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

For HIV-positive African Americans, the mistrust of medical providers due to anticipation of unequal treatment care, prejudice, and bias can become a major deterrent to medication and treatment adherence. Although programs and services incorporate strategies to improve patient–provider relationships, a deeper understanding of their healthcare experiences, especially among those with a dual diagnosis of HIV/AIDS and a nutrition-related chronic disease, is lacking. This qualitative study aimed to address this gap by conducting focus groups with participants who identified themselves as being African American, and having a dual diagnosis of HIV/AIDS, and a chronic disease. Content analysis generated several major themes, highlighting the impact of a negative healthcare experience on their ability to self-manage their health. Factors such as lack of consistency in care team, negative interactions with doctors, feelings of stigma due to prejudice and bias from healthcare staff, loss of privacy, and the need for comprehensive services that targeted their physical, emotional, and nutritional health emerged as recurring sub-themes. These findings provide the foundation for the design of a comprehensive intervention model that helps participants to communicate their medical needs more effectively, thus optimizing their overall health outcomes and quality of life. Full article

Nursing students have limited knowledge of providing quality care to lesbian, gay, bisexual, and transgender individuals. The aim of this study was to explore the psychometric properties of the Nursing Students’ Knowledge of and Attitudes toward Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Concerns (NKALH) survey as well as to examine whether sociodemographic variables may affect attitudes toward LGBT individuals. In this cross-sectional study which was carried out from January–March 2022, 258 nursing students from two Greek universities completed the NKALH. For survey translation, the procedure of forward and backward translation was followed. Construct validity, reliability, and internal consistency were explored via confirmatory factor analysis, the test–retest reliability method, and Cronbach’s alpha index. The correlation between the dimensions of the attitude subscale was used to explore convergent validity. Analyses were carried out with the Statistical Package for the Social Sciences (SPSS), version 26.0. The level of significance was set at <0.05. Confirmatory factor analysis confirmed that the attitude subscale consists of three dimensions (Comfortable, Responsibility, Willingness to Care). The Pearson test (r) revealed strong correlations between two measurements (Comfortable r = 0.932, p < 0.001, Responsibility r = 0.938, p < 0.001, and Willingness to Care r = 0.915, p < 0.001), indicating good reliability. The Cronbach’s alpha index of the total scale was 0.783, highlighting its good internal consistency. Bivariate analysis revealed that sexual orientation, religion, and age are related to knowledge and attitudes toward LGBT individuals. The NKALH survey is a valid and reliable tool to measure the knowledge and attitudes of Greek nursing students on the health concerns of LGBT individuals. Full article

Poor medication adherence is a public health concern leading to a large burden of cardiovascular disease among persons with hypertension. Using data from 3281 persons with diagnosed hypertension (N = 622,581) from the Panamanian National Health Survey (ENSPA) collected in 2019, we assessed the national prevalence of low-moderate medication adherence in hypertensive individuals using the 4-scale Morisky Medication Adherence Scale (4-MMAS) and identifying gender-specific associated factors. Multivariate logistic regression models were used to estimate the association between possible risk factors and low-moderate medication adherence with odds ratios (OR) and 95% confidence intervals (95% CI) stratified by gender. The national prevalence of low-moderate medication adherence was 78.2% (95% CI: 74.7–81.0%); in men it was 74.4% (95% CI: 67.5–80.3%) and in women it was 81.4% (78.4–84.0%). In women, low-moderate medication adherence was associated with living in indigenous area (OR: 5.15; 95% CI: 1.40–18.98), educational level (OR no formal education: 0.77, 95% CI 0.28–2.14; OR for primary education: 0.76, 95% CI 0.38–1.56; OR for secondary education: 0.90, 95% CI 0.48–1.70; Higher education as reference), increased BMI (normal as reference, OR for overweight: 1.35, 95% CI: 0.73–2.50, OR for obesity: 1.65, 95% CI: 0.90–3.03) and medical diagnosis of anxiety/depression (OR: 4.89, 95% CI: 1.36–17.49). However, in men, it was associated with having secondary education (OR: 2.94; 95% CI: 1.03–8.36), currently smoking (OR: 16.74, 95% CI: 1.83–152.70), taking antihypertensive medication with denial of hypertension diagnosis (OR: 4.35, 95% CI: 1.11–17.11) and having less than three annual check-ups (OR for no health check-ups: 2.97, 95% CI: 0.63–13.88; OR for 1–2 check-ups: 1.61, 95% CI: 0.78–3.32: three or more health check-ups: reference). Time since diagnosis was inversely associated with low-moderate adherence. This study assesses for the first time the national prevalence of low-moderate medication adherence among hypertensive individuals in Panama. Low-moderate medication adherence is an important public health issue that should be addressed to achieve blood pressure control in patients diagnosed with hypertension, taking into account gender-specific factors. Full article

