Search Results (67)

Background/Objectives: This study explores the perceptions, experiences, and expectations of pediatric healthcare professionals regarding the implementation of virtual visits (VVs) in routine pediatric practice. Methods: Using the Consolidated Framework for Implementation Research (CFIR) to analyze individual, organizational, and contextual factors influencing the adoption of pediatric virtual visits, we conducted a descriptive cross-sectional survey distributed nationwide among pediatricians, pediatric nurses, and residents. Results: A total of 308 Spanish healthcare professionals correctly completed the REDCap survey and were included in the analysis. The mean age was 44.3 years, and respondents represented both hospital-based (55.8%) and primary care professionals (44.2%). Overall, 74.8% had previous experience with telephone consultations, while only 11% had performed virtual visits. Most professionals believed VVs could be useful in primary care (81.3%) and hospital out-patient settings (73.9%), especially for follow-up appointments, communication of test results, and chronic-care monitoring. VVs were perceived as more appropriate for older children and adolescents than for infants. Major concerns included poor internet connection (52.6%), and data security (37.4%); however, a particularly relevant finding was the low confidence in using digital tools, particularly among older professionals. Comparative analyses by age and workplace setting identified differences in interest, perceived barriers, and access to technical resources. Hospital-based clinicians reported greater interest in adopting VVs and better access to technological resources compared with primary care professionals. The professionals’ age was inversely associated with interest in VVs. Notably, 72.6% of respondents expressed interest in receiving specific VV training, and nearly 90% believed virtual visits should be offered in their workplace. Conclusions: These findings show a high overall acceptance of VVs but also underline persistent barriers related to infrastructure, digital literacy, and clinical applicability in younger children. Addressing these obstacles through training, improved equipment, and clear clinical protocols will be essential for the successful implementation of pediatric VV programs. Full article

Background and Objectives: Adolescent pregnancy remains a major global public-health concern, particularly in low- and middle-income countries. Romania consistently reports the highest teenage birth rate in the European Union, with pronounced regional disparities. This study aimed to assess the incidence, sociodemographic predictors, and obstetric outcomes of adolescent pregnancies over a ten-year period in southeastern Romania. Materials and Methods: A retrospective, population-based study was conducted at the Clinical County Hospital “Saint Andrew the Apostle”, Constanța, from 1 January 2014 to 31 December 2023. All deliveries involving mothers aged ≤19 years were identified from institutional databases. Demographic variables (age, residence, education) and obstetric outcomes (mode of delivery, gestational age, neonatal parameters) were analyzed. Statistical tests included Pearson’s χ², t-tests or Mann–Whitney U tests, and multivariate logistic regression to identify independent predictors of cesarean delivery and preterm birth. Results: Among 13,416 hospital deliveries, 1640 (12.2%) involved adolescent mothers (mean age 16.3 ± 1.4 years). Most originated from rural areas (64.6%) and had only primary education (42.8%). Cesarean section was performed in 58.3% of cases—significantly higher among rural (61.2%) and low-education (62.4%) groups (p < 0.05). The leading indications were cervical dystocia (19.2%) and cephalopelvic disproportion (16.9%). Preterm birth occurred in 30.5% and low birth weight in 27.1% of neonates. Multivariate analysis identified primiparity (OR 2.10; 95% CI 1.45–3.05; p < 0.001) and low education (OR 1.56; 95% CI 1.09–2.21; p = 0.015) as independent predictors of cesarean delivery, while rural residence and low education predicted prematurity (OR 1.84; 95% CI 1.12–3.02; p = 0.016). Conclusions: Adolescent pregnancy in southeastern Romania remains a persistent public-health challenge concentrated among rural and low-education populations. These patterns are consistent with previously described vulnerabilities in adolescent populations, including developmental and healthcare-access challenges, although such factors were not directly measured in this study. Community-based prevention, comprehensive sexual education, and adolescent-friendly obstetric pathways are urgently needed to reduce the burden of teenage pregnancy in Eastern Europe. These associations should be interpreted with caution, as the retrospective design precludes causal inference. Full article

