to the accurate assessment of caregiver burden and help reduce burden in informal caregivers, patients with renal failure, and others with chronic illnesses worldwide. Full article

Scientific evidence indicates that workers in the health sector are commonly exposed to work-related musculoskeletal pain. Objectives: We aimed to identify the relationship between the presence and intensity of musculoskeletal pain in the neck and lumbar regions reported by Primary Health Care (PHC) workers with workloads and occupational risks, analyze musculoskeletal pain in the presence and absence of self-reported mental disorders based on a medical diagnosis, and identify workers’ strategies to manage pain. Method: This cross-sectional study addressed 338 health professionals working in PHC outpatient services in the extreme South of Brazil. One questionnaire addressed sociodemographic questions concerning occupation, occupational risks, and mental disorders. The Nordic Musculoskeletal Questionnaire was used to assess self-reported musculoskeletal pain. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) measured the workload. A descriptive and inferential analysis was performed using SPSS version 21.0. Results: Most (55.3%) participants reported neck and (64.5%) lower back pain in the previous 12 months, and 22.5% and 30.5% reported intense neck and lower back pain, respectively, in the previous 12 months. The results showed different independent associations with increased musculoskeletal pain among health workers. Dentists presented the highest prevalence of neck pain, while female workers presented the highest prevalence of lower back pain. Furthermore, the perception of ergonomic risk and virtually all self-reported mental disorders (except panic syndrome for neck pain) were associated with pain in the neck and lower back regions and a higher frustration level (mental demand). Additionally, professionals with graduate degrees, nurses, and professionals working the longest in PHC services reported seeking complementary therapies more frequently, while physicians and those with self-reported mental disorders self-medicated more frequently. Full article

(1) Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; (2) Methods: A national survey conducted via an online self-questionnaire, including clinical vignettes for which the midwives proposed a diagnosis, a drug treatment, a mode of birth, and a prognosis. These responses were used to evaluate the conformity of the responses to the guidelines, as well as the influence of certain criteria, such as mode of practise and experience; (3) Results: Of 728 responses, only 26.1% of the midwives reported being aware of the 2017 clinical practise guidelines. The midwives proposed taking the appropriate actions in 56.1% of the responses in the case of a recurrence, and in 95.1% of the responses in the case of a primary infection. For the specific, high-risk case of a nonprimary initial infection at 38 weeks of gestation, reporting knowledge of the recommendations improved the compliance of the proposed care by 40% (p = 0.02). However, 33.8% of the midwives underestimated the neonatal risk at term after a primary initial infection, and 43% underestimated the risk after a primary initial infection at term; (4) Conclusions: The majority of reported practises were compliant despite a low level of knowledge of the guidelines. The dissemination of guidelines may be important to improve information and adherence to appropriate therapeutic practise. Full article

Previous research on co-creation in healthcare indicates that the use of co-creation in the design process of health solutions influences their greater acceptance and adaptation, resulting in greater efficiency of health services and higher usability of implemented health solutions. Analysis of adaptation and acceptance of new technologies reveals the problem of misunderstanding and the need for more trust in modern tools implemented in the healthcare system. The remedy may be the use of co-creation in the process of developing modern medical products and services. This article’s main purpose is to explore the co-creation process in Health 4.0, which is understood as the development of healthcare through the application of methods and tools of the Fourth Industrial Revolution. The literature review provided insights for an analytical framework—the co-creation matrix. We analyzed the case of the Italian medical platform Paginemediche.it to reveal the actors’ engagement in co-creation. The results demonstrated different levels of engagement in improving the efficiency of implementing medical and technological solutions. Both theoretical and practical analysis proved that the co-creation matrix helps more precisely define the scale and scope of co-creation in Health 4.0. Full article

The AUC_0–24 is the most accurate way to track the vancomycin level while the C_min is not an accurate surrogate. Most hospitals in Saudi Arabia are under-practicing the AUC-guided vancomycin dosing and monitoring. No previous work has been conducted to evaluate such practice in the whole kingdom. The current study objective is to calculate the AUC_0–24 using the Bayesian dosing software (PrecisePK), identify the probability of patients who receive the optimum dose of vancomycin, and evaluate the accuracy and precision of the Bayesian platform. This retrospective study was conducted at King Abdulaziz medical city, Jeddah. All adult patients treated with vancomycin were included. Pediatric patients, critically ill patients requiring ICU admission, patients with acute renal failure or undergoing dialysis, and febrile neutropenic patients were excluded. The AUC_0–24 was predicted using the PrecisePK platform based on the Bayesian principle. The two-compartmental model by Rodvold et al. in this platform and patients’ dose data were utilized to calculate the AUC_0–24 and trough level. Among 342 patients included in the present study, the mean of the estimated vancomycin AUC_0–24 by the posterior model of PrecisePK was 573 ± 199.6 mg, and the model had a bias of 16.8%, whereas the precision was 2.85 mg/L. The target AUC_0–24 (400 to 600 mg·h/L) and measured trough (10 to 20 mg/L) were documented in 127 (37.1%) and 185 (54%), respectively. Furthermore, the result demonstrated an increase in odds of AUC_0–24 > 600 mg·h/L among trough level 15–20 mg/L group (OR = 13.2, p < 0.05) as compared with trough level 10–14.9 mg/L group. In conclusion, the discordance in the AUC_0–24 ratio and measured trough concentration may jeopardize patient safety, and implantation of the Bayesian approach as a workable alternative to the traditional trough method should be considered. Full article

Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks’ gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression. Full article

Informed consent is the manifestation of the will that a patient freely expresses toward a medical treatment. The physician is responsible for acquiring informed consent for both medical and nursing procedures. Informed consent represents a juridical–deontological tool that allows therapeutic choices to be shared with the user after having exhaustively explained the risks and benefits of the procedure itself. In fact, the physician has an obligation to provide the patient with clear and comprehensible information about the type of service, the methods of delivery, the benefits, the risks, even unforeseeable ones, and the complications. According to Italian legal guidelines, in cases of presumed health responsibility, the health professional accused of negligence will have to demonstrate that any complication that has arisen, although foreseeable, was not preventable. Through the analysis of a clinical case relating to the procedure of insertion of a bladder catheter performed by a nurse and a review of the literature, the authors explain the importance of the information that must be provided to the patient before carrying out any invasive procedure, even if not performed by the doctor. The authors describe the problem in the Italian context and propose a possible solution. Full article

Healthcare professionals often feel challenged by complex patients and the associated care needs during care transition. Interprofessional collaboration (IPC) is considered an effective approach in such situations. However, a fragmented healthcare system can limit IPC. This study explored experiences of Swiss healthcare professionals regarding complex patient care transition and the potential of IPC. Professionals from nursing, medicine, psychology, physiotherapy, dietetics and nutrition, social service, occupational therapy, and speech therapy were included. A qualitative between-method triangulation design was applied, with two focus group discussions and ten individual interviews. The combination of different data-collection methods allowed us to explore complex patient care transition and to systematically add perspectives of healthcare professionals from different care settings. Three main themes were identified: (1) Participants described their vision of an ideal complex patient care transition, i.e., the status they would like to see implemented; (2) participants reported challenges in complex patient care transition as experienced today; and (3) participants suggested ways to improve complex patient care transition by IPC. This study highlighted that healthcare professionals regarded IPC as an effective intervention to improve complex patient care transition. It emerged that sustainable implementation of IPC across care organizations is currently limited in Switzerland. In the absence of strong and direct promotion of IPC by the healthcare system, professionals in clinical practice can further promote IPC by finding hands-on solutions to overcome organizational boundaries. Full article

The aim of this ecological study is to evaluate correlations between the number of COVID-19 vaccine doses administered in three Italian provinces—one in the south, one in the center and one in the north of the country—and the registered numbers of COVID-19 cases in the same areas. The period of January 2021–September 2022 was considered, with specific analysis for fractions of times corresponding to the spread in Italy of the different SARS-CoV-2 variants. The results confirm the reduction of the effectiveness of the vaccines in preventing new COVID-19 cases in Italy, regardless of latitude, after the appearance of the first omicron variants. The new variants omicron 4 and 5 showed an extremely high spread during the Italian summer months; fortunately, the effects of the vaccinations in preventing new cases was improved compared to the previous omicron variants, showing a negative correlation between the new COVID-19 cases and the number of vaccine doses administered. Full article

The variances in operating room (OR) cancellation rates between different service lines and operators within these service lines were assessed by reviewing the electronic medical record (EMR) covering 34,561 cases performed by 199 OR operators in 2018. We assumed that cancellations would differ between different service lines, but the between-operators variance was minimal within the service line. We hypothesized that most variability would be secondary to patient-specific (weekdays, time of year, and national holidays), seasonal and administrative issues. Of 4165 case cancellations, the majority (73.1%) occurred before the patient arrived at the hospital. A total of 60% of all cancellations were within gastroenterology, interventional cardiology, and orthopedics. Cancellation rate variability between surgeons operating within the same service line greatly varied between services from very homogenous to very diverse across providers. The top reasons for cancellation were: date change, canceled by a patient, or “no show”. The highest cancellation rates occurred on Mondays and Tuesdays, in January and September, and during weeks associated with national holidays. In summary, cancellation variability must be analyzed at the level of individual specialties, operators, and time variability. Full article

Poor supervision, impaired exercise adherence, and low compliance with exercise regimens result in inconsistent effects regarding exercise interventions. A supervised-walk training regimen (9 km/week) may have a positive effect on functional recovery in female total knee arthroplasty (TKA). This study aimed to evaluate the effect of a supervised walking regimen on lower limb muscle strength, functional fitness, and patient-reported outcomes in female TKA. Twenty-eight female TKA were allocated into a control (CON) (n = 14) or walk training (WT) (n = 14) group. WT on treadmills was initiated 12 weeks after TKA. All patients were examined for lower muscle strength (including extension and flexion of hip and knee), physical function (including a 6-min walk test, 8-foot up-and-go test, and 30-s chair stand test), and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Knee flexor (WT: CON; 64.4 ± 4.1 nm/kg: 43.7±3.3 nm/kg; p = 0.001; effect size: 5.62) and extensor strengths (WT: CON; 73.1 ± 7.5 nm/kg: 48.2 ± 2.4 nm/kg; p = 0.001; effect size: 4.47) statistically increased in the WT group compared to the CON group. The 6-min walk test (from 341.3 ± 20.5 m to 405.5 ± 30.7 m; p = 0.001; effect size: 2.46) and 8-foot up-and-go test (from 9.5 ± 0.7 s to 8.3 ± 0.7 s; p = 0.002; effect size: 1.71) tests also showed significant improvements in the WT group in the follow-up compared to the baseline. An increase in quality of life score according to the KOOS questionnaire (WT: CON; 91.0 ± 2.8: 68.1 ± 5.8; p = 0.001; effect size: 5.02) was noted in the WT group compared to the CON group in the follow-up. WT facilitated improvements in knee muscle strength and functional outcomes in TKA patients. Full article

Background: Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. Methods: We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR ‘taster’ sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. Results: Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). Conclusions: HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder. Full article

Research on access to health services during the COVID-19 pandemic is limited, and the conceptualization of access has not typically included access to community resources. We developed and tested an access-to-health-services measure and examined disparities in access among individuals in the U.S. during the pandemic. Data are from a U.S. sample of 1491 respondents who completed an online survey in August 2021. Linear regression models assessed the relationships between the access-to-health-services-measure components, including impact on access to medicine and medical equipment, impact on access to healthcare visits, and confidence in accessing community resources, and predictor variables, including sociodemographic- and health-related factors. Disparities in access to healthcare during the pandemic were associated with sociodemographic characteristics (i.e., race, gender, and age) and health-related characteristics (i.e., chronic illness, mental health condition, and disability). Factors such as race, gender, income, and age were associated with individuals’ degree of confidence in accessing community services. Our study presents a new access-to-health-services measure, sheds light on which populations may be most vulnerable to experiencing reduced access to health services, and informs the development of programmatic interventions to address the salient needs of these populations. Full article