Background: The distribution of vascular risk factors (VRFs) and stroke management vary by geographic area. Our aim was to examine the percentage of the VRFs according to age and sex in ischemic stroke survivors in a geographical area on the Mediterranean coast of Southern Catalonia, Spain. Methods: This was a multicenter, observational, retrospective, community-based study of a cohort, the data of which we obtained from digital clinical records of the Catalan Institute of Health. The study included all patients with a confirmed diagnosis of ischemic stroke who were treated between 1 January 2011 and 31 December 2020. Patients met the following inclusion criteria: residing in the study area, age ≥ 18 years, and presenting ≥1 modifiable vascular risk factor. The exclusion criteria were as follows: death patients (non-survivors) and patients without modifiable VRFs. We collected the demographic, clinical, and VRF variables of the total of 2054 cases included, and we analyzed the data according to age groups, sex, and number of VRFs. Results: Most of the patients included were in the 55–80 age group (n = 1139; 55.45%). Of the patients, 56.48% (n = 1160) presented ≤ 2 modifiable VRFs, and the age group <55 years old (67.01%) presented more VRFs. Hypertension and (>80 years old (38.82%)) and dyslipidemia (<55 years (28.33%)) were the most prevalent VRFs. In the age group 55–80 (69.59% men), the prevalence of VRFs was higher ((3–4 VRF (42.76%) and >4 VRF (5.35%)). Conclusions: These results suggest the presence of many VRFs in people diagnosed with ischemic stroke—although with a lower percentage compared to other studies—and the need for specific individualized interventions for the control of modifiable RFs related to primary and secondary prevention of stroke. Full article

A projected rise in patients with complex health needs and a rapidly ageing population will place an increased burden on the healthcare system. Care coordination can bridge potential gaps during care transitions and across the care continuum to facilitate care integration and the delivery of personalised care. Despite having a national strategic vision of improving care integration across different levels of care and community partners, there is no consolidation of evidence specifically on the salient dimensions of care coordination in the Singapore healthcare context. Hence, this scoping review aims to uncover the key themes that facilitate care coordination for patients with chronic conditions in Singapore to be managed in the community while illuminating under-researched areas in care coordination requiring further exploration. The databases searched were PubMed, CINAHL, Scopus, Embase, and Cochrane Library. Results from Google Scholar were also included. Two independent reviewers screened articles in a two-stage screening process based on the Cochrane scoping review guidelines. Recommendation for inclusion was indicated on a three-point scale and rating conflicts were resolved through discussion. Of the 5792 articles identified, 28 were included in the final review. Key cross-cutting themes such as having standards and guidelines for care programmes, forging stronger partnerships across providers, an interoperable information system across care interfaces, strong programme leadership, financial and technical resource availabilities and patient and provider-specific factors emerged. This review also recommends leveraging these themes to align with Singapore’s national healthcare vision to contain rising healthcare costs. Full article

Despite the significant achievements of current healthcare systems (CHCSs) in curing or treating several acute conditions, there has been far less success coping with noncommunicable diseases (NCDs), which have complex roots and nonconventional transmission vectors. Owing to the impact of the invisible hyperendemic NCDs and the COVID-19 pandemic, the limitations of CHCSs have been exposed. In contrast, the advent of omics-based technologies and big data science has raised global hope of curing or treating NCDs and improving overall healthcare outcomes. However, challenges related to their use and effectiveness must be addressed. Additionally, while such advancements intend to improve quality of life, they can also contribute the ever-increasing health disparity among vulnerable populations, such as low/middle-income populations, poorly educated people, gender-based violence victims, and minority and indigenous peoples, to name a few. Among five health determinants, the contribution of medical care to individual health does not exceed 11%. Therefore, it is time to implement a new well-being-oriented system complementary or parallel to CHCSs that incorporates all five health determinants to tackle NCDs and unforeseen diseases of the future, as well as to promote cost-effective, accessible, and sustainable healthy lifestyle choices that can reduce the current level of healthcare inequity. Full article

This study aimed to summarise different interventions used to improve clinical models and pathways in the management of chronic and acute heart failure (HF). A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. MEDLINE (via PubMed), Embase, The Cochrane Library, and CINAHL were searched for systematic reviews (SR) published in the period from 2014 to 2019 in the English language. Primary articles cited in SR that fulfil inclusion and exclusion criteria were extracted and examined using narrative synthesis. Interventions were classified based on five chosen elements of the Chronic Care Model (CCM) framework (self-management support, decision support, community resources and policies, delivery system, and clinical information system). Out of 155 SRs retrieved, 7 were considered for the extraction of 166 primary articles. The prevailing setting was the patient’s home. Only 46 studies specified the severity of HF by reporting the level of left ventricular ejection fraction (LVEF) impairment in a heterogeneous manner. However, most studies targeted the populations with LVEF ≤ 45% and LVEF < 40%. Self-management and delivery systems were the most evaluated CCM elements. Interventions related to community resources and policy and advising/reminding systems for providers were rarely evaluated. No studies addressed the implementation of a disease registry. A multidisciplinary team was available with similarly low frequency in each setting. Although HF care should be a multi-component model, most studies did not analyse the role of some important components, such as the decision support tools to disseminate guidelines and program planning that includes measurable targets. Full article

South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27–47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community. Full article

Irritable bowel syndrome (IBS) causes abdominal pain during bowel movements and is diagnosed according to the Rome IV international diagnostic criteria. Patients diagnosed as having IBS experience abdominal pain at least 1 day/week, on average, over a 3-month period and not 3 days per month. A diagnosis of IBS is confirmed if symptoms have persisted for more than 6 months. IBS symptoms negatively affect daily life. First, improving daily habits are important to ameliorating IBS symptoms. IBS symptoms can be alleviated by staying active, sleeping, resting and staying stress-free. In addition, it is important to eat three, balanced meals a day on a regular basis and avoid overeating, especially at night. Spicy foods, high-fat foods, and alcohol can exacerbate symptoms. Researchers found, in a literature review, that IBS symptoms can be ameliorated by improving daily habits, thus relieving abdominal pain and the defecation symptoms of IBS. Full article