Background: Rabies is a fatal yet preventable zoonosis. In Saudi Arabia, uneven surveillance and limited public awareness may delay post-exposure prophylaxis (PEP). In Makkah, where residents regularly encounter free-roaming dogs, knowledge gaps could elevate exposure risks. Objectives: This study aims to assess public knowledge, attitudes, and post-bite practices regarding rabies, including wound washing and access to PEP among adult residents of the Makkah Region, and to examine associations with pet dog ownership. Methods: A cross-sectional survey was conducted in the Makkah Region (March–June 2025). An online validated bilingual questionnaire targeted residents ≥ 18 years via social media. Descriptive statistics, chi-square tests, 95% confidence intervals, and binomial logistic regression were applied in IBM SPSS v26; p < 0.05 was significant. Results: Of 523 respondents, 91.8% lived in Makkah city, 52.8% were female, and the age distribution was 18–24 years (44.2%), 25–34 years (35.6%), 35–44 years (12.0%), and ≥45 years (8.2%). Pet dog ownership was rare (1.9%), yet 39.4% reported stray dogs in their communities. Overall, 60.6% knew what rabies is and 63.7% knew it is vaccine-preventable, but 52.2% wrongly believed that transmission occurs only via dog bites. Hospitals (79.7%) and health centers (79.2%) were the most cited vaccination sites; social media was the dominant information source (74.6%). No significant association was found between pet ownership and rabies awareness (all p > 0.05). In multivariable regression (n = 509), adequate rabies knowledge increased the odds of an appropriate intended response (AOR 1.85, 95% CI: 1.27–2.68). Participants aged 30–40 years and those >50 years had significantly lower odds (AOR 0.45, 95% CI: 0.24–0.85 and AOR 0.23, 95% CI: 0.09–0.56, respectively). Conclusions: Despite moderate awareness, critical misconceptions and inconsistent first aid intentions persist. Priority actions include clear, locally adapted education on immediate wound washing and prompt PEP, standardized bite management pathways across facilities, reliable access to vaccines and immunoglobulin, and targeted social media micro-campaigns. By identifying public misconceptions, knowledge gaps, and preferred communication channels, this study provides baseline evidence to guide community awareness programs, intersectoral collaboration, and One Health-based surveillance essential for Saudi Arabia’s progress toward the global “Zero rabies by 2030” goal. Full article

Background: Older adults (≥65 years) account for a substantial share of Emergency Medical Service (EMS) activations, yet differences between nursing homes (NHs) and the community are insufficiently defined. This study aimed to compare EMS responses for older adults inside and outside NHs. Methods: We conducted a retrospective observational study of all EMS activations involving patients ≥65 years in a rural German region from July 2020 to March 2025, based on fully anonymized prehospital patient care reports electronically documented on tablets. Prehospital patient care was assessed using the ABCDE approach, with additional analysis of feedback codes transmitted to the control center (response and on-scene times, physician dispatch, lights and sirens use, feedback codes, hospital destination, and admission urgency). Continuous variables were summarized as mean (SD) or median [IQR], categorical variables as n (%), and group comparisons performed using the Chi-Square test or Fisher’s exact test (categorical) and the t test or Mann–Whitney U test (continuous), as appropriate. Results: Among 46,598 EMS activations in adults aged ≥65 years, 28,749 EMS responses were included in the analysis after excluding non-emergency transports and duplicate physician records. Of these, 20% occurred in NHs (5707/28,749) and 80% in the community (23,042/28,749). Median age was 85 years (IQR 80–89) in NH patients and 80 years (IQR 73–86) in community patients (p < 0.001). Females accounted for 60% (3450/5705) of NH patients and 53% (12,223/23,036) of community patients (p < 0.001). Emergency physicians were dispatched in 7% of NH incidents (392/5707) and 10% of community incidents (2327/23,042; p < 0.001). In NHs, bronchitis/pneumonia was a leading feedback code (6%, 354/5707), whereas in community patients, acute coronary syndrome (ACS) was prominent (5%, 1249/23,042). Admission urgency categories also differed significantly, with NH residents classified as category 3 (outpatient evaluation) in 11% (621/5706) and category 0 (no admission) in 5% (280/5706), whereas community patients were more often classified as category 1 (immediate intervention) in 13% (2886/23,037) (all p < 0.001). Conclusions: NH residents were older, more often female, and presented with low-to-moderate acuity. Frequent diagnoses were closed extremity injuries and bronchitis/pneumonia. In contrast, ACS and other cardiovascular emergencies were more common in the community, particularly among men, consistent with international evidence on sex-specific incidence. NH residents were more often classified as non-urgent or outpatient and transported to nearby hospitals, whereas community patients more frequently required immediate intervention and referral to tertiary centers. In summary, EMS responses for older adults differed in clinical presentations, operational patterns, and hospital pathways. Full article