Background: Communication and advance care directives may be affected by the presence of dementia. We sought to describe the information and end-of-life preferences provided to nursing homes residents and their families. Methods: Trained nurses collected information from 124 residents randomly selected with palliative care needs from eight nursing homes. Results: A total of 54.4% of the residents with dementia had been provided with information about their state of health, compared to 92.5% of the residents without dementia (p < 0.01); family members exhibited no differences regarding information (p = 0.658), regardless of whether the resident was cognitively impaired. Most advance care interventions remained unexplored, except for cases where a transfer to hospital (81.5%) or serotherapy (69.4%) was desired. Decisions regarding palliative sedation (p = 0.017) and blood transfusion (p = 0.019) were lower among residents with dementia. Conclusions: Residents, especially residents with dementia, are provided with limited information and their preferences are inadequately explored. Full article

The purpose of this study was to prospectively monitor and analyze injuries in Greek amateur male soccer players over one competitive season. One hundred and thirty male soccer players in a regional amateur league participated in this study. Injury data and exposure were collected from six teams during training and competition match over one season (2018/19). Injuries were collected weekly and were classified by setting, mechanism, severity, type, calendar distribution, period of injury occurrence, and anatomical location. A total of 103 injuries were recorded during the season, with an incident rate (IR) of 5.5 injuries/1000 h with 95% confidence intervals (CI) values of 4.45 (lower limit) and 6.09 (upper limit). Furthermore, IR was greater for the posterior thigh (IR 1.83/1000 h, 95% CI 1.21–2.44) and hip/groin complex (IR 1.45/1000 h, 95% CI 0.90–1.99) compared to other anatomical locations. Similarly, muscle injuries had greater IR (IR 3.61/1000 h, 95% CI 2.74–4.47) than other tissues. Amateur soccer players had a seven-fold greater chance of getting injured during games (IR 20.76/1000 h, 95% CI 15.28–26.24) rather than during training (IR 3.077/1000 h, 95% CI 2.16–3.80), while injury rates were higher towards the end of a session and peaked in October and February of the season. Based on these results, amateur soccer may benefit from injury prevention strategies incorporated into their regular training practice and focus on muscle injuries, especially in the posterior thigh and the hip/groin complex. Full article

Obesity and vitamin D deficiency are two major public health concerns. Evidence suggests that alteration in gut microbiota composition is a possible risk factor for obesity. Additionally, altered vitamin D status has a potential role in shaping the gut microbial community. Further, the prevalence of obesity has been rising in the Middle East, especially among women of reproductive age, which is of specific concern due to its adverse effects on the health of their offspring. To date, limited evidence is available on the association between gut microbiota composition and vitamin D levels in Arab women. This study aims to identify the associations between serum vitamin D, gut microbiota, and obesity among Saudi females. The current study is a case–control study including 92 women aged 18 to 25 years, (n = 48) with normal weight and (n = 44) with obesity. Anthropometric, biochemical, lifestyle data, and fecal samples were collected and analyzed. We used shotgun metagenomic sequencing to characterize microbial communities of stool samples. Vitamin D levels were significantly associated with alpha and beta diversities. Serum vitamin D levels were positively associated with bacteria known to regulate immunological responses; Bacteroides thetaiotaomicron in the normal weight group (r = 0.34, p = 0.03) and Bifidobacterium adolescentis in the obesity group (r = 0.33, p = 0.04). In conclusion, the findings suggest that vitamin D status may play a role in regulating the gut microbiota composition by inhibiting the growth of pathogenic bacteria while nourishing the beneficial strains. Full article

The COVID-19 pandemic is a major global stressor that has been associated with elevated risk of negative mental health symptoms. As a helping profession, our main task should be identifying factors that may shield individuals from the negative consequences of stress, rather than only focusing on the causes and symptoms of stress. One such factor, identified in the literature, is an individual’s perception of their problem-solving skills. In this study we investigate the role of problem-solving appraisal in the association between perceived stress and psychological well-being. Participants were students (n = 322) who completed the Problem Solving Inventory, the Perceived Stress Scale, the short forms of the trait scale of the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale. The results demonstrate the health-sustaining benefits of problem-solving appraisal, as all dimensions of problem-solving appraisal (problem-solving confidence, approach-avoidance style, and problem-solving control) were directly associated with hopelessness and anxiety. The stress-buffering role of problem-solving appraisal with respect to hopelessness was demonstrated through the interaction between perceived stress and problem-solving appraisal. However, problem-solving appraisal did not buffer the effects of stress on anxiety. The findings indicate that problem-solving appraisal may be an important protective resource that could be beneficial for coping with other negative events and experiences beyond COVID-19. The implications of these findings for interventions are discussed. Full article

Nursing theories focus on individual and community care and human relationships in unique contexts. One of these contexts is the community in which a theory-based systematic nursing practice process is warranted. This article describes a theory of Community Caring for Public Health Nursing (CCPHN), which is grounded in four nursing metaparadigms by Fawcett: persons, environment, health, and nursing. This theory has three assumptions: (1) community caring fosters care demonstrations in nursing, (2) caring communities comprise members with community attachments united by their common values rather than rigid customs, and (3) community caring is expressed competently in mutual-care practices. From these assumptions, a nursing perspective supporting the community caring process is exhibited as the expression of caring by public health nurses toward supportive and promotive nursing processes that enhance a caring community. Nurses play critical roles in leading the establishment of caring communities. In future research, it is critical to verify whether building a caring community by public health nursing practices based on this theory of CCPHN contributes to the health and well-being of the people in the community. Full article

Background: Understanding patient experience is key to optimize access and quality of outpatient cancer rehabilitation (physical or occupational therapy, PT/OT) services. Methods: We performed a retrospective mixed-method analysis of rehabilitation medical record data to better understand patient experience and aspects of care that influenced experience. From the medical record, we extracted case characteristics, patient experience data (Net Promoter Survey^®, NPS) and patient-reported outcome (PRO) data. We categorized cases as ‘promoters’ (i.e., highly likely to recommend rehabilitation) or ‘detractors’, then calculated NPS score (−100 [worst] to 100 [best]). We identified key themes from NPS free-text comments using inductive content analysis, then used Pearson [r] or Spearman [ρ] correlation to explore relationships between NPS, characteristics, and PRO improvement. Results: Patients (n = 383) were 60.51 ± 12.02 years old, predominantly women with breast cancer (69.2%), and attended 14.23 ± 12.37 visits. Most were ‘promoters’ (92%); NPS score was 91.4. Patients described two experiences (themes) that influenced their likelihood to recommend rehabilitation: (1) feeling comfortable with the process and (2) observable improvement in health/functioning, and described attributes of clinic staff, environment and clinical care that influenced themes. Likelihood to recommend rehabilitation was associated with achieving the minimal clinical important difference on a PRO (ρ = 0.21, p < 0.001) and cancer type (ρ = 0.10, p < 0.001). Conclusion: Patients who received specialized cancer PT/OT were highly likely to recommend rehabilitation. Feeling comfortable with the rehabilitation process and making observable improvements in health and/or functioning influenced likelihood to recommend. Rehabilitation providers should leverage the findings of this study optimize access to and quality of cancer rehab services. Full article

Automated dental imaging interpretation is one of the most prolific areas of research using artificial intelligence. X-ray imaging systems have enabled dental clinicians to identify dental diseases. However, the manual process of dental disease assessment is tedious and error-prone when diagnosed by inexperienced dentists. Thus, researchers have employed different advanced computer vision techniques, as well as machine and deep learning models for dental disease diagnoses using X-ray imagery. In this regard, a lightweight Mask-RCNN model is proposed for periapical disease detection. The proposed model is constructed in two parts: a lightweight modified MobileNet-v2 backbone and region-based network (RPN) are proposed for periapical disease localization on a small dataset. To measure the effectiveness of the proposed model, the lightweight Mask-RCNN is evaluated on a custom annotated dataset comprising images of five different types of periapical lesions. The results reveal that the model can detect and localize periapical lesions with an overall accuracy of 94%, a mean average precision of 85%, and a mean insection over a union of 71.0%. The proposed model improves the detection, classification, and localization accuracy significantly using a smaller number of images compared to existing methods and outperforms state-of-the-art approaches. Full article

Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies. Full article

Background: It is not known whether intensive care unit (ICU) patients’ family members realistically assess patients’ health status. Objectives: The aim was to investigate the agreement between family and intensivists’ assessment concerning changes in patient health, focusing on family members’ resilience and their perceptions of decision making. Methods: For each ICU patient, withdrawal criteria were assessed by intensivists while family members assessed the patient’s health development and completed the Connor–Davidson Resilience Scale and the Self-Compassion Scale. Six months after ICU discharge, follow-up contact was established, and family members gave their responses to two hypothetical scenarios. Results: 162 ICU patients and 189 family members were recruited. Intensivists’ decisions about whether a patient met the withdrawal criteria had 75,9% accuracy for prediction of survival. Families’ assessments were statistically independent of intensivists’ opinions, and resilience had a significant positive effect on the probability of agreement with intensivists. Six months after discharge, family members whose relatives were still alive were significantly more likely to consider that the family or patient themselves should be involved in decision-making. Conclusions: Resilience is related to an enhanced probability of agreement of the family with intensivists’ perceptions of patients’ health progression. Family attitudes in hypothetical scenarios were found to be significantly affected by the patient’s actual health progression. Full article

Background: Excessive gingival display or “gummy smile” is a clinical condition where a maxillary gum shows between the inferior line of the superior lip and the gingival line of the incisive superior during a spontaneous smile. The aim of this research was to understand the various skeletal and dentoalveolar components contributing to a gummy smile in a sample of 120 patients. Material and Methods: This retrospective case-control study had the primary objectives of analyzing the existence of a correlation between the presence of gingival exposure and the alteration of the inclination of the upper incisors with respect to the Frankfurt plane, the Palatine plane (bi-spinal) and to the NA line in a sample of orthodontic patients, and also evaluating the association with skeletal, dental, and aesthetic cephalometric parameters. Result and Conclusions: In our study, it’s emerged a correlation between the gingival exposure and the presence of alterations to incisal torque in the vestibular direction and the quantity of maxillary gingiva evident during the smile, which is correlated in particular to the Is–Sts distance, overjet and overbite. The major indicative data, therefore, are related to the vertical position of the upper incisors, in particular with respect to the upper lip and to the sagittal position. Full article

Postpartum depression (PPD) is a serious public health problem in many Middle Eastern countries. Mothers with PPD experience various extreme symptoms that affect their daily lives. This study aims to discover how common PPD is in the Jazan region, the most significant risk factors, and how likely depressed women are to seek help. An observational cross-sectional survey targeting a sample of 444 mothers in their first year after delivery using a pre-tested and validated EDPS standard tool to evaluate the prevalence of postpartum depression amongst them has been conducted. The data was collected and then analyzed using SPSS. Descriptive statistics and inferential statistics were used for data analysis. Multivariate logistic regression was used to assess the risk factors associated with PPD. The results indicate an extremely high prevalence of PPD in Jazan (75.7%). The prevalence of mothers having suicidal ideation was 6.3% quite often, 5.0% sometimes, and 7.9% hardly. Regarding the duration of depression symptoms, 34.78% were less than a month, 20.72% were less than six months, and 13.06% were less than one year. The study shows that the development of depression symptoms occurred within less than a week for 30.4% of the women. The most significant association with PPD was a lack of family support, which significantly increased the risk of PPD (OR = 5.9; p-value < 0.001). The mothers who had unexpected pregnancies had a risk of PPD (OR = 2.5; p-value < 0.001). Current research has revealed a high prevalence of postpartum depression among mothers in the Jazan region and that it is associated with different risk factors that increase the probability of PPD development. Pregnant women need to raise their awareness about PPD and learn how to avoid or deal with it. Full article

