Search Results (13,288)

Introduction: With the emergence of the expert patient and the expansion of health literacy, the importance of planning and building health technologies aimed at teaching and training health professionals, especially nurses, due to their activities with patients in Primary Health Care, with the aim of meeting the real and constant demands of the expert patient, is evident. Methods: Methodological study with a quantitative approach. The course was constructed based on a scope review, scientific reference, and observational visits during the months of September 2021 and August 2022. For validation, an organized electronic form was used with general information about the research and items of the course constructed for later evaluation by the judges with the three-point Likert scale and with the application of the Delphi Technique between the months of September and October 2022; for the agreement of the judges, the Content Validation Coefficient > 0.8 was considered. Results: Based on the content selected in the scope review, the reference contribution, and the observational visits, the course was constructed. Nine judges participated in the validation stage in Delphi I with a total Content Validation Coefficient above 0.90 and with some suggestions for modifications and improvements pointed out by them. In Delphi II, six judges evaluated the course, resulting in a total Content Validation Coefficient of 0.99. Conclusions: The course developed was considered valid to support the training of Primary Health Care nurses in the formation of the expert patient, with a view to promoting patient autonomy in self-care management, optimizing Primary Health Care, and reducing unnecessary hospital admissions. Full article

Background: This systematic review evaluates the efficacy of rehabilitation-focused exercise interventions for lumbar degenerative disc disease (DDD), a leading cause of chronic low back pain. Methods: Following PRISMA guidelines, a comprehensive search was conducted across international and regional databases (PubMed, Scopus, Web of Science, Magiran, SID, and Noormags) covering the period from January 2010 to January 2025. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251088811. Using keywords such as “lumbar DDD,” “exercise therapy,” and “rehabilitation,” a total of 2495 records were identified. After screening, 20 studies—including clinical trials, quasi-experimental, and experimental designs—met the inclusion criteria and were assessed using the McMaster Critical Review Form for Quantitative Studies. Results: Interventions such as hydrotherapy, core stability training, Pilates, and suspension exercises were found to significantly reduce pain and improve functional outcomes. While multimodal approaches (e.g., aquatic exercise combined with acupuncture) showed positive effects, the comparative studies revealed no significant differences between modalities. Suspension training demonstrated superior efficacy in pain reduction compared to isolated core stability exercises. The methodological quality of included studies ranged from good to excellent, with the majority rated as very good or excellent (McMaster scores: 8 “excellent,” 7 “very good,” and 5 “good”). Common limitations among the studies included methodological heterogeneity, small sample sizes (n = 14–30), and insufficient long-term follow-up. Conclusions: Exercise-based rehabilitation is an effective strategy for managing lumbar DDD. Evidence particularly supports the use of suspension training and aquatic therapy for superior improvements in pain and functional outcomes. Future research should aim to adopt standardized protocols, recruit larger sample sizes, and include extended follow-up periods to produce more robust and generalizable findings. Full article

Background/Objectives: Older adults (65+) are the fastest growing age group in Canada, comprising 18.8% of the country’s population. During the COVID-19 pandemic, use of virtual care, including telehealth and tele-medicine, increased dramatically among older adults in Canada who often face higher health risks, mobility limitations, and many barriers to accessing healthcare. Despite the rapid expansion in virtual care, no systematic review has focused specifically on virtual care among older adults in Canada. This review aims to explore the factors influencing virtual care adoption and the experiences of older Canadians during the pandemic through a systematic review. Methods: Conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the review involved a comprehensive search of PubMed, Scopus, ESCBOHost, and Web of Science on 2 May 2025, yielding 281 unique citations. After screening and applying eligibility criteria, 15 studies employing quantitative, qualitative, or mixed-methods designs, with sample sizes ranging from 15 to 2,282,798, were included and appraised using the Mixed Methods Appraisal Tool (MMAT). Results: The review identified three domains of factors and the ways in which each factor shapes older adults’ virtual care experiences: (1) personal factors influencing virtual care use and demand (e.g., age, education, language, income, immigration status, community sizes), (2) resource factors impacting virtual care adoption (e.g., technology access, support), and (3) varying virtual care experiences among older adults (e.g., in assessment and communication efficacy, privacy, care quality, convenience, safety, and costs). Conclusions: This review highlights the complexities of virtual care engagement among older adults and underscores the need for inclusive, tailored strategies to improve the accessibility and effectiveness of virtual care delivery in both pandemic and post-pandemic contexts. Full article