Unsafe disposal of unused and expired antimicrobial drugs increases their presence in the environment, thereby contributing to the emergence and spread of antimicrobial resistance. This study addressed the lack of sufficient data on unused and expired antimicrobial disposal practices among peri-urban residents in Ghana. This knowledge–attitude–practice (KAP)-based study offers context-specific insights to inform public health education and antimicrobial disposal policy interventions. A cross-sectional study was conducted among 310 residents in the Ho municipality using a well-structured questionnaire. Data was collected on the knowledge, attitudes, and practices of households on how they dispose of unused and leftover antimicrobials. Origin Pro 2022 software was used to analyze the data. Many respondents were males (n = 175, 56.5%) and aged between 18 and 30 years (n = 196, 63.2%). About 87.1% (n = 270) of the respondents agreed that improper disposal of unused antimicrobials could negatively affect the environment. Most of the respondents (71.9%, n = 223) had not received counseling on recommended antimicrobial disposal; 75.5% (n = 234) of respondents were not aware of institutions collecting unused or expired medicines; and 73.5% (n = 228) had never participated in a medicine-return program. Discarding antimicrobials into household trash bins was the most common way of disposal among respondents. The preferred sites to return unused/leftover antimicrobials were community pharmacies and hospitals. Although respondents showed some knowledge and positive attitudes toward safe antimicrobial disposal, further education is needed. Furthermore, most respondents disposed of antimicrobials in household trash, highlighting the need for take-back programs and community pharmacy-based collection. Incorporating disposal guidance into medication counseling and patient information leaflets can enhance awareness and promote appropriate practices. Full article

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes services unequal for residents in the city. To achieve fair and rapid access to medical services, healthcare accessibility and equity have become key concerns. The introduction of tele-health, i.e., online visits or digital health, can help balance the distribution of medical resources to improve accessibility and equity, particularly for elderly patients with chronic diseases. Methods: To quantitatively assess the spatial accessibility of healthcare facilities, an improved two-step floating catchment area method with tele-health (i2SFCA-TH) is proposed to study the demand–supply ratio by considering traveling time, chronic diseases, and online visits based on services provided by community and tertiary hospitals. An optimization model using mixed-integer programming to maximize average accessibility under resource constraints could help improve overall accessibility and reduce differences in access among all residential divisions to achieve better equity in the region. Results: By applying the method in a metropolitan city in China, it is observed that the overall spatial accessibility of residential divisions in the city is 0.72, but the gap between the highest and the lowest reaches 2.36; i.e., significant differences exhibit due to uneven allocation of medical resources. By introducing tele-health, the gaps of access among different divisions can be decreased, with the largest gap reduced to 1.49, and the accessibility in divisions with poor medical resource allocation can be increased. Finally, the mean healthcare accessibility and equity in the study region can be improved to 0.75. In addition, it is shown that proper management of medical resources and patients’ willingness to accept online visits could help improve accessibility and equity, which can provide insights for hospital management and urban planning. Conclusions: An integrated framework to quantitatively assess and optimally improve healthcare accessibility and equity of medical resource allocation through tele-health is presented in this paper. An i2SFCA-TH method and an optimization model are used in the framework, which provides hospital management and urban planners a quantitative tool to improve accessibility and equity in metropolitan cities in China and other countries. Full article