This study explores the perceived congruence of effective values of nursing leadership between the nurse leaders and the staff nurses in a multicultural tertiary hospital. Methods: This is a descriptive sequential mixed-methods study conducted in a multicultural medical city in Saudi Arabia. Purposive sampling was used in the qualitative phase, while stratified sampling was used for the quantitative part. There were 70 participants in the qualitative phase, including 33 nurse leaders and 37 staff nurses. The quantitative phase had 571 participants, including 105 nurse leaders and 466 staff nurses. Results: Congruent values were categorised into six emerging themes: (1) cascading deference; (2) paragon of probity; (3) professional competence; (4) compassionate presence; (5) team diversity and inclusion; (6) calibrated communication. The quantitative survey confirmed that the values identified from the interviews were considered to be vital by both nurse leaders and staff nurses, and there were no statistically significant differences between staff nurses’ and nurse leaders’ perceptions, regardless of their nationality, as demonstrated by one-way ANOVA, with p-values less than 0.05 deemed to be statistically significant. Conclusion: Both nurse leaders and staff nurses in the multicultural institution have congruent leadership values that are perceived as essential to achieve institutional goals and, ultimately, safe and high-quality patient care. Full article

In our study, attitudes and perceptions of adult primary health care users regarding COVID-19 vaccination were evaluated. A single-center, cross-sectional study was conducted during a 1-year period (March 2021–March 2022) in a rural area in Crete, Greece. A sample of 626 self-reported questionnaires was collected at the end of the study period. Overall, 78% of respondents stated that they had received the COVID-19 vaccine. The reasons behind vaccine uptake were mainly personal beliefs and the desire to avoid professional constraints. The presence of diabetes type 2, fear of infection, and high perceived efficacy of vaccine previous flu vaccination, living with vulnerable persons, and the influence of scientific information were all significant predictors of COVID-19 vaccine uptake. On the contrary, unwillingness and/or uncertainty to be vaccinated was associated with fear of vaccine side effects, information insufficiency, media/internet information, older age, the presence of inflammatory arthritis, previous COVID-19 infection, the belief that infection confers much greater immunity than the vaccine, and attitudes against vaccinations in general were predictors against COVID-19 vaccination. In conclusion, taking into account all of the above predictors and particularly those regarding safety and vaccine effectiveness may guide future strategies appropriately tailored to specific characteristics and needs of different geographic populations. Full article

The objective of this study is to discover any possible association of gender or practitioner classification with orthodontic knowledge and attitudes towards orthodontic treatment. Descriptive cross-sectional research was conducted on two groups of dentists in the Ha’il region of Saudi Arabia. Group I included general practitioners, while Group II had non-orthodontic specialists. The findings suggest a statistically significant (p < 0.05) difference between the knowledge and attitudes of general practitioners and non-orthodontic specialists. Independent two tailed t-scores for difference in Knowledge (t-score = 3.19919, p = 0.003) and Attitude (t-score = 2.16314, p = 0.048319), highlight significant disparities in the knowledge and attitudes of general practitioners and non-orthodontic specialists. However, no statistically significant difference was observed in terms of knowledge and attitudes based on gender differences. This study captures and highlights subtle information that is very significant in dealing with critically important orthodontics issues. The study suggests that it is possible that a non-orthodontic specialist may suggest an altogether different line of treatment with different consequences when compared to a general practitioner and vice versa. This may result in unwanted, permanent orthodontic effects, highlighting the significance of the early stage of orthodontic treatment awareness. This research reveals disparities between the perceptions of general practitioners and non-orthodontic specialists about the stage and relevance of orthodontic treatment. It is strongly advised to see an orthodontic expert rather than a general practitioner or non-orthodontic specialist for orthodontic issues. Full article

Studies have shown that aerobic exercise (AE) may improve symptoms related to non-specific neck pain (NNP); however, the variables of the exercise programs and the overall effectiveness of AE have not been evaluated in a systematic review. Therefore, this review aimed to describe and discuss the variables of the AE programs used in clinical trials for patients with NNP. Included studies were analyzed for the selected AE variables such as intensity, frequency, duration, delivery, supervision, and adherence. The PEDro scale was used to assess the methodological quality of the studies. From the literature search, six studies met the inclusion criteria and were evaluated. After reviewing all the included studies, it was found that a range of AE interventions were used such as cycling, brisk walking, aerobics, stationary bike, treadmill running, circuit training, and swimming. Further, the duration was between 30 and 45 min for each session, with or without progressive increases from week to week. The intervention periods ranged from 1 month to 6 months in duration. Most studies used AE three times per week. Furthermore, exercise intensity was measured with either subjective (BORG) or objective measures (heartrate reserve). Justification for the specified intensity and reporting of adverse events was reported only in two studies and differed between studies. Exercise interventions were poorly reported. This review showed that moderate-intensity AE undertaken three times per week, in patients with NNP, may be beneficial for pain and function; however, the development of reporting standards is essential for the successful replication of studies. Full article

Background: Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors. Methods: This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis. Results: The average BES score was 10.67 (SD = 6.66, 0–34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman’s rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (r_s = −0.14–0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05–6.04 times those of male participants and those without such experiences (p < 0.05). Conclusion: The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy. Full article

The velocity loss method is often used in velocity–based training (VBT) to dynamically regulate training loads. However, the effects of velocity loss on maximum strength development and training efficiency are still unclear. Therefore, we conducted a dose–response meta–analysis aiming to fill this research gap. A systematic literature search was performed to identify studies on VBT with the velocity loss method via PubMed, Web of Science, Embase, EBSCO, and Cochrane. Controlled trials that compared the effects of different velocity losses on maximum strength were considered. One–repetition maximum (1RM) gain and 1RM gain per repetition were the selected outcomes to indicate the maximum strength development and its training efficiency. Eventually, nine studies with a total of 336 trained males (training experience/history ≥ 1 year) were included for analysis. We found a non–linear dose–response relationship (reverse U–shaped) between velocity loss and 1RM gain (p_{dose–response relationship} < 0.05, p_{non–linear relationship} < 0.05). Additionally, a negative linear dose–response relationship was observed between velocity loss and 1RM gain per repetition (p_{dose–response relationship} < 0.05, p_{non–linear relationship} = 0.23). Based on our findings, a velocity loss between 20 and 30% may be beneficial for maximum strength development, and a lower velocity loss may be more efficient for developing and maintaining maximum strength. Future research is warranted to focus on female athletes and the interaction of other parameters. Full article

Physiotherapy (PT) is a profession that includes education and close contact for long periods of time with patients for treatment sessions. Globally, smoking is prevalent and is expected to increase in the next decades; thus, smoking cessation (SC) is an important management strategy to mitigate further escalation. Little is known about PT practice in SC, and therefore, this study aimed to systematically review and discuss the published literature about the role of physiotherapists in smoking cessation management, opinions, and prevalence of SC counselling in physiotherapy practice; and to explore barriers towards smoking cessation counselling within physiotherapy practice. A systematic search was conducted through EBSCO, and articles were included if they assessed the role of PTs in SC management. The databases were searched for studies published between 1 January 1970 to 1 April 2022. Articles were excluded if they did not include PTs, if they did not include assessment of SC management/counselling, if they were not cross-sectional studies, if they were not written in the English language, or if they were conference abstracts. Seven studies were included in the review. The search identified no studies that have investigated the role of PTs in vaping cessation. It was found that PTs are not addressing SC counselling and management enough in their practice. In addition, the search revealed that lack of training, time, and knowledge are the most common barriers against including SC counselling in physiotherapy practice and rehabilitation programs. Exploring possibilities of including SC counselling according to the clinical guidelines is encouraged. Additionally, establishing solutions to overcome barriers against SC counselling as part of physiotherapy practice is essential. Full article

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl–Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains. Full article

Polypharmacy is an increasing health concern among older adults and results in many health risks. Nurses have an important role to play in supporting medication management and promoting medication safety across different settings. This study aims to provide a meta-synthesis of qualitative studies investigating the perceptions and experiences of nurses in caring for older adults with polypharmacy. Electronic databases including PsycArticles, CINAHL Complete, MEDLINE, and ERIC were searched between September 2001 and July 2022. Potential studies were checked against inclusion and exclusion criteria. We included peer-reviewed studies reporting data on the experiences of nursing staff across different settings. Studies unitizing any qualitative approach were included, and the included studies were reviewed and analyzed using a thematic synthesis approach. Study quality was examined using the Critical Appraisal Skills Programme checklist for qualitative research. A total of nine studies with 91 nurses were included. Four major themes emerged: older adults suffering from polypharmacy, the importance of multidisciplinary teams, nursing roles in caring for older adults, and the complexity and barriers of implementing polypharmacy management. Healthcare professionals should pay attention to the impacts of polypharmacy in older adults’ lives and should acknowledge the importance of team-based polypharmacy care in supporting older adults. Nurses play a key role in caring for older adults with polypharmacy, therefore, they should be empowered and be involved in medication management. Full article

(1) Background: Healthcare professionals´ clinical practice, their care of patients and the clinical decision-making process may be influenced by ethical and moral sensitivity. However, such outcomes have been scarcely studied in physical therapists. This study aimed to explore ethical sensitivity and moral sensitivity in practicing physical therapists, and to compare both variables by gender. (2) Methods: Cross-sectional study. 75 physical therapists (58.7% women; average age = 34.56 (8.68) years) were asked to fill in questionnaires measuring ethical sensitivity (Ethical Sensitivity Scale Questionnaire) and moral sensitivity (Revised-Moral Sensitivity Questionnaire). (3) Results: The sample showed high ethical sensitivity (116.14 ± 15.87 over 140) and high moral sensitivity (40.58 ± 5.36 over 54). When comparing by gender, women reported significantly higher ethical sensitivity than men (p = 0.043), as well as higher scores in the following dimensions: Caring by connecting with others (p = 0.012) and Working with interpersonal and group differences (p = 0.028). However, no differences were found in moral sensitivity (p = 0.243). (4) Conclusion: Physical therapists showed high levels of ethical and moral sensitivity, whilst women reported higher ethical sensitivity than men. Understanding physical therapists´ ethical and moral sensitivity is essential to design and implement integrated education programs directed to improve the quality of care of patients in their daily clinical practice. Full article

Interprofessional teamwork provides significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer unit is uncommon. Therefore, a qualitative study was conducted to assess the perceptions of outpatient breast cancer patients regarding interprofessional collaboration in the breast care unit of an Indonesian referral center hospital. The teamwork involved in the interprofessional collaboration included breast cancer specialists, pharmacists, and nurses. In this study, in-depth interviews were performed with nine breast cancer outpatients. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. The findings were divided into two categories to gather breast cancer patients’ viewpoints on interprofessional collaboration: (1) obstacle components to interprofessional collaboration: incompleteness of health personnel, no justification from health personnel, no knowledge of patients about health professionals, no involvement of patients in the therapy decision making; (2) enabling elements: patient-oriented, patient expectations, collaboration among healthcare personnel, patient participation in interprofessional collaboration, health personnel responsibilities, comprehensive hospital services. Respondents assumed interprofessional collaboration positively. However, several obstacles must be overcome to implement interprofessional collaboration in a breast care setting effectively. The research findings can be utilized to establish interprofessional collaborations aimed at improving quality healthcare in breast cancer units. Full article