Background: Undercover police work is a psychologically high-risk profession that exposes officers to chronic stress, identity conflicts, and moral dilemmas. The aim of the present review is to evaluate the psychological consequences associated with undercover police work, focusing on specific psychopathological risk factors. Methods: A systematic search was conducted in PubMed, PsycINFO, Web of Science, and Scopus databases. Studies were conducted in the United States, the United Kingdom, New Zealand, and Canada. The present systematic review analyzed data from 380 current undercover operatives, 372 former UCOs, 578 officers without undercover experience, and 60 pre-operational agents. Results: From an initial pool of 365 records, 10 studies were identified, of which 6 met the inclusion criteria. The most frequently reported psychological risk factors included anxiety, hypervigilance, identity issues, dissociative symptoms, and substance misuse. These were assessed using validated self-report instruments (e.g., SCL-90), structured interviews, and clinical evaluations. Long-term consequences were more prominent post-deployment, particularly among former UCOs. Conclusions: Undercover work is associated with an elevated risk of mental health problems, especially after the end of operations. Future research should focus on standardizing assessment tools and identifying protective factors. The findings support the development of targeted interventions such as pre-deployment psychological screening, ongoing monitoring, and structured reintegration programs to safeguard UCOs’ well-being. Full article

Background: Midwifery’s Intangible Heritage was officially recognized by the United Nations Educational, Scientific and Cultural Organization on 6 December 2023, highlighting that elements of midwifery knowledge and practice, shaped over generations, constitute cultural heritage worth safeguarding. While previous studies have investigated midwives’ perceptions of professional identity, none have done so within the explicit framework of MIH. Objective: this study explored how midwives and student midwives in Cyprus perceive the intangible heritage of their profession and how it relates to their shared professional identity. Methods: A qualitative descriptive study was conducted between April and July 2023. Three focus groups were held, involving 22 participants: 15 registered midwives and 7 student midwives. A semi-structured interview guide consisting of 10 questions was used, developed by the lead author (M.P.) based on the literature and improvisation and finalized with the research team (E.H., S.V., N.M.) after expert input. Thematic analysis was performed inductively to identify recurrent themes. Results: Four major themes emerged: (1) key elements of Midwifery’s Intangible Heritage and their transmission across generations; (2) a sense of shared professional identity; (3) perceived threats to the midwifery profession; and (4) midwives’ expectations for the future of the profession. Conclusions: The findings reflect the historical background of midwifery in Cyprus and its contrast with contemporary practice, particularly within the context of the overmedicalization of birth and societal perceptions of midwifery in the socio-cultural setting. Safeguarding Midwifery’s Intangible Heritage requires both empowering women to seek midwifery-led care and enabling midwives to practice autonomously within their full professional scope. In addition, policymakers and educational bodies must support the preservation of midwives’ core skills through targeted educational curricula, structured mentorship, and continuous professional development. Full article

Background/Objectives: Pacifier use in infants has both beneficial and harmful implications, and dipping pacifiers in sweeteners is used by some parents to soothe infants. This study aimed to assess pacifier usage among mothers in Jeddah, Saudi Arabia, and to examine its association with child demographics, maternal socioeconomic status (SES), and maternal knowledge of the risks associated with dipping pacifiers in sweeteners. Methods: A cross-sectional study was conducted among mothers of healthy children aged 2 to 4 years during community-awareness events in Jeddah. Participants completed a validated Arabic questionnaire covering pacifier use patterns, feeding practices, SES background, and knowledge regarding the adverse effects of pacifier sweetening. Results: A total of 1438 mothers participated. The mean age of children was 34.3 ± 10.7 months, with 441 children (30.7%) reported as pacifier users. Among them, 202 (45.8%) used pacifiers both during the day and at night. Most children (35.6%) discontinued use between 4 and 6 months of age. Only 6.1% of mothers reported adding sweeteners to pacifiers. Pacifier usage was significantly higher among first-born children (37.6%, p < 0.001), those who received both bottle- and breastfeeding (65.5%, p < 0.001), and children enrolled in nursery (62.1%, p = 0.007). Most mothers (75.6%) were aware of the link between sweetened pacifiers and dental caries, and 69.4% of those who had this knowledge avoided giving their child a pacifier (p = 0.077). Conclusions: Birth order, feeding practices, and nursery attendance are key predictors of pacifier use. Enhancing parental awareness and education may support early interventions to promote healthier oral and feeding habits in young children. Full article

