Search Results (6,353)

Background: Health equity can only be achieved when every individual has access to quality healthcare without fear of being discriminated against. This study analyzed the sociodemographic characteristics associated with self-reported racial discrimination when receiving medical care in the United States. Methods: This quantitative cross-sectional study utilized the 2022 National Trends Survey 6. We performed a logistic regression analysis using 6102 survey responses from study participants who answered the question about perceived discrimination. Results: Older adults aged 75 years and above had significantly lower odds of reporting perceived discrimination when receiving medical care compared to those aged 18–34 years (AOR = 0.24; 95% CI: 0.10–0.58). The odds of reporting perceived discrimination were significantly higher among non-Hispanic Blacks (AOR = 7.30; 95% CI: 4.48–11.88), Hispanics (AOR = 3.56; 95% CI: 2.45–5.17), non-Hispanic Asians (AOR = 5.95; 95% CI: 2.25–15.73), and individuals identifying as non-Hispanic Other (AOR = 10.91; 95% CI: 5.42–21.98), compared to non-Hispanic Whites. Compared to individuals from households earning less than USD 20,000, the odds of reporting perceived discrimination when receiving medical care were significantly lower among individuals from households earning between USD 50,000 and <USD 75,000 (AOR = 0.42; 95% CI: 0.23–0.78) and those earning USD 75,000 or more (AOR = 0.43; 95% CI: 0.22–0.83). Conclusions: Despite having a multicultural and ethnically diverse population, racial discrimination persists in the United States and has become a barrier to achieving health equity. Health organizations should implement policies that ensure health workers attend mandatory anti-racism training. Full article

Background: Social and financial services are essential for the inclusion and well-being of people with disabilities (PWDs), who often rely on family caregivers to access these systems. In Saudi Arabia, where disability inclusion is a strategic goal under Vision 2030, understanding caregiver experiences is crucial to identifying service gaps and improving accessibility. Objectives: This study aimed to explore caregivers’ perspectives on awareness, perceived barriers, and accessibility of social and financial services for PWDs in Saudi Arabia. The analysis is grounded in Andersen’s Behavioural Model of Health Service Use and the WHO’s International Classification of Functioning, Disability and Health (ICF) framework. Methods: A cross-sectional survey was conducted with 3353 caregivers of PWDs attending specialised day schools. The survey collected data on demographic characteristics, service awareness, utilisation, and perceived obstacles. Exploratory Factor Analysis (EFA) identified latent constructs, and Structural Equation Modelling (SEM) was used to test relationships between awareness, barriers, and accessibility. Results: Findings reveal that over 70% of caregivers lacked awareness of available services, and only about 3% had accessed them. Key challenges included technological barriers, complex procedures, and non-functional or unclear service provider platforms. Both User Barriers and Service Barriers were negatively associated with Awareness and Accessibility. Awareness, in turn, significantly predicted perceived Accessibility. Caregiver demographics, such as age, education, gender, and geographic location, also influenced awareness and service use. Conclusions: There is a pressing need for targeted awareness campaigns, accessible digital service platforms, and simplified service processes tailored to diverse caregiver profiles. Inclusive communication, decentralised outreach, and policy reforms are necessary to enhance service access and promote the societal inclusion of PWDs in alignment with Saudi Arabia’s Vision 2030. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusion: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

Objectives: Norovirus outbreaks occur in densely populated environments, such as long-term care facilities, hospitals, and schools. On 22 October 2022, an outbreak of acute gastroenteritis was reported at a kindergarten in Korea. An epidemiologic investigation was conducted to identify the source of the infection and prevent further spread. Methods: Rectal swab and environmental samples were collected for bacterial and viral testing. A retrospective cohort study was conducted among 114 kindergarteners at the kindergarten. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to assess associations of contact with the primary case, as well as food and water consumption. Results: Of the kindergarteners, 28 out of 114 (24.6%) met the case definition. The primary case occurred on 19 October, and subsequent cases began on 21 October. Sharing the same four-year-old class as the primary case (RR, 2.56; 95% CI, 1.35–4.87), being in the same regular class (RR, 2.37; 95% CI, 1.27–4.41), being on the same floor during after-school class (RR, 3.49; 95% CI, 1.74–7.00), and attending the same English class (RR, 1.98; 95% CI, 1.05–3.72) were statistically significant. Consumption of drinking water on the third floor and fourth floor on 20 October had significantly higher and lower RRs, respectively. Norovirus was detected in 9 out of 18 rectal swab samples (50.0%). Conclusions: This norovirus outbreak at the kindergarten was presumed to have been caused by person-to-person transmission from the primary case. Isolation and restriction of symptomatic children in kindergartens should be thoroughly implemented. Additionally, enhanced surveillance among family members of affected individuals is necessary to prevent further outbreaks. Full article