Background: The world is transitioning to an obese future, but few studies have measured the burden of increased maternal body mass index (BMI) on pathological fetal overgrowth, especially the trends in this burden and its heterogeneity in populations with different characteristics. Methods: A population-based retrospective cohort study was conducted with 7,998,620 Chinese females who had participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013–2017. The proportions of macrosomic and LGA neonates attributable to high BMI (population attributable fraction, PAF) and annual percent change of yearly PAFs were estimated. Results: We found that the burden of macrosomic and LGA (large-for-gestational-age) neonates attributable to high pre-pregnancy BMI increased among Chinese females with planned pregnancies during 2013–2017. The PAF of macrosomia attributable to high BMI increased from 3.16% (95% confidence interval: 2.97–3.35%) to 7.11% (6.79–7.42%) by 23.60% (16.76–30.85%) annually, and the PAF of LGA increased from 2.35% (2.21–2.48%) to 5.00% (4.79–5.21%) by 21.98% (16.14–28.11%) annually. Our study identified that participants with disadvantaged socioeconomic status (including those without higher education, living in provinces with GDP per capita < 40,000 CNY, tier IV, and tier V cities) and residing in northern and southwestern China were at high risk of a rapidly expanding burden. Conclusions: Government authorities should control pre-pregnancy BMI through nationwide intervention programs and direct more resources to focus on the unfair burden on females with disadvantaged socioeconomic status. Full article

ECG provides critical information in a waveform about the heart’s condition. This information is crucial to physicians as it is the first thing to be performed by cardiologists. When COVID-19 spread globally and became a pandemic, the government of Saudi Arabia placed various restrictions and guidelines to protect and save citizens and residents. One of these restrictions was preventing individuals from touching any surface in public and private places. In addition, the authorities placed a mandatory rule in all public facilities and the private sector to evaluate the temperature of individuals before entering. Thus, the idea of this study stems from the need to have a touchless technique to determine heartbeat rate. This article proposes a viable and dependable method to estimate an average heartbeat rate based on the reflected light on the skin. This model uses various deep learning tools, including AlexNet, Convolutional Neural Networks (CNNs), Long Short-Term Memory Networks (LSTMs), and ResNet50V2. Three scenarios have been conducted to evaluate and validate the presented model. In addition, the proposed approach takes its inputs from video streams and converts these streams into frames and images. Numerous trials have been conducted on volunteers to validate the method and assess its outputs in terms of accuracy, mean absolute error (MAE), and mean squared error (MSE). The proposed model achieves an average 99.78% accuracy, MAE is 0.142 when combing LSTMs and ResNet50V2, while MSE is 1.82. Moreover, a comparative measurement between the presented algorithm and some studies from the literature based on utilized methods, MAE, and MSE are performed. The achieved outcomes reveal that the developed technique surpasses other methods. Moreover, the findings show that this algorithm can be applied in healthcare facilities and aid physicians. Full article

Arthroplasty for the hip/knee and surgeries for hip fractures are increasing worldwide. The aims of this study were to investigate changes in health-related quality of life (HRQOL) after surgery with an early mobility education program, and to explore their associations with pain and anxiety. Pain intensity and anxiety were assessed with the visual analogue scale (VAS) and Beck Anxiety Inventory (BAI), and HRQOL was assessed with the Short Form-36 (SF-36). The physical component summary (PCS) and mental component summary (MCS) and eight subscales of the SF-36 were calculated. At pre-operation, the patients suffered from moderate pain and mild anxiety, and their HRQOL scores were low (4.9, 7.8, 35.4, and 48.2 for the VAS, BAI, PCS, and MCS, respectively). The pain, anxiety, and HRQOL improved after surgery and had moderate to large effect sizes at 6-month follow-up (Glass’s delta = 1.23, 0.88, 0.81, and 0.67 for VAS, BAI, PCS, and MCS, respectively). Pain and anxiety were strongly correlated to HRQOL at each stage, with the maximum correlation (r = −0.34 to −0.93) reached at 6-month follow-up. The surgery effectively improves HRQOL, as the reduced pain and anxiety lead to better physical and mental HRQOL. Full article

To date, extensive research has been conducted on vaccination against COVID-19 during pregnancy to verify the safety and efficacy of the vaccines, despite the fact that pregnant women were excluded from the initial clinical trials. The ever-increasing number of scientific publications has confirmed the absence of biological mechanisms associating mRNA vaccines with adverse effects in pregnancy and breastfeeding, although few studies have been carried out on their effect on fertility. While the Italian legal system provides for maternity protection measures and indemnity for vaccination damages pursuant to law no. 210/1992, it is not exempt from controversy. This contribution describes the state of play on COVID-19 vaccination in pregnant and lactating women, including: current recommendations for pregnant and lactating women; ethical issues related to vaccination hesitancy among pregnant women; the legislative paradox whereby sanctions may be imposed on women in certain professional categories who refuse vaccination because they are pregnant; and the possible legal consequences in the event of harm to the unborn child due to vaccination. All of this is considered in accordance with the principles of medical ethics, taking into account the national legislation. Full article

This study aimed to analyze the effects of nonpharmacological interventions on perimenopausal and postmenopausal women with sleep problems. Eight databases (MEDLINE/PubMed, Cochrane Library, EMBASE, CINAHL, and four Korean databases) were searched, from their inception through to 30 November 2021, for randomized controlled trials (RCTs) evaluating the effects of nonpharmacological interventions versus control conditions on sleep quality and insomnia in perimenopausal and postmenopausal women. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the severity of insomnia was assessed using the Insomnia Severity Index (ISI). In the meta-analysis, corrected standardized mean differences (SMDs; Hedges’ g) and 95% confidence intervals (CIs) were calculated as effect measures by applying the random effects model and inverse variant method. Fifteen trials met our inclusion criteria. Nonpharmacological interventions were found to have positive effects on sleep quality, measured with the PSQI (SMD = −1.32; 95% CI = −1.78 to −0.86; p < 0.001), and on the severity of insomnia, measured using the ISI (SMD = −1.11; 95% CI = −1.82 to –0.41; p = 0.002), compared with the control groups. Among perimenopausal and postmenopausal women with sleep problems, nonpharmacological interventions improved sleep quality and reduced the severity of insomnia. Full article

The increase in the number of elderly patients with degenerative diseases has brought additional medical and financial pressures, which are adding to the burden on society. The development of sports rehabilitation robotics (SRR) is becoming increasingly sophisticated at the technical level of its application; however, few studies have analyzed how it works and how effective it is in aiding rehabilitation, and fewer individualized exercise rehabilitation programs have been developed for elderly patients. The purpose of this study was to analyze the working methods and the effects of different types of SRR and then to suggest the feasibility of applying SRR to enhance the physical abilities of elderly patients with degenerative diseases. The researcher’s team searched 633 English-language journal articles, which had been published over the past five years, and they selected 38 of them for a narrative literature review. Our summary found the following: (1) The current types of SRR are generally classified as end-effector robots, smart walkers, intelligent robotic rollators, and exoskeleton robots—exoskeleton robots were found to be the most widely used. (2) The current working methods include assistant tools as the main intermediaries—i.e., robots assist patients to participate; patients as the main intermediaries—i.e., patients dominate the assistant tools to participate; and sensors as the intermediaries—i.e., myoelectric-driven robots promote patient participation. (3) Better recovery was perceived for elderly patients when using SRR than is generally achieved through the traditional single-movement recovery methods, especially in strength, balance, endurance, and coordination. However, there was no significant improvement in their speed or agility after using SRR. Full article

Globally, cancer is a leading cause of death, with cervical cancer ranking second among all cancers. Its adversity impacts not only individuals but also families, societies, and governments. The quality of services, as informed by the knowledge and adequacy of the health workers, plays an important role in both prevention, diagnosis, and management of the disease. A cross-sectional study among 108 purposively selected health workers in rural health facilities in the Eastern Cape province was conducted to assess knowledge on cervical cancer and associated risk factors through the use of validated structured questionnaires. The Statistical Package for Social Sciences was used for analysis, with a 95% confidence interval and a p-value of 0.05 considered significant. A total of 91.7% of the 108 participants were female, and 25% were over the age of 50. A total of 88% and 85.2% indicated sexually transmitted disease and human immunodeficiency virus as major risk factors, respectively. The HPV, pap smear, and vaccination age were known by 64.8%, and vaccine availability was known by 71.3%. Only 40.7% of workers were trained on cervical screening, and 35.2% were trained on the interpretation of pap smear results. An overall knowledge score of 53% was obtained, with more experienced clinicians scoring lower grades. This study identified inadequacies in essential knowledge for successful implementation of cervical cancer services and found that extensive training was needed. Full article

During the COVID-19 pandemic, implementing catastrophic healthcare surge capacity required a network of facility infrastructure beyond the immediate hospital to triage the rapidly growing numbers of infected individuals and treat emerging disease cases. Providing regional continuity-of-care requires an assessment of buildings for alternative care sites (ACS) to extend healthcare operations into non-healthcare settings. The American Institute of Architects (AIA) appointed a COVID-19 ACS Task Force involving architects, engineers, public health, and healthcare professionals to conduct a charrette (i.e., intensive workshop) to establish guidance during the alert phase of the pandemic. The task force developed an ACS Preparedness Assessment Tool (PAT) for healthcare teams to assist with their rapid evaluation of building sites for establishing healthcare operations in non-healthcare settings. The tool was quickly updated (V2.0) and then translated into multiple languages. Subsequently, the authors of this manuscript reviewed the efficacy of the PAT V2.0 in the context of reported case studies from healthcare teams who developed a COVID-19 ACS in community settings. In summary, policy makers should re-examine the role of the built environment during emergency pandemic response and its impact on patients and health professionals. An updated ACS PAT tool should be established as part of the public health preparedness for implementing catastrophic healthcare surge capacity. Full article

This study assesses inpatients’ preferences for participating in medical decision-making and determines the factors’ rankings in order of importance and whether they vary for respondents with different characteristics. Case 1 best-worst scaling (BWS) was used for the study design. Thirteen attributes influencing inpatient medical decision-making participation were identified based on a literature review and interview results. A balanced incomplete block design was used to form choice sets for the BWS questionnaire for a cross-sectional study examining inpatients’ preferences for participating in medical decision-making. Based on results from 814 inpatient participants, the three most important factors influencing inpatients’ medical decision-making participation were inpatients’ trust in physicians, physicians’ professional expertise, and physicians’ attitudes. The mixed logit model results reflect the significant heterogeneity in respondents’ preferences for shared decision-making. To facilitate resource allocation, improve the physician-patient relationship, and encourage patient decision-making participation more actively and effectively, decision-makers should emphasize patients’ trust, enhance physicians’ ability to diagnose and treat diseases, and improve their attitudes toward providing care and communication from the perspectives of patients, physicians, and the social environment. Further research is needed on the heterogeneity of patients’ preferences for participating in medical decision-making and how to improve patient participation. Full article

Emotion detection is a fundamental component in the field of Affective Computing. Proper recognition of emotions can be useful in improving the interaction between humans and machines, for instance, with regard to designing effective user interfaces. This study aims to understand the relationship between emotion and pupil dilation. The Tobii Pro X3-120 eye tracker was used to collect pupillary responses from 30 participants exposed to content designed to evoke specific emotions. Six different video scenarios were selected and presented to participants, whose pupillary responses were measured while watching the material. In total, 16 data features (8 features per eye) were extracted from the pupillary response distribution during content exposure. Through logistical regression, a maximum of 76% classification accuracy was obtained through the measurement of pupillary response in predicting emotions classified as fear, anger, or surprise. Further research is required to precisely calculate pupil size variations in relation to emotionally evocative input in affective computing applications. Full article