Background: Patient safety culture is critical for enhancing the quality and safety of healthcare. Studies in low- and middle-income countries have reported challenges in developing patient safety culture, especially in implementing nonpunitive responses to errors and event reporting. However, evidence from Laos remains limited. Objectives: This study aimed to assess patient safety culture in hospitals in southern Laos, using a validated survey tool to identify strengths and areas of improvement. Methods: A cross-sectional study using purposive sampling was conducted in four provincial and twenty-three district hospitals in southern Laos. Healthcare workers on patient safety committees responded to the Hospital Survey on Patient Safety Culture. The positive response rate was analyzed. Bivariate tests (chi-square/Fisher’s exact) were applied to compare positive response rates between hospital types and professions. Results: A total of 253 valid responses (75.5%) were analyzed. “Organizational Learning–Continuous Improvement” scored over 75% in both provincial and district hospitals. In contrast, “Nonpunitive Response to Error” and “Frequency of Events Reported” were scored <20% on average. Provincial hospitals scored significantly higher than district hospitals in supervisory support and handoffs. Conclusions: This study illustrated strengths in organizational learning while identifying nonpunitive responses and event reporting as critical areas of improvement for hospitals in Laos. To improve patient safety, hospitals in Laos must promote a culture in which errors can be reported without fear of blame. Strengthening leadership support and reporting systems is essential. These findings can inform strategies to enhance patient safety in other low-resource healthcare settings. Full article

Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health assessment, interactive learning, and community building. While empowerment is a core concept of GANC, the ways it manifests and the elements that facilitate it remain unclear. Method: We conducted a generic qualitative study across four organizations in Brussels, using multiple data collection methods. This included interviews with 13 participants and 21 observations of GANC sessions, combining both the insider and outsider perspective. An adapted version of the Pregnancy-Related Empowerment Scale (PRES) guided the interviews guide and thematic analysis. Results: We identified seven themes that capture how empowerment occurs in GANC: peer connectedness, provider connectedness, skillful decision-making, responsibility, sense of control, taking action, and gaining voice. Several aspects of GANC contribute to empowerment, particularly the role of facilitators. Conclusions: This study highlights how GANC enhances empowerment during pregnancy through interpersonal, internal, and external processes. Important components within GANC that support this process include the group-based format and the interactive nature of the discussions. The presence of skillful GANC facilitators is an essential prerequisite. In a diverse and often vulnerable context like Brussels, strengthening empowerment through GANC presents challenges but is especially crucial. Full article

Background: China is confronted with the dual challenges of deeply interwoven population aging and the digitalization process. The digital integration and mental health issues of the elderly group are becoming increasingly prominent. Objectives: The present study aimed to analyze the pathways through which individual, family, and social factors influence Internet use in the elderly through a multi-level analysis framework, to examine the association between Internet use and mental health with a view to providing empirical evidence for digital technology-based mental health intervention programs for the elderly, and to promote the scientific practice of the goal of healthy aging. Methods: Based on the data of the 2021 China General Social Survey (CGSS) and provincial Internet development indicators, a mixed cross-sectional dataset was constructed. Logistic hierarchical regression and OLS regression methods were adopted to systematically investigate the multi-level factors associated with Internet use among the elderly group and its association with mental health. Results: The results indicate that individual resources (younger age, higher education level, and good health status) and family technical support (family members’ Internet access) are strongly associated with Internet usage among the elderly, while regional Internet penetration rate appears to operate indirectly through micro-mechanisms. Analysis of the association with mental health showed that Internet use was related to a lower score of depressive tendency (p < 0.05), and this association remained robust after controlling for variables at the individual, family, and social levels. Conclusions: The research results provide empirical evidence for the health promotion policies for the elderly, advocating the construction of a collaborative intervention framework of “individual ability improvement–intergenerational family support–social adaptation for the elderly” to bridge the digital divide and promote the digital integration of the elderly population in China. Full article

