Search Results (329)

Respectful maternity care involves privacy, dignity, and informed choice within the process of delivery as stipulated by the World Health Organization (WHO). Informed consent is a cornerstone of patient-centered care, representing not just a formal document, but an ongoing ethical and clinical process through which women are offered objective, understandable information to support autonomous, informed decision-making. This narrative review critically examines the literature on informed consent in maternity care, with particular attention to both obstetric-led and midwifery-led models of care. In addition to identifying institutional, cultural, and systemic obstacles to its successful implementation, the review examines the definition and application of informed consent in perinatal settings and evaluates its effects on women’s autonomy and satisfaction with care. Important conclusions emphasize that improving women’s experiences and minimizing needless interventions require active decision-making participation, a positive provider–patient relationship, and ongoing support from medical professionals. However, significant gaps persist between legal mandates and actual practice due to provider attitudes, systemic constraints, and sociocultural influences. Women’s experiences of consent can be more effectively understood through the use of instruments such as the Mothers’ Respect (MOR) Index and the Mothers’ Autonomy in Decision Making (MADM) Scale. To promote genuinely informed and considerate maternity care, this review emphasizes the necessity of legislative reform and improved provider education in order to close the gap between policy and practice. Full article

Moralization is the process by which preferences become moral values. We investigated a practice that is changing its moral status on college campuses in the United States: affirmative consent to sexual activity. We tested whether messages given to students just before they entered a party impacted their thinking about consent in moral terms—i.e., as a clear issue, with broad consensus, and an imperative to action. At two social clubs on a college campus in 2017, we randomly assigned moralistic vs. informational messages about consent, delivered at the party’s door. At the club that had pre-existing messaging about consent, the moralistic (vs. informational) message increased students’ thinking about consent in moral terms. By contrast, in the club without prior consent messaging, the informational (vs. moralistic) pledge increased students’ thinking about consent in moral terms. We then investigated and found weak evidence for a small reduction in administrative-level student conduct complaints compared to prior and subsequent years as a result of a one-night consent message treatment unique to each of the 12 clubs hosting a party. Theoretically, our findings make progress toward understanding processes of moralization. Pragmatically, they suggest the importance of locally tailored messages that reflect and shape the values of social groups. Full article

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA), represent a spectrum of systemic disorders characterized by necrotizing inflammation of small- to medium-sized vessels. Nailfold videocapillaroscopy (NVC) is a validated, non-invasive technique routinely employed in the assessment of microvascular involvement in systemic sclerosis and in the differential diagnosis of Raynaud’s phenomenon; its application in the context of AAV, particularly EGPA, has not been investigated yet. The present study aims to assess the presence and the possible pattern of microcirculatory abnormalities detected by NVC in EGPA patients, and to explore potential correlations between capillaroscopic findings and disease activity status. Methods: A total of 29 patients with EGPA (19 women and 10 men), aged between 51 and 73 years, and 29 age- and sex-matched healthy controls were retrospectively enrolled between October 2023 and April 2025, after providing informed consent and meeting the inclusion and exclusion criteria. NVC was conducted in both groups to assess various morphological parameters, and mean capillary density was also calculated. Results: This study observed the presence of capillaroscopic alterations in the EGPA group, including decreased capillary density (38%), neoangiogenesis (72%), rolling (100%), pericapillary stippling (66%), and inverted capillary apex (52%). Overall, when comparing healthy controls with EGPA patients, microcirculatory abnormalities were significantly more prevalent in the latter. Specifically, scores for neoangiogenesis, capillary rolling, pericapillary stippling, and inverted capillary apex showed p-values < 0.001. Conclusions: Our study demonstrates a higher prevalence of four nailfold videocapillaroscopic abnormalities in patients with EGPA compared to healthy controls. However, the identification of these capillaroscopic alterations as specific to EGPA requires further confirmation. Ongoing studies aim to explore the potential role of NVC as a diagnostic marker and to investigate its correlation with the clinical manifestations of EGPA. Full article