Background: Metformin is a drug used to treat patients with type 2 diabetes, especially those who suffer from obesity. It is also used in the treatment of women with polycystic ovary syndrome (PCOS). This disease is related to insulin resistance and multiplied blood sugar ranges. Furthermore, it has been established that the use of metformin improves the menstrual cycles and ovulation rates of these women. Methods: A structured questionnaire was conducted to determine the prevalence of breast cancer among women using metformin in the Ha’il region. Result: The incidence of breast cancer among women using metformin in the Ha’il region is very low. Thus, it can be said that breast cancer cases declined among diabetics taking metformin. This means that metformin use is associated with a lower risk of breast cancer in women with type 2 diabetes, even in cases where these women have a family history of breast cancer. Conclusions: According to previous findings, metformin has been linked to lower breast cancer risk in women with type 2 diabetes. Furthermore, the findings of this study corroborate the literature on this subject by indicating that there is a substantial connection between metformin use and a lower risk of breast cancer in women with type 2 diabetes. However, further in vitro and in vivo experiments are crucial to investigate the protective effect of metformin against breast cancer and to confirm our findings. Full article

General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs’ current workload and provision of healthcare in summer 2021 (May 2021–July 2021) and early 2022 (January 2022–February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs’ work routines and how better working conditions in times of high demand could be achieved in future pandemics. Full article

Home healthcare services are public or private service that aims to provide health services at home to socially disadvantaged, sick, needy, disabled, and elderly individuals. This study aims to increase the quality of home healthcare practice by analyzing the factors affecting it. In Megacity Istanbul, data from 1707 patients were used by considering 14 different input variables affecting home healthcare practice. The demographic, geographic, and living conditions of patients and healthcare professionals who take an active role in home healthcare practice constituted the central theme of the input parameters of this study. The regression method was used to look at the factors that affect the length of time a patient needs home healthcare, which is the study’s output variable. This article provides short planning times and flexible solutions for home healthcare practice by showing how to avoid planning patient healthcare applications by hand using methods that were developed for home health services. In addition, in this research, the AB, RF, GB, and NN algorithms, which are among the machine learning algorithms, were developed using patient and personnel data with known input parameters to make home healthcare application planning correct. These algorithms’ accuracy and error margins were calculated, and the algorithms’ results were compared. For the prediction data, the AB model showed the best performance, and the R² value of this algorithm was computed as 0.903. The margins of error for this algorithm were found to be 0.136, 0.018, and 0.043 for the RMSE, MSE, and MAE, respectively. This article provides short planning times and flexible solutions in home healthcare practice by avoiding manual patient healthcare application planning with the methods developed in the context of home health services. Full article

Eastern Europe continues to have the highest rates of cancer of the uterine cervix (CUC) and human papillomavirus (HPV) infection in Europe. Aim: The aim of this study was to investigate CUC trends in Bulgaria in the context of a lack of a population-based screening program and a demographic crisis. Methodology: This was a retrospective study of 7861 CUC patients who were registered in the Bulgarian National Cancer Registry (BNCR) between 2013 and 2020 and followed up with until March 2022. We used descriptive statistics and modeling to assess temporal trends in new CUC incidence rates and identify factors associated with survival. Results: Bulgaria’s population has decreased by 11.5% between 2011 and 2021. The CUC incidence rate decreased from 29.5/100,000 in 2013 to 23.2/100,000 in 2020 but remains very high. The proportion of patients diagnosed in earlier stages of CUC has decreased over time. Up to 19% of patients with CUC in Bulgaria are diagnosed between the age of 35 and 44 years. The median survival was 101.5 months, with some improvement in later years (adjusted HR = 0.83 for 2017–2020). Conclusions: In countries with well-established population-based screening, CUC is nowadays considered a rare disease. However, it is not considered rare in Bulgaria. Population-based screening starting at an earlier age is the fastest way to improve outcomes. Full article

Background: For centuries, convalescent plasma (CP) has been recommended to treat a diverse set of viral diseases. Therefore, the present study was undertaken to evaluate the effectiveness of CP in critically ill COVID-19 patients. Methods and Materials: From 23 March 2021 to 29 December 2021, an open-label, prospective cohort, single-centre study was conducted at Chest Disease Hospital, Jammu and Kashmir, Srinagar. Patients with severe manifestation of coronavirus disease 2019 (COVID-19) under BST (best standard treatment) +CP were prospectively observed in order to evaluate effectiveness of CP therapy and historical control under BST were used as the control group Results: A total of 1667 patients were found positive for COVID-19. Of these, 873 (52.4%), 431 (28.8%), and 363 (21.8%) were moderately, severely, and critically ill, respectively. On 35th day post-infusion of CP, all-cause mortality was higher in the BST (best standard treatment) +CP group 12 (37.5%) compared to 127 (35%) in the BST group with an odds ratio (OR) of 1.4 and hazard ratio (HR) (95% CI: 1.08–1.79, p = 0.06). Similarly, 7 (21.9) patients in the BST+CP group and 121 (33.3) patients in the BST group showed the transition from critically ill to moderate disease with subhazard ratio (s-HR 1.37) (95% CI: 1.03–2.9). Conclusions: In the present study, we could not find any significant difference in the CP group and BST +CP in primary outcome of reducing all-cause mortality in critically ill patients with negligible Nabs levels. However, beneficial results were observed with use of CP in a limited number of secondary outcomes which includes days of hospitalization, negative conversion of SARS-CoV-2 on basis of RT-PCR on 7th day and 14th day, need for invasive mechanical ventilation on 14th day post-CP treatment, and resolution of shortness of breath. Full article

Mental health problems are common among university students. Specific type of family background is one of the important factors contributing to these problems. This study aimed to evaluate the proportion of severe mental health problems and the associations between severity and types of problems and family backgrounds. This was a cross-sectional descriptive study. We reviewed the database and medical records of 125 university students aged over 18 years who attended the mental health consultation clinic for university students, 123 Primary Care Unit, Khon Kaen University, between 1 January and 31 December 2018. The characteristics of the participants were summarized using descriptive statistics. We performed an analysis using logistic regression to obtain the crude and adjusted odds ratio. The proportion of severe mental health problems was 50.4%. The most common problem was learning problems (54.4%). The severity of the problems reported by the students was associated with communication failure in the family (AOR = 3.30 [95% CI: 1.14–9.52], p = 0.027). All students who experienced domestic violence in their family had severe mental health problems. This study re-appraised the utility of the context of the family as a predictor of current problems of university students. Full article

China used to be the world’s leading nation in terms of international (outward) tourism till the COVID-19 outbreak. However, due to the COVID-19 crisis, several new macro and micro-level factors might affect their international (outward) traveling behavior. The purpose of the current research was to examine the avoidance of international traveling for leisure in the Chinese population. The goal of the study was to highlight the importance of information self-efficacy and digital literacy as the key factors influencing tourists’ traveling readiness. To achieve the goal, the study adapted the quantitative instruments from existing sources to map media exhaustion, information overload, and perceived health concerns, i.e., perceived effectiveness of health-protective measures, fear of new possible outbreaks, and pandemic crisis at source and destination. Chinese citizens’ opinions were collected during the third quarter of the year 2022. Specifically, the quantitative survey from China collected a total number of 1308 respondents. This study used the statistical analysis software SPSS to analyze collected data. The findings conclude that the role of media is pivotal to shaping and predicting future trends in tourism preferences, perception of protective measures against COVID-19, and perceived seriousness of the pandemic crisis in the Chinese population. In addition, technology readiness (as hard self-efficacy) and health-related information literacy (soft self-efficacy) are critical to cope with the dark aspects of information exhaustion, overload, and pandemic seriousness in the post-truth era. The study is unique, as it examines the role of the seriousness of the pandemic at its source and destination and fear of new outbreaks simultaneously, underlining the potential future of immersive tourism (i.e., virtual reality, augmented reality, or mixed reality-based tourism). This study has drawn interesting theoretical and practical implications for researchers, policymakers, and academicians. Full article

The association between oral frailty (OFr) and body action has been investigated, but its association with systemic function remains unclear. Therefore, this cross-sectional study examined the association between OFr with decreased bone mineral density (BMD) and renal function in residents of Shika town, Ishikawa Prefecture, Japan aged ≥40 years. This study included 400 inhabitants. The OFr total score was assessed using three oral domains in the Kihon Checklist (a self-reported comprehensive health checklist), the number of teeth, and brushing frequency per day. Measurements were the estimated glomerular filtration rate (eGFR) and the osteo-sono assessment index (OSI). Using a two-way analysis of covariance (p = 0.002), significantly lower OSI was indicated in the eGFR < 60 and OFr group than in the eGFR of < 60 and non-OFr group after adjusting for age, body mass index, and drinking and smoking status as confounding factors. Multiple logistic regression analysis confirmed this relationship (p = 0.006). Therefore, lower BMD seems to be associated with lower renal function only when accompanied by OFr. Further longitudinal studies are needed to confirm these results. Full article

The incidence of hypocalcemia is high in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing denosumab treatment. Since 2018, we have carried out a “multidisciplinary integrated care program for osteoporosis among patients with CKD and ESRD” in our hospital. The aim of this study was to compare the incidence of denosumab-associated hypocalcemia among patients with advanced CKD and ESRD before and after the integrated care program. We retrospectively reviewed the records of patients on their first dose of denosumab treatment from January 2012 to December 2021. A total of 3208 patients were included in our study. Among the 3208 patients, there were 101 dialysis patients, 150 patients with advanced CKD (stage 4 and 5), and 2957 patients with an estimated glomerular filtration rate (eGFR) higher than or equal to 30. The incidence of post-treatment severe hypocalcemia (corrected calcium level less than 7.0 mg/dl) within 30 days was significantly higher in the dialysis and advanced CKD group than in patients with an eGFR higher than or equal to 30 (6.9% vs. 2.0% vs. 0.1%, respectively, p < 0.001). Based on the results of the multivariate regression model, poor renal function (p < 0.05) and lower baseline corrected calcium level (p < 0.05) were associated with severe hypocalcemia within 30 days following the first dose of denosumab treatment. The incidence of post-treatment severe hypocalcemia within 30 days in advanced CKD and dialysis patients was significantly lower after the integrated care program (6.8% vs. 0.8%, p < 0.05). Our study shows that multidisciplinary integrated care may reduce the incidence rate of denosumab-associated severe hypocalcemia among patients with advanced CKD and ESRD. Full article

Objectives: E. cloacae is an opportunistic organism that causes serious infections, particularly in immuno-compromised and hospitalized patients, along with the emergence of resistance traits. The COVID-19 pandemic has impacted the epidemiological pattern and resistance traits of E. cloacae infections as well as those of other bacteria. The study aims to assess the epidemiological patterns, resistance characteristics and clinical outcomes of E. cloacae in Saudi Arabia and the impact of the COVID-19 pandemic. Methods: King Fahad Medical City in Riyadh provided the data between January 2019 and December 2021 for the retrospective study of 638 isolates of E. cloacae. The clinical outcome of an E. cloacae infection was also determined by collecting and statistically analyzing the clinical records of 153 ICU patients. Results: The total percentage of resistant E. cloacae isolates decreased from 48.36% in 2019 to 38% in 2020 and 37.6% in 2021. The overall mortality rate among ICU patients was 40.5%, with an adult age group having a substantial relative risk value of 1.37. Conclusion: E. cloacae is a prevalent nosocomial infection in which adult age is a significant risk factor for mortality. Moreover, this study emphasizes the importance of comparing E. cloacae resistance trends before and throughout the pandemic period in order to better understand the bacteria’s behaviour. Full article