Background: Schizophrenia affects patients’ organizational thinking, as well as their ability to identify problems. The main objective of this study was to explore healthcare consultants’ application of AI mind maps to educate patients with schizophrenia regarding their perceptions of family function, social support, quality of life, and loneliness, and to help these patients think more organizationally and understand problems more effectively. Methods: The study used a survey research design and purposive sampling method to recruit 66 participants with schizophrenia who attended the psychiatric outpatient clinic of a hospital in central Taiwan. They needed to be literate, able to respond to the topic, and over 18 years old (inclusive), and they attended individual and group health education using AI mind maps over a 3-month period during regular outpatient clinic visits. Results: The study results show that patients’ family function directly affects their quality of life (p < 0.05) and loneliness (p < 0.05), satisfaction with social support affects quality of life and loneliness directly (p < 0.05), and satisfaction with social support is a mediating factor between family function and quality of life (p < 0.05), as well as a mediating factor between family function and loneliness (p < 0.05). Conclusions: Therefore, this study confirms the need to provide holistic, integrated mental health social care support for patients with schizophrenia, showing that healthcare consultants can apply AI mind maps to empower patients with schizophrenia to think more effectively about how to mobilize their social supports. Full article

Background and Objectives: Although survival after congenital cardiac malformations (CCM) has improved, little is known about Romanian children’s own perceptions of health-related quality of life (HRQoL) or their emotional burden. We compared HRQoL, depressive symptoms, and anxiety across lesion severity strata and explored clinical predictors of impaired HRQoL. Methods: In this cross-sectional study (1 May 2023–30 April 2025), 72 children (mean age 7.9 ± 3.0 years, 52.8% male) attending a tertiary cardiology clinic completed the Romanian-validated Pediatric Quality of Life Inventory (PedsQL), Children’s Depression Inventory (CDI) and the Screen for Child Anxiety-Related Emotional Disorders questionnaire (SCARED-C, child version). Lesions were classified as mild (n = 22), moderate (n = 34), or severe (n = 16). Left-ventricular ejection fraction (LVEF) and unplanned cardiac hospitalisations over the preceding 12 months were extracted from electronic records. Results: Mean PedsQL total scores declined stepwise by severity (mild 80.9 ± 7.3; moderate 71.2 ± 8.4; severe 63.1 ± 5.4; p < 0.001). CDI and SCARED-C scores rose correspondingly (CDI: 9.5 ± 3.0, 13.6 ± 4.0, 18.0 ± 2.7; anxiety: 15.2 ± 3.3, 17.2 ± 3.8, 24.0 ± 3.4; both p < 0.001). PedsQL correlated positively with LVEF (r = 0.51, p < 0.001) and negatively with hospitalisations (r = −0.39, p = 0.001), depression (r = −0.44, p < 0.001), and anxiety (r = −0.47, p < 0.001). In multivariable analysis, anatomical severity remained the sole independent predictor of lower HRQoL (β = −8.4 points per severity tier, p < 0.001; model R² = 0.45). Children with ≥ 1 hospitalisation (n = 42) reported poorer HRQoL (69.6 ± 8.0 vs. 76.1 ± 11.1; p = 0.005) and higher depressive scores (p < 0.001). Conclusions: HRQoL and internalising symptoms in Romanian children with CCM worsen with increasing anatomical complexity and recent hospital utilisation. The severity tier outweighed functional markers as the main determinant of HRQoL, suggesting that psychosocial screening and support should be scaled to lesion complexity. Integrating the routine use of the Romanian-validated PedsQL, CDI, and SCARED-C questionnaire into cardiology follow-up may help identify vulnerable patients early and guide targeted interventions. Full article