Background: Out-of-hospital cardiac arrest (OHCA) survivors and their relatives may face challenges following hospital discharge, relating to mood, cognition, and returning to normal day-to-day activities. Identified research gaps include a lack of knowledge around what type of intervention is needed to best navigate recovery. In this study, we investigate the feasibility and patient acceptability of a new virtual psychoeducational group intervention for OHCA survivors and their relatives and compare it to a control group receiving a digital information booklet. Methods: V-CARE is a comparative, single-blind randomized pilot trial including participants at selected sites of the STEPCARE trial, in the United Kingdom and Sweden. Inclusion criteria are a modified Rankin Scale (mRS) ≤ 3 at 30-day follow-up; no diagnosis of dementia; and not experiencing an acute psychiatric episode. One caregiver per patient is invited to participate optionally. The intervention group in V-CARE receives four semi-structured, one-hour-long, psychoeducational sessions delivered remotely via video call by a trained clinician once a week, 2–3 months after hospital discharge. The sessions cover understanding cardiac arrest; coping with fatigue and memory problems; managing low mood and anxiety; and returning to daily life. The control group receives an information booklet focused on fatigue, memory/cognitive problems, mental health, and practical coping strategies. Results: Primary: feasibility (number of patients consented) and acceptability (retention rate); secondary: satisfaction with care (Client Satisfaction Questionnaire 8 item), self-management skills (Self-Management Assessment Scale) and, where available, health-related outcomes assessed in the STEPCARE Extended Follow-up sub-study including cognition, fatigue, mood, quality of life, and return to work. Conclusions: If preliminary insights from the V-CARE trial suggest the intervention to be feasible and acceptable, the results will be used to design a larger trial aimed at informing future interventions to support OHCA recovery. Full article

Background/Objectives: In the Republic of Serbia, measles vaccination was first introduced in 1971, while combined vaccination (measles, mumps, rubella) was made mandatory in 1996 as part of the national vaccination program. Reported prevalence values for 2023 were <0.75 cases per 100K population for measles, 0.09 cases per 100K for mumps, and no cases of rubella. Methods: This cross-sectional study was performed in May, 2024 as part of the project “Herd Immunity to Vaccine-Preventable and Other Relevant Infections in the Belgradian Population.” It focused on assessing herd immunity to measles, mumps and rubella (MMR) among residents insofar as these remain a public concern despite the availability of vaccines. A total of 2533 subjects were distributed across nine age groups, covering those aged 1–70⁺ years and various professional groups residing in Belgrade. Participants were stratified by age and activity. Upon obtaining individual information by online questionnaire and receiving a signed statement of informed consent, blood samples were obtained for IgG antibody testing (ELISA) to determine MMR serological status. The results were compared to national and international immunization standards to evaluate herd immunity levels. Results: Our results indicate varying levels of immunity for each virus, with specific demographic groups showing different immunity levels. Total measles seroprevalence during this study was 74.7%, with significant variation across all age groups. While high seropositivity was observed in both children (90.7%) and elder age groups (98.4%), middle-aged individuals in the age group 30–49 years showed significantly lower IgG levels. Between 2021 and 2023, there were no registered cases of rubella detected in Serbia, which indicates a high level of immunity. This was confirmed here with consistently high IgG levels across all age groups, with an average seropositivity of 94.8%. Average mumps seropositivity across all age groups was 85.1%. The lowest value was in the young child (1–5 years) age group (76.1%); the highest was in the elderly group (92.6%). Conclusions: The current findings suggest that the Belgradian population has strong overall immunity to MMR, yet with some concerns regarding measles immunity in middle-aged adults, suggesting a potential need for catch-up vaccinations. While rubella status indicates strong herd immunity and minimal risk of outbreaks, mumps immunity in some groups (children, middle-aged adults) is below the protective threshold. While it is still sufficient to prevent widespread transmission, it should be closely observed. To our knowledge, this study is the first of its kind to provide data about MMR seroprevalence in Belgrade. Findings indicate the need for constant surveillance and revaccination of vulnerable/seronegative groups. Full article