Little is known about the changes in perception of illness among patients with the acute coronary syndrome (ACS) during cardiac rehabilitation programme (CRP). The purpose of this study is to determine changes in perception of illness with ACS patients during CRP to evaluate the association of patients’ characteristics with the perception of illness at the end of Phase II of CRP. A descriptive longitudinal study was conducted among 450 patients who attended 8-weeks of Phase II CRP at 2 public hospitals in Malaysia and perception of illness was assessed using Brief Illness Perception Questionnaire (BIPQ). The assessment was conducted before Phase II (T0), during the 4th session (T1), and at the end of right after the 8th session (T2). One-way repeated measures of ANOVA analysed the changes of perception at T1 and T2 while logistic regression analysis evaluated the association of patients’ characteristics with the perception of illness at T2. Perception of illness changed during and after CRP from T0 to T1, and T1 to T2 (p < 0.001). The patient viewed ACS as an illness that changed from being more acute to a chronic condition as the sessions progressed. Previous history of acute myocardial infarction (OR = 2.380, 95% CI 1.46, 5.49) and angioplasty intervention were both found to be associated with the perception of illness (OR = 3.857, 95% CI 1.55, 9.61). Perception of illness changed during CRP and these changes are associated with patients’ previous history of cardiac events. Phase II can be viewed as the second window of opportunity for healthcare professionals to intervene early in modifying the perception of illness. Full article

(1) Background: Hemoadsorption is a method of blood purification with a wide spectrum of indications. Pre-emptive use of hemoadsorption in patients undergoing heart surgery with cardiopulmonary bypass is considered to reduce the risk of postoperative systemic inflammatory response syndrome. The current study aimed to identify the spectrum of blood proteins adsorbed on the polymer matrix of the CytoSorb hemoadsorption system and to investigate their influence on cultured endothelial cells in vitro. (2) Methods: Adsorbers used for intraoperative hemoadsorption were obtained from patients undergoing on-pump valve surgery in acute endocarditis. Proteins were extracted from the adsorbers, purified, identified with mass-spectrometry and applied to cultured human aortic endothelial cells. (3) Results: A broad range of blood proteins were identified in the material eluted from the CytoSorb adsorber. When added to cultured ECs, these protein extracts caused severe reduction in cell viability and migration. After 24 h exposure, transcriptional changes with up-regulation of multiple metabolic regulators were observed and verified on the protein level. Genes responsible for control of mitosis were significantly down-regulated. (4) Conclusions: In summary, our data reveal that intraoperative hemoadsorption allows broad spectrum removal of a wide range of molecules eliciting endothelial damage. Full article

Background: Preoperative patient evaluation and optimization in a preoperative evaluation center (PEC) has been shown to improve operating room (OR) efficiency and patient care. However, performing preoperative evaluation on all patients scheduled for surgery or procedure would be time- and resource-consuming. Therefore, appropriate patient selection for evaluation at PECs is one aspect of improving PEC efficiency. In this study, we evaluate the effect of an enhanced preoperative evaluation process (PEP), utilizing a nursing triage phone call and information technology (IT) optimizations, on PEC efficiency and the quality of care in bariatric surgery patients. We hypothesized that, compared to a traditional PEP, the enhanced PEP would improve PEC efficiency without a negative impact on quality. Methods: The study was a retrospective cohort analysis of 1550 patients from January 2014 to March 2017 at a large, tertiary care academic health system. The study was a before/after comparison that compared the enhanced PEP model to the traditional PEP model. The primary outcome was the efficiency of the PEC, which was measured by the reduction of in-person patient visits at the PEC. The secondary outcome was the quality of care, which was measured by delays, cancellations, and the need for additional testing on the day of surgery (DOS). Results: The enhanced PEP improved the primary outcome of efficiency, as evident by an 80% decrease in in-person patient visits to the PEC. There was no reduction in the secondary outcome of the quality of care as measured by delays, cancellations, or the need for additional testing on the DOS. The implementation of the enhanced PEP did not result in increased costs or resource utilization. Conclusions: The enhanced PEP in a multi-disciplinary preoperative process can improve the efficiency of PEC for bariatric surgery patients without any decrease in the quality of care. The enhanced PEP process can be implemented without an increase in resource utilization and can be particularly useful during the COVID-19 pandemic. Full article

The presence of non-biomedical foreign objects (NBFO), such as coins, buttons and jewelry, and biomedical foreign objects (BFO), such as medical tubes and devices in chest X-rays (CXRs), make accurate interpretation difficult, as they do not indicate known biological abnormalities like excess fluids, tuberculosis (TB) or cysts. Such foreign objects need to be detected, localized, categorized as either NBFO or BFO, and removed from CXR or highlighted in CXR for effective abnormality analysis. Very specifically, NBFOs can adversely impact the process, as typical machine learning algorithms would consider these objects to be biological abnormalities producing false-positive cases. It holds true for BFOs in CXRs. This paper examines detailed discussions on numerous clinical reports in addition to computer-aided detection (CADe) with diagnosis (CADx) tools, where both shallow learning and deep learning algorithms are applied. Our discussion reflects the importance of accurately detecting, isolating, classifying, and either removing or highlighting NBFOs and BFOs in CXRs by taking 29 peer-reviewed research reports and articles into account. Full article

The recent COVID-19 pandemic has increased students’ stress as they may feel under increased pressure to have a good performance and compensate for the disruption to their education. Improving attention levels and learning capacity may assist in ameliorating academic performance. Qigong is a traditional Chinese medicine technique that appears to have positive effects on the management of mental health and may provide tools for coping with stressful situations. This paper explores data obtained while conducting a previous study and includes an excess of data from a total of 44 participants who were previously divided into an experimental Qigong group and a sham Qigong control group. The improvements in specific auditory processing and reaction times may indicate benefits in attention and learning capacity. These improvements were more pronounced in the experimental Qigong group compared to the sham Qigong group. Qigong may be able to assist in improving students’ academic performance and can be easily integrated into physical education classes. It could also assist students to cope with the increased academic pressure resulting from the COVID-19 pandemic context. Full article

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16–18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale—Modified, Perceived Stress Scale-10, How do you cope?—Questionnaire, Athens Insomnia Scale as well as the authors’ own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13–6.06 and OR = 2.35, 95% CI: 1.60–3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93–14.80 and OR = 3.29, 95% CI: 2.07–5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13–4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide. Full article

Background: In Italy, the administration of the COVID-19 vaccine booster dose started on 27 September 2021, supported by clinical trials corroborating its efficacy. Given the paucity of real-world effectiveness data, this study aims to estimate the vaccine effectiveness of the booster dose against SARS-CoV-2 infection, severe disease, and death in the adult Sicilian population. Methods: This retrospective cohort study was carried out from 1 January to 31 March 2022 and included all residents in Sicily aged ≥ 18 years without previous SARS-CoV-2 infection and with a complete mRNA vaccine primary cycle. The cohort was split into two groups (booster and primary cycle) matched by age, gender, vaccine type, and month of completion of the primary vaccination cycle. Results: 913,382 subjects were observed in the study: 456,690 (50%) were vaccinated with two doses and 456,692 (50%) with three doses. There were 43,299 cases of SARS-CoV-2 among the two-doses vaccinees (9.5%) and 10,262 (2.2%) among the three-doses counterpart. Vaccine effectiveness in the booster cohort was 76.5% and 74.4% against SARS-CoV-2 infection, 85.7% and 79.7% against severe disease, and 84.1% and 73.1% against intubation or death, for BNT162b2 and mRNA-1273, respectively. Conclusions: This study confirmed the remarkable efficacy profile of the SARS-CoV-2 vaccine booster dose against infection, severe disease, and death attributable to the virus. Overall, the results of this study provide important real-world data to support the continued roll-out of the COVID-19 booster dose and have the potential to inform public health policy and guide decisions on vaccination strategies in countries around the world. Full article

Background: Pancreatic cancer is one of the most common malignant neoplasms with an increasing incidence, low rate of early diagnosis, and high degree of malignancy. In recent years, immunotherapy has made remarkable achievements in various cancer types including pancreatic cancer, due to the long-lasting antitumor responses elicited in the human body. Immunotherapy mainly relies on mobilizing the host’s natural defense mechanisms to regulate the body state and exert anti-tumor effects. However, no bibliometric research about pancreatic cancer immunotherapy has been reported to date. This study aimed to assess research trends and offer possible new research directions in pancreatic cancer immunotherapy. Methods: The articles and reviews related to pancreatic cancer immunotherapy were collected from the Web of Science Core Collection. CiteSpace, VOSviewer, and an online platform, and were used to analyze co-authorship, citation, co-citation, and co-occurrence of terms retrieved from the literature highlighting the scientific advances in pancreatic cancer immunotherapy. Results: We collected 2475 publications and the number of articles was growing year by year. The United States had a strong presence worldwide with the most articles. The most contributing institution was Johns Hopkins University (103 papers). EM Jaffee was the most productive researcher with 43 papers, and L Zheng and RH Vonderheide ranked second and third, with 34 and 29 papers, respectively. All the keywords were grouped into four clusters: “immunotherapy”, “clinical treatment study”, “tumor immune cell expression”, “tumor microenvironment”. In the light of promising hotspots, keywords with recent citation bursts can be summarized into four aspects: immune microenvironment, adaptive immunotherapy, immunotherapy combinations, and molecular and gene therapy. Conclusions: In recent decades, immunotherapy showed great promise for many cancer types, so various immunotherapy approaches have been introduced to treat pancreatic cancer. Understanding the mechanisms of immunosuppressive microenvironment, eliminating immune suppression and blocking immune checkpoints, and combining traditional treatments will be hotspots for future research. Full article

In recent years, there has been an exponential increase in studies demonstrating the positive effects of the religiosity/spirituality (R/S) approach on patients’ physical and mental health. In mental health units, patients want professionals to be sensitive to their spiritual and/or religious needs, which is a fundamental aspect of a holistic approach to patients. Qualitative research with an exploratory and descriptive design with an ethnographic-phenomenological approach through in-depth interviews with sixteen professionals from Spanish mental health units. There is no consensus on the definition of spirituality; however, all of them believe that R/S has a positive influence on the health of patients in coping with illness. They believe that their own R/S may interfere with the professional–patient relationship and their attention to spiritual needs. Few professionals address these needs, citing limitations such as lack of time and lack of specific training in spiritual care. More research is needed on the spiritual care of mental health professionals to define the framework, professional training, and associated challenges in the spiritual care of patients. Full article

In 2019, 2020, and 2021, Sendero Health Plans, an ACA health insurance company, implemented Hepatitis C Virus (HCV) health education and outreach screening campaigns. Chi-square goodness-of-fit and tests of independence were performed to assess and compare the uptake of HCV screening among baby boomers in 2019, 2020, and 2021. In 2019, 2020, and 2021, 17.9% (308/1,718), 10.9% (93/852), and 8.5% (37/435) of eligible members were screened, respectively. Individuals were more likely to be screened for HCV in 2019 than in 2020 and 2021 (p < 0.0001). In 2019, 2020, and 2021, 39.9%, 26.9%, and 48.6% of annual screenings occurred during the health campaign months, respectively. Annual HCV screening rates were lower during the COVID-19 pandemic period than in the pre-pandemic cohort. However, screening rates during the months of outreach and education contributed to nearly 50% of annual screenings in the pandemic year 2021, thus representing a positive impact on preventive screening uptake despite the pandemic. Missed screening opportunities affect HCV transmission, diagnosis, and treatment. Yet, health education and outreach continue to work, even during a pandemic. Full article