This work proposes a new method to refill fuel cell electric vehicle hydrogen tanks from a storage system in hydrogen refueling stations. The new method uses the storage tanks in cascade to supply hydrogen to the refueling station dispensers. This method reduces the hydrogen compressor power requirement and the energy consumption for refilling the vehicle tank; therefore, the proposed alternative design for hydrogen refueling stations is feasible and compatible with low-intensity renewable energy sources like solar photovoltaic, wind farms, or micro-hydro plants. Additionally, the cascade method supplies higher pressure to the dispenser throughout the day, thus reducing the refueling time for specific vehicle driving ranges. The simulation shows that the energy saving using the cascade method achieves 9% to 45%, depending on the vehicle attendance. The hydrogen refueling station design supports a daily vehicle attendance of 9 to 36 with a complete refueling process coverage. The carried-out simulation proves that the vehicle tank achieves the maximum attainable pressure of 700 bars with a storage system of six tanks. The data analysis shows that the daily hourly hydrogen demand follows a sinusoidal function, providing a practical tool to predict the hydrogen demand for any vehicle attendance, allowing the planners and station designers to resize the elements to fulfill the new requirements. The proposed system is also applicable to hydrogen ICE vehicles. Full article

Based on our question, “Are reels/short-videos the real deal in video-based learning?” this study explores the effectiveness of short (around 2 min) video-based learning in engaging medical students from the second large medical Portuguese school. With the increasing integration of digital tools in education, video content has emerged as a dynamic method to enhance learning experiences. This cross-sectional survey was conducted by using anonymous self-administered questionnaires, prepared with reference to previous studies, and distributed to 264 informed students who voluntarily agreed to participate. This sample represented 75.5% of the students attending the classes. The questionnaires included topics related to the 65 short videos about practical classes, as well as the students’ learning preferences. The collected data were analyzed using descriptive and comparative statistics. The students considered that the content and format of the videos were adequate (99.6% and 100%, respectively). Specifically, the videos helped the students to better understand the practical classes, consolidate and retain the practical content, and simplify the study for the exams. Additionally, the videos were praised for their high-quality audiovisual content, being innovative, complete, concise, short and/or adequate, or better than other formats such as printed information. The combination of written and audiovisual support materials for teaching and studying is important and has been shown to improve students’ performance. This pedagogical methodology is well-suited for the current generation of students, aiding not only in study and exam preparation but also in remote learning. Full article

Mozambique soils are known for having an unbalanced agronomic and environmental composition that results in poor agricultural production yields. However, agriculture is the main economic activity of Mozambique, and soils must be characterised for their elemental deficiencies and/or excesses. This paper sampled nine farms from the Manica and Sussundenga districts (Manica province) in three campaigns in 2021/2022, 2022/2023, and 2023/2024 (before and after the rainy seasons). They were subjected to a physical–chemical analysis to assess their quality from the fertility and environmental contamination point of view. Attending to the physical–chemical properties analysed, and for all the soils and sampling campaigns, a low concentration below the limit of detection for B of <0.2 mg/Kg for the majority of soils and a low concentration of Al < 0.025 mg/Kg for all the soils were obtained. Also, higher concentrations for the majority of soils for the Ca between 270 and 1634 mg/Kg, for the Mg between 41 and 601 mg/Kg, for the K between 17 and 406 mg/Kg, for the Mn between 13.6 and 522 mg/Kg, for the Fe between 66.3 and 243 mg/Kg, and for the P between <20 and 132 mg/Kg were estimated. In terms of texture and for the sand, a high percentage between 6.1 and 79% was found. In terms of metal concentrations and for all the soils of the Sussundenga district and sampling campaigns, a concentration above the reference value concentration for the Cr (76–1400 mg/Kg) and a concentration below the reference value concentration for the Pb (5–19 mg/Kg), Ba (13–120 mg/Kg) and for the Zn (10–61 mg/Kg) were evaluated. A multivariate data analysis methodology was used based on cluster and discriminant analysis. The analysis of twenty-three physical–chemical variables of the soils suggested four clusters of soils characterised by deficiencies and excess elements that must be corrected to improve the yield and quality of agricultural production. Moreover, the multivariate analysis of the metal composition of soil samples from the second and third campaigns, before and after the rainy season, suggested five clusters with a pristine composition and different metal pollutant compositions and concentrations. The information obtained in this study allows for the scientific comprehension of agricultural soil quality, which is crucial for designing agronomic and environmental corrective measures to improve food quality and quantity in the Manica and Sussundenga districts and ensure environmental, social, and economic sustainability. Full article