Background/Objectives: A history of cancer has been linked to stress and concerns about its recurrence. We aimed to test the benefits of an evidence-based self-help stress reduction method, the Clinical Emotional Freedom Technique (EFT), in survivors of cutaneous melanoma, and to contrast its effects on wellbeing and perceptions of cancer recurrence when delivered in a group versus individual instruction setting. Methods: This study was preregistered at clinicaltrials.gov (NCT05421988, 3 April 2022). Fifty-three patients aged 18 and above, diagnosed with melanoma (stage T1a–T2a) at least 6 months prior, and not in active treatment were recruited from a private skin cancer clinic. After consent, all participants were randomized in one step into three condition groups: Group EFT (G-EFT; n = 16), Individual EFT (I-EFT; n = 18), and a waiting-list control condition (CC; n = 19). G-EFT and I-EFT participants attended weekly treatment sessions for four weeks. Perceptions of cancer recurrence and wellbeing measures were obtained pre- and post-intervention and at three-months follow-up using online questionnaires. Subjective units of distress (SUDs) were recorded by the EFT instructor at the beginning and end of each session. Results: Two-way repeated measures ANOVAs revealed significant improvements from pre- to post-intervention in both EFT conditions in terms of participants’ understanding of how to prevent recurrence and in their spiritual wellbeing. No statistically significant effects were found for fear of recurrence, recurrence perceptions, and affect. Significant decreases in SUD scores were observed in both EFT conditions. Over 80% of the experimental conditions’ participants reported positive changes and satisfaction. Conclusions: The findings provide support for offering EFT instruction as a non-pharmacological and noninvasive self-help method to ameliorate the stress of cancer diagnosis and treatment, and for its similar effectiveness in either a group or individual format. Full article

Lateral cephalometric analysis is commonly used in orthodontics for skeletal classification to ensure an accurate and reliable diagnosis for treatment planning. However, most current research depends on analyzing different type of radiographs, which requires more computational time than 3D analysis. Consequently, this study addresses fully automatic orthodontics tracing based on the usage of artificial intelligence (AI) applied to 2D and 3D images, by designing a cephalometric system that analyzes the significant landmarks and regions of interest (ROI) needed in orthodontics tracing, especially for the mandible and maxilla teeth. In this research, a computerized system is developed to automate the tasks of orthodontics evaluation during 2D and Cone-Beam Computed Tomography (CBCT or 3D) systems measurements. This work was tested on a dataset that contains images of males and females obtained from dental hospitals with patient-informed consent. The dataset consists of 2D lateral cephalometric, panorama and CBCT radiographs. Many scenarios were applied to test the proposed system in landmark prediction and detection. Moreover, this study integrates the Grad-CAM (Gradient-Weighted Class Activation Mapping) technique to generate heat maps, providing transparent visualization of the regions the model focuses on during its decision-making process. By enhancing the interpretability of deep learning predictions, Grad-CAM strengthens clinical confidence in the system’s outputs, ensuring that ROI detection aligns with orthodontic diagnostic standards. This explainability is crucial in medical AI applications, where understanding model behavior is as important as achieving high accuracy. The experimental results achieved an accuracy exceeding 98.9%. This research evaluates and differentiates between the two-dimensional and the three-dimensional tracing analyses applied to measurements based on the practices of the European Board of Orthodontics. The results demonstrate the proposed methodology’s robustness when applied to cephalometric images. Furthermore, the evaluation of 3D analysis usage provides a clear understanding of the significance of integrated deep-learning techniques in orthodontics. Full article

Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult situations at work, define the actions applied when a difficult situation occurs, and assess the level of stress and other factors influencing the level of stress experienced by paediatric nurses. Methods: This study was conducted using an original survey form and a standardised psychological questionnaire based on the Perceived Stress Scale (PSS-10) for paediatric nurses. Results: The study involved 416 paediatric nurses and indicated a medium level of stress among the nurses. The median stress level, calculated as the sum of answers to questions based on the PSS-10, was 18 (16.0 ÷ 20.0), and the mean was 17.9 (min–max = 1–30). The median Sten score was 6 (5.0 ÷ 7.0), and the mean Sten score was 5.94 (min–max = 2–9). Nurses aged 21–30 years, who live in a city, have a Bachelor of Science in Nursing or a Master of Science in Nursing, and work ≥ 61 h a week and 161–250 h a month experience a higher level of stress. Factors such as choosing which child to help first, spending a great deal of time filling out medical documentation, obtaining a sick child’s consent to perform nursing procedures which the child does not understand, involving the minor in decision-making, impolite or offensive behaviour from a sick child or their parents, ineffective nursing and treatment methods, providing care against the opinion/views of a sick child or their parents, difficulties in or a lack of understanding of the situation of a sick child and their family, performing nursing procedures that can cause the child pain, and the inability to fulfil a sick child’s request increase the level of stress experienced by paediatric nurses. When a difficult situation occurs at work occurs, the nurses usually meet and talk about the situation with someone close (72.4%) or engage in other activities to avoid thinking about the situation (66.6%). They consult a psychologist/psychotherapist very rarely (9.6%) and a psychiatrist extremely rarely (4.6%). Conclusions: Polish paediatric nurses were found to experience a medium level of stress. Since paediatric nurses are exposed to stress, providing them with psychological care is important. The level of perceived stress is dependent on the nurse’s age, place of residence, and education, as well as weekly and monthly working durations. Paediatric nurses experience many difficult situations in their everyday work that influence their stress levels. Management should pay special attention to difficult workplace situations faced by paediatric nurses and implement regular actions to reduce the levels of stress experienced. Full article

Objectives: The aim of this study was to investigate the feasibility of contrast-enhanced ultrasound (CEUS)-guided microwave ablation for managing iatrogenic hepatic hemorrhage following percutaneous liver puncture. Materials and methods: This retrospective study analyzed six patients (5 males, 1 female; mean age 56.8 ± 12.3 years) with CEUS-confirmed active hepatic hemorrhage refractory to 10 min compression and Agkistrodon halflorum hemagglutinase administration after percutaneous liver puncture (2023–2024). Etiologies included portal vein cavernous transformation (n = 4) and therapeutic intervention complications (n = 2). All patients underwent CEUS-guided microwave ablation comprising three phases: bleeding site localization, real-time ultrasound-guided ablation, and immediate postprocedural verification (CEUS: n = 6; DSA: n = 2). The protocol was approved by the institutional ethics committee with written informed consent. Results: All six patients achieved immediate hemostasis (mean 2.8 min) through CEUS-guided microwave ablation with 100% technical/clinical success. Preprocedural localization combined color Doppler and CEUS, while intraoperative real-time guidance ensured precise microwave needle placement. Post-ablation verification relied on CEUS (n = 6) with DSA confirmation in two cases. No major complications occurred; one patient reported transient abdominal pain resolving spontaneously. All patients remained stable during 7-day follow-up with no delayed complications. Conclusions: This study suggests that CEUS-guided microwave ablation is a rapid, minimally invasive, and effective option for iatrogenic hepatic hemorrhage, warranting further validation in larger cohorts. Full article