Maple syrup urine disease (MSUD) is a metabolic disorder characterized by a difficulty to digest and process proteins necessary for growth. To monitor and maintain the ideal growth of children with MSUD, caregivers need to carefully control the consumption of harmful branched-chain amino acids (BCAAs). The dietary limits of amino acids for MSUD patients are recommended and controlled by pediatricians and metabolic dietitians according to age, height, weight, and the prevailing percentage of amino acids in the body. This study introduces an intelligent dietary tool called MSUD Baby Buddy for caregivers of MSUD patients that tracks the amino acids intake out of baby formulas for babies 0–6 months old. This tool aims to provide accurate recommendations of the appropriate daily intake of protein and BCAAs based on the patients’ data, plasma BCAAs, and formula preferences. We use a knowledge-based system, including knowledge acquisition and verification, as well as knowledge management tool validation, and the ripple-down rules are employed for building the system. MSUD Baby Buddy can support the maintenance of adequate amino acid levels and increase awareness about the control of BCAAs. The average usability of MSUD Baby Buddy is 84.25, indicating that the tool is intuitive and may help caregivers to easily determine the recommended doses of formula based on patients’ biometric data and preferred formula. On the other hand, interviews with metabolic dietitians revealed some drawbacks, which were addressed to further improve the tool. MSUD Baby Buddy is expected to help caregivers of MSUD patients to independently track nutrient intake and reduce the number of visits to the pediatrician and metabolic dietitian. Full article

Stress and stressors related to clinical practice are some of the main reasons for the discomfort reported by nursing students. It is important to identify the causes of stress and seek strategies to reduce the stress levels in nursing students. Clinical training seminars have proven to be a useful tool to reduce stress levels. This study aims to evaluate the effects of a series of clinical training seminars on the levels of stress and perception of stress factors before the start of clinical practice among undergraduate Spanish nursing students. A two-phase, sequential mixed-methods design was used. For the quantitative phase, data were collected using Cohen’s Perceived Stress Scale and the KEZKAK questionnaire before and after the clinical training seminars. Qualitative data were collected through a focus group session held after the clinical training period. The results show a significant reduction (p = 0.002) in perceived stress levels after the clinical training seminars, and also a change in students’ perception of stressors in the clinical placement. This study provides valuable information for the development of content for clinical training seminars. Universities should develop strategies to reduce stress in their students caused by the clinical placement. Full article

(1) Background: Water is necessary for the preparation of some medicines found in pharmacies where the local water source does not meet the required purity. This study aimed to investigate the presence of coliform contamination in water used for drug reconstitution in community pharmacies in Jordan. (2) Methods: Two water samples from 50 randomly selected community pharmacies representing all Jordanian governorates were filtered and then cultured in plate count agars to determine total microbial count, and in m-Endo Agar Les and Eosin Methylene Blue (EMB) agar to cultivate Escherichia coli (E. coli). The presence of E. coli was further characterized with gram stains, biochemical tests, and Polymerase chain reaction (PCR). Antibiotic susceptibility of isolated E. coli was tested against a variety of standard antibiotics. (3) Results: Community pharmacies used droppers filled with water from coolers (62%), bottled water (20%), boiled tap water (16%) and tap water (2%). The majority of the sampled water contained coliform bacteria (88%), and E. coli was isolated from 26% of all samples. Statistical analysis showed no significant difference in the percentage of contaminated water samples based on its source location. Nonetheless, the results showed a tendency for higher proportions of contamination in droppers filled from boiled tap water (37.5%; SE: 17.1), followed by water from water coolers (25.8%; SE: 7.9), and then from bottled water (20%; SE: 12.7). All of the isolated E. coli were sensitive to gentamycin, ciprofloxacin and levofloxacin. The susceptibility of the isolates to ceftazidime, doxycycline, tetracycline, azithromycin and amoxicillin/clavulanic acid were 92%, 61%, 46%, 23% and 15%, respectively. (4) Conclusions: This study confirms the widespread presence of multidrug-resistant bacteria in water intended for reconstituting drugs in local pharmacies. These findings expose an alarming situation that needs special attention by the acting pharmacists and competent authorities. Higher levels of personal hygiene in the pharmacies coupled with regular inspection of water quality may reduce the risk of microbial contamination in compounded products, especially multidrug-resistant strains of E. coli and other index microorganisms. Full article

This study examined whether depression mediates a relationship between academic helplessness and life satisfaction and whether the mediating effect differs depending on participation in leisure time physical activity (LTPA) from a sample of 2384 middle school students in South Korea. Identifying these factors could help in developing intervention strategies for promoting life satisfaction. Structural equation modeling analyses were employed to understand how various factors influence adolescents’ life satisfaction. First, the effect of academic helplessness on life satisfaction was mediated by depression. Second, the mediating effect of depression was moderated according to participation in LTPA: the size of the negative mediating effect of depression on the relationship between academic helplessness and life satisfaction was reduced in the LTPA group compared to the non-LTPA group. The current findings suggest that encouraging engagement in physical activity may be a crucial vehicle for affecting academic helplessness, depression, and life satisfaction among early adolescents. Implications and future directions are discussed. Full article

Giving birth is one of the most impressive experiences in life. However, many pregnant women suffer from fear of childbirth (FOC) and experience labour in very different ways, depending on their personality, previous life experiences, pregnancy, and birth circumstances. The aim of this study was to analyse how fear of childbirth affects the childbirth experience and to assess the related consequences. For this, a descriptive cross-sectional study was carried out in a sample of 414 women between 1 July 2021 and 30 June 2022. The Birth Anticipation Scale (BAS) was used to measure fear of childbirth and the Childbirth Experience Questionnaire (CEQ-E) was applied to measure satisfaction with the childbirth experience. Fear of childbirth negatively and significantly predicted the childbirth experience. In addition, women who were more fearful of childbirth were found to have worse obstetric outcomes and a higher likelihood of having a caesarean delivery (p = 0.008 C. I 95%). Fear behaved as a risk factor for the birth experience, so the greater the fear, the higher the risk of having a worse birth experience (OR 1.1). Encouraging active listening and support strategies may increase pregnant women’s confidence, thus decreasing their fear of the process and improving their childbirth experience. Full article

Medical device usability testing offers many benefits, including finding medical device usage errors and providing safety to users. As usability testing becomes mandatory for medical devices, manufacturers are increasing the cost burden. In order to perform a high-quality usability test, it is important to implement a usability test procedure, but guidelines for this are lacking. In this paper, we propose a method to systematically design and implement a usability test procedure. We propose methods to reduce test time-costs and apply them to implement the final procedure. Next, by applying the proposed method to sinus surgical navigation system, it is shown that the total time was reduced by 21% compared to the usability summative test procedure previously used in the same system. Full article

While previous studies have examined antecedents and outcomes of work engagement among general nurses, studies among psychiatric nurses remain limited. This study aimed to explore the antecedents (i.e., job crafting and nursing practice environment) and outcomes (i.e., strength-oriented care attitudes, mental health, and turnover intention) of work engagement among psychiatric nurses in Japan. This cross-sectional study included 309 nurses from three psychiatric hospitals in Japan (valid response rate: 60.4%). Data collection using the self-administered questionnaire took place from July to August 2021. We performed Structural Equation Modeling to examine the directional relationships among variables. Job crafting (β = 0.57, p < 0.01) and nursing practice environment (β = 0.23, p = 0.01) exhibited positive effects on work engagement. Work engagement had positive effects on strength-oriented care attitudes (β = 0.15, p = 0.04) and mental health (β = 0.37, p < 0.01) as well as negative effects on intention to resign from their profession as a nurse (β = −0.17, p = 0.01). Job crafting and a healthier nursing practice environment could help enhance work engagement. Higher work engagement could contribute to improving strength-oriented care attitudes, mental health, and intention to resign from their profession as a nurse. Full article

Background: Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. Methods: This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. Results: Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turnaround time to receive their appointment. Conclusions: This study identifies several characteristics associated with the turnaround time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence-base in the government sector of the emirate of Dubai. Full article

The outcomes of advanced non-small cell lung cancer (NSCLC) patients have been significantly improved with novel therapies, such as tyrosine kinase inhibitors and immune checkpoint inhibitors. However, in resource-limited countries, platinum-doublet chemotherapy is mainly used as a first-line treatment. We investigate clinical parameters to predict the response after chemotherapy, which may be useful for patient selection. A clinical prediction score (CPS) was developed, based on data from a retrospective cohort study of unresectable stage IIIB or IV NSCLC patients who were treated with platinum-doublet chemotherapy in the first-line setting with at least two cycles and an evaluated response by RECIST 1.1 at Surin Hospital Cancer Center, Thailand, between July 2014 and December 2018. The clinical parameters in the prediction model were derived by risk regression analysis. There were 117 responders (CR or PR) and 90 non-responders (SD or PD). The clinical prediction score was developed by six clinical parameters including gender, age, smoking status, ECOG, pre-treatment albumin, and histologic subtype. The AuROC of the model was 0.71 (95% CI 0.63–0.78). The internal validation was performed using a bootstrap technique and showed a consistent AuROC of 0.66 (95% CI 0.59–0.72). The prediction score ranged from 0–13, with a score of 0–8 meaning a low probability (PPV = 50%) and a score of 8.5–13 meaning a high probability (PPV = 83.7%) for chemotherapy response. Advanced NSCLC patients who cannot access novel therapies and have a CPS of 8.5–13 have a high probability for chemotherapy response in the first-line setting. This CPS could be used for risk communication and making decisions with patients, especially in regard to chemotherapy. Full article

Lung cancer is the most common cause of mortality from malignant tumors worldwide. The five-year survival rate for people with advanced stages varies considerably, from 35.4% to 6.9%. The angiogenic potential of bcl2 is not well known, nor is the way in which tumor cells with excessive bcl2 expression affect VEGF production. Hypothetically, given that tumor growth, progression and metastasis are dependent on angiogenesis, the antiapoptotic effect is expected to form a link between these two molecules. The aim of this study was to evaluate the relationship between bcl-2 and VEGF expression, clinicopathological features and survival in 216 patients with advanced NSCLC. Archival tumor tissues were examined by immunohistochemistry for the expression of bcl-2 and VEGF. Immunoreactivity for bcl-2 was observed in 41.4% of NSCLCs, 51% of squamous and 34.8% of adenocarcinomas-expressed Bcl-2. There was an inverse correlation of mononuclear stromal reaction and bcl-2 expression in adenocarcinoma (p < 0.0005). A total of 71.8% NSCLCs were VEGF positive, 56% of squamous and 82.2% of adenocarcinomas. High level of VEGF expression was significantly associated with histology type (p = 0.043), low histology grade (p = 0.014), clinical stage IV (p = 0.018), smoking history (p = 0.008) and EGFR mutations (p = 0.026). There was an inverse correlation in the expression of Bcl-2 and VEGF in NSCLC patients (p = 0.039, r = −0.163). Two-year survival of patients with unresectable NSCLC was 39.3%, and 50% of patients were alive at 17 months. Our results demonstrated no difference in survival for patients in advanced NSCLC grouped by bcl-2 and VEGF status. Additionally, we observed an inverse correlation in the expression of Bcl-2 and VEGF in NSCLC and mononuclear reaction and bcl-2 expression in adenocarcinomas. Full article