Objectives: The aim of this study was to analyse no-show patterns in healthcare appointments, identify associated factors, and explore key determinants influencing non-attendance. Study Design: This was a retrospective observational study. Methods: We analysed 120,405 healthcare appointments from 2022–2023 in Turin, Northern Italy. Data included demographics, appointment characteristics, and attendance records. Logistic regression identified significant predictors of no-shows, adjusting for confounders. Results: A 5.1% (n = 6198) no-show percentage was observed. Younger patients (<18 years) and adults (18–65 years) had significantly higher odds of missing appointments than elderly patients (>65 years) (OR = 2.32, 95% CI: 2.17–2.47; OR = 2.46, 95% CI: 2.20–2.74; p < 0.001). First-time visits had a higher no-show risk compared to follow-up visits and diagnostics (OR = 1.11, 95% CI: 1.04–1.18; p < 0.001). Each additional day of waiting increased the likelihood of no-show by 1% (OR = 1.01, 95% CI: 1.01–1.01; p < 0.001). Conclusions: No-show percentages are influenced by demographic and service-related factors. Strategies targeting younger patients, longer waiting times, and non-urgent appointments could reduce no-show percentages. Full article

Accurate classification of breast cancer histopathology images is critical for early diagnosis and treatment planning. Yet, conventional deep learning models face significant challenges under limited annotation scenarios due to their reliance on large-scale labeled datasets. To address this, we propose Dynamic Cross-Scale Swin Transformer (DCS-ST), a robust and efficient framework tailored for histopathology image classification with scarce annotations. Specifically, DCS-ST integrates a dynamic window predictor and a cross-scale attention module to enhance multi-scale feature representation and interaction while employing a semi-supervised learning strategy based on pseudo-labeling and denoising to exploit unlabeled data effectively. This design enables the model to adaptively attend to diverse tissue structures and pathological patterns while maintaining classification stability. Extensive experiments on three public datasets—BreakHis, Mini-DDSM, and ICIAR2018—demonstrate that DCS-ST consistently outperforms existing state-of-the-art methods across various magnifications and classification tasks, achieving superior quantitative results and reliable visual classification. Furthermore, empirical evaluations validate its strong generalization capability and practical potential for real-world weakly-supervised medical image analysis. Full article

Chronic pain (CP) markedly impairs quality of life (QoL) and contributes to physical, psychological, and social dysfunction. In Saudi Arabia, limited research exists on CP and its impact on QoL. This cross-sectional questionnaire-based study conducted at King Abdullah Medical City, Makkah, over 3 months aimed to comparatively assess CP severity and the QoL between individuals who attended specialized pain clinics and those who did not. Data were collected from 250 participants by using a five-part questionnaire, including the RAND 36-Item Health Survey 1.0, to assess QoL. Statistical analysis included descriptive statistics and comparative analysis using the Statistical Package for the Social Sciences v22.0, with p-values of <0.05 considered significant. Most of the participants were female (56%), aged > 18 years (94.4%), Saudi nationals (88%), and married (72%). The most frequently reported pain site was the knee (33.6%). The mean scores for QoL domains were low, especially physical functioning (18.5), emotional well-being (38.4), and social functioning (38.8). Pain severity and poor general health were significantly associated with nationality, educational level, and clinic type. In conclusion, CP profoundly diminished QoL, particularly in terms of physical, emotional, and social aspects. Outcomes were influenced by factors such as educational level, employment, nationality, and clinical care settings. Full article