Background/Objectives: Colorectal cancer is a significant health problem worldwide. Surgery is the primary curative treatment for most colorectal cancers. Cardiopulmonary exercise testing is now performed widely before surgery, and it is the most objective and precise means of evaluating pre-surgical physical fitness. Also, we can use the 6 min walk test to measure cardiorespiratory fitness before surgery. Methods: We included colorectal patients who were awaiting open abdominal or laparoscopic surgery. After admission to the hospital, patients who signed informed consent forms fulfilled a short questionnaire about health and physical status, preoperative physical activities, and quality of life questionnaire (EORTC QLQ-C30). Patients performed a 6 min walk test (6MWT) 2 days before surgery and 7 days after surgery. 6MWT is a tool for measuring the functional status of fitness. Also, they fulfilled the quality of recovery questionnaire (QoR 15) 7 days after surgery. Results: In a final analysis, we included 72 patients with a mean age of 62.48. We compared the number of steps, walk distance, average and maximal walk speed, and average and maximal heart rate before and after surgery, overall, and by group. Our findings show a statistically significant difference between men and women in the walk distance (F = 4.99, p = 0.02) The number of steps showed a statistically significant difference according to patients’ ages (F = 2.90, p = 0.02). Also, we detected differences in the average and maximum heart rate during walking when comparing body mass index (average heart rate F = 5.72, p = 0.00, maximum heart rate F = 2.52, p = 0.04). Conclusions: Our study provides evidence that average and maximal heart rate during the 6 min walk test was higher in the postoperative period, especially in overweight and obese participants. Full article

Background: Prediabetes, a precursor state to type 2 diabetes mellitus (T2DM), is characterized by elevated glucose levels that are not yet in the diabetic range. It is often associated with comorbidities such as obesity, hypertension, and dyslipidemia, driven by unhealthy lifestyle factors. This study aims to assess the relationship between adherence to the Mediterranean diet and anthropometric measures, such as body mass index and waist circumference, in Arab adults with prediabetes, considering other lifestyle patterns, including smoking, socioeconomic status, and physical activity. Methods: We performed baseline data analysis among a sample of prediabetic participants of a clinical trial aimed at improving physical activity and healthy lifestyle behaviors. Patients were recruited from the Sheikh Jarrah Clalit Health Services clinic in East Jerusalem. Eligible participants were identified via medical record review and invited by their primary physician. After providing informed consent, participants completed interviewer-administered questionnaires covering sociodemographic data, physical activity, and dietary habits. Physical measurements, including height, weight, and waist circumference, were taken using standardized protocols. Adherence to the Mediterranean diet was assessed using the locally adapted Israeli Mediterranean Diet Adherence Screener (I-MEDAS). Results: A total of 172 prediabetic adults aged 40–69.9 years were recruited. The majority of participants exhibited high adherence to the Mediterranean diet, with 80.2% achieving a high adherence score. However, no significant associations were found between Mediterranean diet adherence and BMI or waist circumference. Active smokers were 70.6% less likely to adhere to the Mediterranean diet compared to nonsmokers, and participants with equal-to-average income had lower odds of adhering to the diet compared to those with below-average income. Conclusions: These findings underscore the need for tailored public health strategies that address local cultural, economic, and environmental factors influencing dietary habits. Improving adherence to the Mediterranean diet in this population will require a multifaceted approach, with further research needed to understand the complex relationship between diet, lifestyle, and chronic disease prevention. Full article

Community Forest Management (CFM) and REDD+ projects have emerged as key strategies for promoting environmental conservation and livelihood improvement. This review explores the effectiveness of incorporating free, prior, and informed consent (FPIC), safeguard principles, grievance redress mechanisms, and benefit-sharing mechanisms into CFM and REDD+ in Cambodia, with a focus on enhancing communities’ livelihoods and climate change adaptation. This paper synthesizes findings from recent literature on CFM and REDD+ in Cambodia and internationally, analyzing key case studies, policy frameworks, and community engagement strategies. Findings suggest that while REDD+ projects offer potential economic and ecological benefits, challenges related to land tenure, equity in benefit-sharing, and community participation remain. This review highlights the need for stronger community engagement, a robust conflict management structure, clear land tenure policies, equitable benefit-sharing mechanisms, and more climate change adaptation activities to ensure the success of CFM and REDD+ projects in Cambodia and the Global South. Full article