Elderly care practitioners are at specific risk of experiencing prolonged moral distress, which is associated with occupational health-related problems, low job satisfaction, and staff turnover. So far, little attention has been paid to the moral concerns specific to elderly care, a field whose importance is constantly growing as the populations in Western countries age. By drawing on seven workshop conversations as data and interaction-oriented focus group research, conversation analysis and discursive psychology as methods, we aim to study the ways in which elderly care practitioners discuss moral distress in their work. We found that the moral distress experienced was related to three topics that arose when client work and teamwork contexts were discussed: the power to influence, equal treatment of people, and collaboration. The interaction in client work and teamwork contexts differed systematically. The discussion on client work was characterised by negotiations on the rights and wrongs of care work, whereas the teamwork discussion engendered emotional outbursts, a potential manifestation of work-related burnout. Hence, attempts to improve the work-related health of elderly care practitioners require time and space for sharing the emotional load, followed by reflection on what could be improved in the work and what institutional solutions could help in morally distressing situations. Full article

Background: Cardiovascular diseases represent one of the most important problems for public health. Research indicates that elderly patients consider sexual satisfaction as a fundamental aspect of their quality of life and a better sexual function is related to higher general wellbeing. Objective: The main objective of this study was to investigate the mediating role of anxiety and depression in the relationship between quality of life and sexual satisfaction in cardiovascular (CVD) patients. Methods: The sample comprised 128 adult patients, males and females, hospitalized in a Cardiology Rehabilitation clinical center. To collect data, the following were used: a demographic information sheet, the left ventricular ejection fraction (EF) to evaluate cardiac function, cardiovascular diagnosis type, the HADS scale to evaluate anxiety and depression states, a test for sexual satisfaction evaluation (SAS) and the SF-36 survey to measure quality of life. Results: The results indicated that only SF-36 physical health is indirectly related to SAS through its relationship with anxiety. Conclusion: A mediating model was proposed to explore the underlying association between sexual satisfaction and quality of life. We recommend investigating perceived general health and sexuality as clinical indicators for therapeutic decisions and risk evaluation for the management of cardiovascular diseases. Full article

It has been three years since the initial outbreak of COVID-19 in Wuhan, China, which incurred huge damage both physically and psychologically on human’s normal life. As a prevention measure, the lockdown was first adopted by Wuhan, then by a long list of Chinese cities and many other major cities around the world. Lockdown is the most restrictive social distancing strategy, turning out effective in mitigating the spreading of COVID-19 on the community level, which, however, cuts off all social interactions and isolates healthy people from each other. The isolated nature of the lockdown could induce severe mental health issues, forming one major source of depression and domestic violence. Given the potential side effect, a comprehensive investigation based on reliable data sources is needed to evaluate the real psychological impact of COVID-19 lockdown and its evolution over time, particularly in the time when the Omicron variant, known for its low death risk, dominates the pandemic. Based on the Baidu Searching Index data collected for Wuhan and Shanghai, two major cities in China that suffered from long-lasting (over two months) lockdowns in 2020 and 2022, respectively, it is found that the major psychological issue during the lockdown period is not induced by the spreading of COVID-19, but by the execution of lockdown. With the deepening of knowledge about COVID-19 and the decrease in the death risk, the psychological impact of lockdown keeps increasing, while the impact of virus spreading becomes less important and even irrelevant to depression and domestic violence issues. The findings reveal that from the psychological perspective, the negative effect of lockdown already overweighs the positive one, which is especially true for the Omicron variant provided its almost ignorable death risk. Therefore, it is necessary to re-evaluate the yield and cost of lockdown for those countries where the COVID-19 pandemic has not yet come to an end. Full article

The COVID-19 disease has many symptoms, including fever, dry cough, tachypnea, and shortness of breath, but other symptoms can accompany the disease. The disease can also have oral manifestations. The aim of this narrative review is to describe the oral manifestations of COVID-19 in children and adolescents by summarizing the current knowledge as it was described in various case reports and original articles. A review of the literature was carried out by searching the online databases PubMed, Web of Science and Scopus, between October 2022 and 12 November 2022. For this narrative review, 890 articles from three databases and manual search were screened. Saliva was discovered to be a potential screening tool for the infection with the SARS-CoV-2, although it is most reliable in the first few days of infection. Different alteration of the oral mucosa, such as ulcers, erosions and gingivitis were reported. Oral manifestations accompanied children with COVID-19-related multisystem inflammatory syndrome, Kawasaki disease, thrombocytopenic purpura and erythema multiforme. COVID-19 had an indirect effect on oral harmful habits by decreasing their frequency during the lockdown. Although they occur more rarely, oral manifestations can accompany COVID-19 disease in children and adolescents, and they can be an early sign of the disease. Full article

The COVID-19 pandemic has hampered the optimum management of retinal diseases. This study examined the impact of the pandemic on the intravitreal-injection practice in two academic centers in Italy along with the related medico-legal implications. A retrospective analysis of electronic medical records from 16 March 2020 to 14 March 2021 at the ophthalmological departments of University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG) was conducted. The data collected between 16 March 2020 and 14 June 2020 (lockdown), 15 June 2020 and 13 September 2020 (unlock), and 14 September 2020 and 14 March 2021 (second wave) were compared with those of the same period of the previous year. Weekly data on the administered drug and the number and type of treated disease were collected and analyzed. During the lockdown, a drop of 59% at SGD (p < 0.00001) and 77% at UMG (p < 0.00001) in intravitreal injections was found. In the first year of the pandemic, the reduction in injections was approximately of 27% (p < 0.0008) and 38% (p < 0.0001) at SGD and UMG, respectively. The COVID-19-related containment measures and the health resources redistribution have led to a delay in the treatment of chronic diseases of the retina, prioritizing the undeferrable ones. The lack of management guidelines has conceived relevant ethical and medico-legal issues that need to be considered in future measures planning. Full article

Diabetes mellitus (DM) is a major health issue in Saudi Arabia. Prevention of DM and its complications requires an understanding of the disease and modifiable behaviors (e.g., physical activity—PA). The purpose of this study was to examine the trends in knowledge of the general population regarding DM to better understand the shortcomings in the current awareness programs. This article presents a cross-sectional series study where a survey was distributed to a total of 3493 participants over four years, from 2017 till 2020, to assess general knowledge about DM, including information about PA. The mean percentage of correct responses of DM general knowledge was 63.8 ± 19.0 in 2017, which decreased to 61.3 ± 18.7 in 2020 with a significant beta coefficient of −0.8 ± 0.2 (p < 0.001). Participants’ awareness about PA remained constantly high for four years: the mean percentage of correct responses was 82.1 ± 23.6 in 2017 and 82.0 ± 23.1 in 2020, and the beta coefficient was −0.5 ± 0.3 (p = 0.147). Furthermore, stratification by demographics showed that the majority of the subgroups (age, sex, educational status, marital status, having relative with DM, nationality) reported a significant declining trend in general DM knowledge. In addition, some of the subgroups also showed a declining trend in PA awareness. Future prevention efforts should assess the community’s DM knowledge regularly to tailor awareness efforts to the population segments that need heightened educational interventions. Full article

Combating mental illnesses such as depression and anxiety has become a global concern. As a result of the necessity for finding effective ways to battle these problems, machine learning approaches have been included in healthcare systems for the diagnosis and probable prediction of the treatment outcomes of mental health conditions. With the growing interest in machine and deep learning methods, analysis of existing work to guide future research directions is necessary. In this study, 33 articles on the diagnosis of schizophrenia, depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), anorexia nervosa, and attention deficit hyperactivity disorder (ADHD) were retrieved from various search databases using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) review methodology. These publications were chosen based on their use of machine learning and deep learning technologies, individually assessed, and their recommended methodologies were then classified into the various disorders included in this study. In addition, the difficulties encountered by the researchers are discussed, and a list of some public datasets is provided. Full article

Long-COVID is a clinical condition in which patients affected by SARS-CoV-2 usually report a wide range of physical and cognitive symptoms from 3 to 6 months after the infection recovery. The aim of the current study was to assess the link between self-reported long-COVID symptoms and reaction times (RTs) in a self-administered Visual Detection Task (VDT) in order to identify the predictor symptoms of the slowing in reaction times to determine attention impairment. In total, 362 participants (age (mean ± S.D.: 38.56 ± 13.14); sex (female–male: 73.76–26.24%)) responded to a web-based self-report questionnaire consisting of four sections: demographics, disease-related characteristics, and medical history questions. The final section consisted of a 23 item 5-point Likert-scale questionnaire related to long-term COVID-19 symptoms. After completing the questionnaire, subjects performed a VDT on a tablet screen to assess reaction times (RTs). An exploratory factorial analysis (EFA) was performed on the 23 long-COVID symptom questions, identifying 4 factors (cognition, behavior, physical condition, presence of anosmia and/or ageusia). The most important predictors of RTs were cognition and physical factors. By dissecting the cognitive and physical factors, learning, visual impairment, and headache were the top predictors of subjects’ performance in the VDT. Long-COVID subjects showed higher RTs in the VDT after a considerable time post-disease, suggesting the presence of an attention deficit disorder. Attention impairment due to COVID-19 can be due to the presence of headaches, visual impairments, and the presence of cognitive problems related to the difficulty in learning new activities. The link between the slowing of reaction times and physical and cognitive symptoms post-COVID-19 suggests that attention deficit disorder is caused by a complex interaction between physical and cognitive symptoms. In addition, the study provides evidence that RTs in a VDT represent a reliable measure to detect the presence of long-COVID neurological sequelae. Full article

Background: The COVID-19 pandemic has dramatically affected all aspects of the patient’s pathway to cancer diagnosis and subsequent treatment. Our main objective was to evaluate the status of cancer trials in Ukraine as of September 2022. Methods: Initially, we examined with a narrative review the state of breast, colorectal, and cervical cancer population-based screening. Subsequently, we assessed each trial status for the years 2021 and 2022. Results: Estimates of participation in breast and cervical cancer screening are different from region to region. Moreover, regarding cervical cancer screening, extremely different participation estimates were reported: 73% in 2003 vs. <10% 2020. Our data show that from 2014 to 2020, despite the pandemic, cancer trials in Ukraine significantly increased from 27 to 44. In 2021 no trials were completed; in fact, we observed that out of 41 trials, 8 were active not recruiting, 33 were recruiting, and 0 were completed or terminated. In 2022 in Ukraine, for oncological pathologies, only 3 trials were registered, while in 2021, 41 trials were registered. The suspension of trials regarded above all concern hematological tissue (66.7%) and the genitourinary tract (60%). Conclusions: Our work has highlighted how the areas most affected by the conflict present criticalities in oncological care. Full article

In July 2020, Mayo Clinic introduced a hospital-at-home program, known as Advanced Care at Home (ACH) as an alternate option for clinically stable medical patients requiring hospital-level care. This retrospective cohort study evaluates the impact of the addition of a dedicated ACH patient acquisition Advanced Practice Provider (APP) on average length of stay (ALOS) and the number of patients admitted into the program between in Florida and Wisconsin between 6 July 2020 and 31 January 2022. Patient volumes and ALOS of 755 patients were analyzed between the two sites both before and after a dedicated acquisition APP was added to the Florida site on 1 June 2021. The addition of a dedicated acquisition APP did not affect the length of time a patient was in the emergency department or hospital ward prior to ACH transition (2.91 days [Florida] vs. 2.59 days [Wisconsin], p = 0.22), the transition time between initiation of the ACH consult to patient transfer home (0.85 days [Florida] vs. 1.16 days [Wisconsin], p = 0.28), or the total ALOS (6.63 days [Florida] vs. 6.34 days [Wisconsin], p = 0.47). The average number of patients acquired monthly was significantly increased in Florida (38.3 patients per month) compared with Wisconsin (21.6 patients per month) (p < 0.01). The addition of a dedicated patient acquisition APP resulted in significantly higher patient volumes but did not affect transition time or ALOS. Other hospital-at-home programs may consider the addition of an acquisition APP to maximize patient volumes. Full article