During the COVID-19 pandemic, some studies suggested that transmission events could originate from schools. This study aimed to evaluate early-warning methods for identifying asymptomatic COVID-19 cases by implementing screening programs in schools. This study was conducted between September 2021 and May 2023, employing a rotation-screening plan for COVID-19 detection on a sample of students aged 14 to 19 years attending secondary schools in the regions of Tuscany, Veneto, Apulia and Friuli-Venezia Giulia. The schools were divided into two groups: experimental and control, with a ratio of 1:2. Two types of molecular salivary tests for SARS-CoV-2 were used to conduct the screening. This study included 16 experimental schools and 32 control schools. Out of 2527 subjects, 11,475 swabs were administrated, with 9177 tests deemed valid for analysis (a 20% loss of tests). Among these, 89 subjects (3.5%) tested positive. In control schools, 1895 subjects (6.5%) tested positive for SARS-CoV-2. This study recorded peaks in infections during the winter and autumn months, consistent with patterns observed in the general population. Beginning in September 2022, a shift occurred, with 2.6% of positive cases reported in the case schools compared to 0.3% in the control schools. Initially, most cases of COVID-19 were detected in the control schools; however, as the pandemic emergency phase concluded, cases were primarily identified through active screening in experimental schools. Although student participation in the active screening campaign was low during the project’s extension phase, this approach was efficacious in the early identification of positive cases. Full article

Survivors of pediatric cancer are at risk for late effects and require risk-adapted long-term follow-up (LTFU) care. Yet less than 50% of survivors attend LTFU care. This study aimed to identify barriers and enablers of engaging with LTFU care as perceived by Canadian survivors of pediatric cancer and healthcare providers (HCPs). Survivors (n = 108) and HCPs (n = 20) completed surveys assessing barriers and enablers to attending LTFU care, summarized using descriptive statistics. Participants were invited to participate in survivor focus groups (n = 22) or HCP semi-structured interviews (n = 7). These were analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation for Behaviour Change (COM-B) model, which explores how an individual’s capability, opportunity, and motivation influence a target behaviour. Structural barriers, transitioning from pediatric to adult care, and time constraints were highlighted as barriers that affect survivors’ physical opportunity to engage in LTFU care. Accessibility, financial support, HCPs and family support, and community resources were highlighted as enablers that better survivors’ physical and social opportunity to engage in LTFU care. In conclusion, Canadian survivors of pediatric cancer highlighted barriers that limited their physical opportunity to attend LTFU care, while factors that enhanced their physical and social opportunities facilitated greater engagement with LTFU care. Full article

This concept paper outlines an implementation strategy for a mandatory training programme using the ADDIE instructional design model for delivery to nurses and other health professionals in an interprofessional education (IPE) environment). Background: Competence in Basic Life Support (BLS) is a lifesaving requirement for health professionals in clinical settings to ensure patient safety and accreditation outcomes. It is essential that health professionals are supported in attending mandatory training, including BLS. To inform learning and teaching strategies, it is useful to apply theoretical perspectives to the development of mandatory staff training methods. However, various training models exist, and few are grounded in instructional design theory to the unique environment for BLS in IPE. Method: A theory-based implementation strategy is outlined for a mandatory interprofessional training programme including BLS, using the ADDIE model to enhance patient outcomes. ADDIE is an instructional design framework comprising five elements: Assess, Design, Develop, Implement and Evaluate; describing a learning methodology that can be readily applied to mandatory training in IPE. Results: Through its iterative capability, the ADDIE model promotes learner needs and rapid acquisition of clinical skills that improve training accessibility. The strategy can equip educators with teaching skills based on a robust theoretical model, with potential to promote nursing and health professional attendance for mandatory training. Conclusions: Mandatory health professional training that addresses a theory informed strategy framed by the ADDIE model can support interprofessional collaboration and consistent competency across healthcare teams. This strategy has potential to contribute by demonstrating how instructional design can be operationalised to improve the effectiveness and engaging approach to BLS training and education to the unique dynamics of an interprofessional environment. Full article