Background: Medical clearance for competitive sports is vital to safeguarding athletes’ health, particularly in high-intensity disciplines like football. In Italy, fitness assessments follow stringent protocols set by the Commissione di Vigilanza per il controllo dell’Idoneità Sportiva (COCIS), with a strong focus on cardiovascular screening. The primary goal is to prevent sudden cardiac death (SCD), a rare but catastrophic event in athletes. Methods: This paper provides an in-depth narrative review of the 2023 COCIS guidelines, examining the cardiological screening process, required diagnostic tests, management of identified cardiovascular conditions, and the protocols’ role in reducing SCD risk. Results: Comparisons with international standards underscore the effectiveness of the Italian approach. Conclusions: The COCIS 2023 guidelines provide clear, evidence-based protocols for cardiovascular risk assessment, significantly enhancing athlete safety and reducing the incidence of SCD in high-intensity sports. Full article

Background/Objectives: Pancreatic cancer (PC) is a diagnosis with a poor prognosis which can be associated with significant distress and may hinder a patient’s ability to understand treatment details. Educating patients based on their learning preferences (LPs) and emotions may allow for personalized, enhanced care. Methods: This prospective project enrolled patients with non-metastatic PC. Phase 1 utilized the Learning Preference Barometer (LPB) and Emotional Journey Barometer (EJB), which are digital instruments co-designed by CANCER101 (C101) and the Health Collaboratory, to assess patient LPs and emotional states. Phase 2 provided information prescriptions aligned with LPs through C101’s Prescription to Learn^® (P2L) platform. Collected data included demographics, treatment, LPs (auditory, kinesthetic, linguistic, visual), patient engagement with P2L, and patient emotional states with qualitative verbal validation. Descriptive variables were used to report outcomes. Results: Primary LPs in the 47 participating patients were as follows: linguistic 45%, visual 34%, auditory 11%, and kinesthetic 9%, with secondary preferences in the majority (53%). Those patients (66%) who accessed P2L had linguistic and visual preferences; the majority accessed 1- 2 resources out of the 25 provided. Resources accessed aligned to 88% of patient LPs. The majority of patients (60%) initiated treatment prior to initial EJB, and 40% were treatment naive. Common baseline emotions were optimistic (47% vs. 36%, respectively), satisfied (11% vs. 25%), acceptance (11% vs. 11%), and overwhelmed (5% vs. 11%). Conclusions: Assessing LPs and emotional state allows for personalized patient education and clinical encounters for PC patients. Future work includes examining the effects of personalized approaches on patient satisfaction, decision-making, health outcomes, and the overall patient–clinician relationship. Full article

Background/Objective: Executive functions (EFs) are essential in the daily management of arthritis, as they influence treatment adherence, decision-making, and the ability to cope with disease-related challenges. The objective of this study was to compare EFs alongside functional status and quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and examine their associations with disease activity and clinical variables. Methods: In this cross-sectional study, 140 patients (70 RA, 70 PsA) were assessed using the Stroop-TBAG, Wisconsin Card Sorting Test (WCST), and Adult Executive Functioning Inventory (ADEXI). Functional status and quality of life were measured with the Health Assessment Questionnaire (HAQ) and WHOQOL-BREF, respectively. Correlations with disease activity (DAS28-CRP), age, and disease duration were examined. Results: RA patients had significantly higher disease activity and longer disease duration. They showed poorer performance on the Stroop Test (color–word time: 61.6 ± 14.8 vs. 52.4 ± 10.9 s, p < 0.001; errors: 3.2 ± 2.1 vs. 2.1 ± 1.5, p = 0.001), more WCST perseverative errors (p = 0.002), and higher ADEXI inhibition scores (13.9 ± 2.5 vs. 12.9 ± 3.0, p = 0.013). DAS28-CRP was correlated with EF impairments, disability, and poorer quality of life in RA (p < 0.05). In PsA, EFs remained relatively stable, although higher disease activity was associated with worse HAQ scores (p = 0.001). Treatment type was not linked to EF, but patients on combination therapy reported lower physical (p = 0.009) and psychological (p = 0.014) quality of life, along with higher HAQ scores (p = 0.016). Conclusions: This study revealed that patients with RA exhibit more pronounced executive dysfunction, along with lower ADL skills and quality of life compared to those with PsA. These findings highlight the need for multidimensional assessment strategies in inflammatory arthritis, especially in RA, where cognitive and functional outcomes are closely tied to clinical burden. Full article

Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated with VI in Duhknah, a rural area in Qassim Province, Saudi Arabia. Methods: This cross-sectional study, conducted in May 2024, included 929 participants aged 6–90 years from Duhknah, a rural area in Qassim Province, Saudi Arabia. Refractive errors (REs) were measured using a non-cycloplegic autorefractometer. Anterior and posterior eye examinations were performed using slit lamp biomicroscopy, direct ophthalmoscopy, and 90 D fundus biomicroscopy. VI was classified based on the International Classification of Diseases 11th revision (ICD-11), 2018. Results: The findings revealed that 671 (72.2%) participants had never undergone an eye examination. The overall prevalence of presenting VI was 370 (39.8%), comprising 21.6% with mild VI, 11.0% moderate, 4.1% severe, and 3.1% classified as blind. The prevalence of hyperopia, myopia, and astigmatism was 20.6%, 36.9%, and 13.2%, respectively. Uncorrected REs were the most common cause of VI (81.4%), followed by amblyopia (13.5%) and cataracts (3.2%). Regression analysis showed that women had 1.58 times higher odds of VI (p = 0.001). Participants with eye examinations for one year or more had 3.64 times higher odds (p < 0.001). Additionally, the risk of VI was significantly lower among older participants (ages 18–90) compared to younger ones (ages 6–17), (p < 0.001). Conclusions: This study found most participants had never had an eye exam, and VI was highly prevalent in the rural community. These findings underscore the need to strengthen primary eye care in rural Saudi Arabia. Regular vision screening, particularly for children, and better access to refractive services could significantly reduce VI and support the goals of Saudi Vision 2030. Full article

Objectives: In view of a lack of evidence on the subject, we aimed to perform a scoping review to understand the impact of health education among people attending mass gatherings. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines. PubMed, EMBASE, Scopus, and Cochrane Library were searched from inception to March 2025 to identify eligible studies. Observational and interventional studies that reported the impact of health education on any health-related outcome among those attending a mass gathering were considered. A narrative synthesis of review results was performed to gather evidence. Recommendations were framed in the context of this evidence. Results: Of the 1731 records, only 17 studies met the inclusion criteria. These included cross-sectional (n = 10), pre-post design (n = 3), quasi-experimental (n = 2), randomized controlled trial (n = 1), and ethnographic (n = 1) studies. These studies involved participants attending hajj, umrah, and basketball events. The current evidence on health education in mass gatherings is highly varied in its objectives, intervention strategy, educational plan, mode of delivery, design, and reported outcomes. Most studies agreed that health education should be initiated by the country of origin and continued throughout the event. It is recommended that this education should be tailored to patient needs based on age, medical condition, and other personal factors, and given in the local language for better acceptability. Such sources can be provided in various forms, either online or offline, as per the participant’s convenience. Conclusions: The current evidence on the effectiveness of health education during mass gatherings, particularly in pilgrimage settings, is varied and inconsistent. Participant-tailored health education should be provided, preferably in the local language, through convenient formats. Full article

Background: Concerns over women’s mental health have intensified globally, especially among mothers managing dual careers and family responsibilities. Positive Psychology Interventions (PPIs), such as gratitude journaling and well-being workshops, have demonstrated promise in enhancing mental health; however, their applicability in Arab contexts remains underexplored. This study aims to investigate the effectiveness of PPIs on mothers’ well-being, gratitude, depression, anxiety, and stress in Saudi Arabia. Methods: This quasi-experimental, one-group pretest–posttest study assessed the effects of a four-week PPI on 37 Saudi working mothers (aged 21–50 years) employed at a private school in Riyadh. The intervention included guided gratitude journaling thrice weekly and two workshops on positive psychology and gratitude. Pre- and post-intervention assessments used validated Arabic versions of the Depression Anxiety Stress Scale (DASS-21), WHO-5 Well-being Index, and Gratitude Questionnaire (GQ-6). Results: Significant improvements were found post-intervention: depression, anxiety, and stress scores decreased (p < 0.001), while well-being and gratitude increased (p = 0.001). However, participants with lower household income (<50,000 SAR) showed less improvement, indicating a potential moderating effect of socioeconomic status. Conclusions: The intervention demonstrated promising short-term improvements in mental health and well-being among Saudi mothers. The findings underscore the importance of culturally appropriate PPIs and highlight the need for further research using controlled, long-term designs. Limitations include the small, non-random sample, absence of a control group, and restriction to a single geographic region. Full article