Background: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion in genetically predisposed individuals. Management typically involves a strict gluten-free diet (GFD). However, there are limited data concerning adherence to GFD among adult CD patients in Saudi Arabia. Therefore, this study aimed to pilot test the assessment of knowledge, adherence to GFD, and barriers to adherence to GFD among adult celiac patients in Madinah, Saudi Arabia. Methods: Cross-sectional data were collected from 36 adults with celiac disease at King Fahad Hospital, Madinah (2021–2022). After obtaining consent, participants completed an online questionnaire covering sociodemographic data, GFD knowledge, adherence, and related barriers. Results: Only 33% of participants were aware of the Ministry of Health’s GFD support program, with 30.6% utilizing gluten-free products and 27.8% receiving financial assistance. Higher adherence scores were significantly associated with awareness of the program, reading nutrition labels, understanding GFD requirements, receiving financial support, and using separate utensils for gluten-free food preparation. The majority (58.3%) had not consulted a dietitian, and no significant association was found between dietitian consultation and GFD adherence. Poor knowledge and difficulty interpreting nutrition labels were reported as primary barriers. Conclusions: Improving public and patient awareness of the GFD and available support programs is essential in enhancing adherence among CD patients in Saudi Arabia. Healthcare providers should play a more active role in patient education and ongoing support. Full article

Background: Solid organ transplantation, which began as an experimental procedure over 100 years ago, has now become a viable therapeutic option for the vast majority of patients with end-stage organ failure. However, a major limiting factor remains the shortage of organs available for transplantation. To expand the donor pool, it is essential to increase awareness of transplantation, including its legal, cultural, and ethical aspects. Every year, numerous organizations, primarily non-governmental, organize hundreds of campaigns promoting transplantation worldwide. The majority of these initiatives are one-time events tied to observances such as World Transplant Day, World Kidney Day, and others. The growing role of social media in spreading information is also becoming a key factor in promoting organ donation and transplantation, as social factors play an important role in expanding the donor pool. Many organizations that support transplantation, along with healthcare providers, widely use platforms like Facebook and other social media to promote and increase organ donation. Objectives: The “Second Life” is a social campaign presentation to raise awarenes about transplantation. Project Description: The campaign has been running continuously for 17 years in Poland, promoting the concepts of organ donation and transplantation in collaboration with high school students. During this time, 950 high schools across the country participated in the project, with approximately 450,000 high school students actively engaging in the campaign. Outcomes: They organized a series of activities to promote organ donation and transplantation within their social circles, distributing nearly 1.5 million declarations of will. Additionally, they helped raise awareness about presumed consent and educated others on the concepts of organ donation and transplantation. Conclusions/Implications: This long-term initiative is crucial for raising awareness, educating the public, and promoting the idea of organ donation. It fosters a more positive attitude toward organ donation and transplantation, ultimately contributing to the expansion of the donor pool and an increase in transplantations in the near future. Full article

Background/Objectives: This study aimed to evaluate the progress in auditory speech perception in a group of children with cochlear implants and additional disabilities, whose implants were implanted at a public hospital in southern Chile between 2013 and 2019. This population has historically been excluded from research due to uncertainties regarding their outcomes. Methods: All pediatric patients who received cochlear implants between 2013 and 2019 were considered for inclusion. After obtaining informed consent, relevant data were collected from their medical records. A total of 18 children met the inclusion criteria. Data analysis was performed using Jamovi software. Results: The minimum age at cochlear implant activation was 2 years, and the maximum was 16.1 years. The median Category of Auditory Performance (CAP) score was 0 pre-implantation and increased to 2 to 12 months post-implantation. Conclusions: Cochlear implantation provides clear benefits for children with additional disabilities. Although gains in auditory perception may be limited in some cases, implantation enables access to the world of sound. Even when oral language development is not fully achieved, parents frequently report positive changes in their children’s interaction with their environment, suggesting an overall improvement in quality of life. Full article