By 2040, more than 80 million Americans will be aged ≥65, yet contemporary senior living communities still operate on a hospitality-first model developed for healthier cohorts three decades ago. This commentary argues that the next generation of senior living must pivot from hotel-style amenities to person-centric health platforms that proactively coordinate medical, functional, and social support. We outline four mutually reinforcing pillars. (1) Data infrastructure that stitches together clinical, functional, and social determinants of health enables continuous risk stratification and early intervention. (2) Ambient and conversational artificial-intelligence tools can extend sparse caregiving workforces while preserving resident autonomy. (3) Value-based contractual arrangements—for example, Medicare Advantage special-needs plans embedded within senior living sites—can realign financial incentives toward prevention rather than occupancy. (4) Targeted policy levers, including low-income housing tax credits for the “forgotten middle” and outcomes-based regulatory frameworks, can catalyze adoption at scale. Ultimately, re-architecting senior living around integrated technology, value-based financing and supportive regulation can transform these communities into preventive-care hubs that delay nursing home entry, improve quality of life, and reduce total cost of care. Full article

This study explores the role of community-centered farm-based hospitality in promoting sustainable rural development, with a focus on South Tyrol, Italy. A survey of 461 local residents assessed perceptions of agritourism’s impact on agricultural heritage, environmental sustainability, and community well-being. Factor analysis identified two main constructs—Agroheritage Sustainability and Empowered Eco-Tourism—which together capture the multifaceted benefits of agritourism. Agroheritage Sustainability reflects the preservation of traditional farming practices, cultural landscapes, and intergenerational knowledge, emphasizing the role of tourism in maintaining cultural identity and preventing land abandonment. Empowered Eco-Tourism highlights the socio-economic benefits of sustainable tourism, including community empowerment, environmental stewardship, and the creation of new economic opportunities. The study’s findings indicate that local residents view agritourism as a holistic approach that supports rural livelihoods while preserving cultural heritage and promoting ecological resilience. The analysis further supports the potential of farm-based hospitality as a model for sustainable rural development, aligning closely with EU policies and global best practices. The Roter Hahn initiative in South Tyrol serves as a practical example of this approach, demonstrating the value of certification programs in enhancing transparency, quality, and sustainability. These insights provide valuable guidance for policymakers and tourism developers seeking to promote sustainable rural tourism globally. The contribution of this research lies in its empirical validation of a dual-construct model that links community engagement with agroecological and cultural sustainability, offering a transferable framework for evaluating agritourism as a lever for sustainable rural development in diverse regional contexts. Full article

The present study explores residents’ perceptions of Stintino (Sardinia, Italy) as a tourist destination. The municipality is predominantly known for La Pelosa beach, widely regarded as one of the most attractive coastal sites in Europe. However, its popularity has raised critical issues related to carrying capacity and seasonal overcrowding, contributing to a tourism model centered almost exclusively on beach-related activities. This study aims to investigate how locals conceptualize their place beyond the dominant seaside narrative, particularly considering Stintino’s identity as a former fishing village with a strong maritime tradition. As part of Italy’s designated inner areas, Stintino also embodies a deep-rooted connection to cultural heritage, further reinforcing the need for its preservation. Adopting a photovoice-based participatory visual methodology, this study engaged 15 local stakeholders from key sectors (hospitality, fishing tourism, retail, gastronomy, and cultural institutions) who produced and discussed photographic representations of their lived experience of the territory. The visual material was thematically analyzed using a conceptual framework informed by theories of place perception and social representations. The findings suggested a multifaceted territorial storytelling rooted in local heritage, symbolic spaces, and everyday practices. Tourism governance strategies could incorporate community-based approaches, such as participatory mapping and inclusive narrative development, to foster more sustainable and place-sensitive promotion models. Full article

Marginalized populations face significant barriers to mental health care, such as stigma, poverty, and limited access to adapted services, with conventional psychiatric approaches often falling short. This study aimed to explore how psychiatric care can be adapted to better meet the needs of vulnerable populations. Data were collected from psychiatry residents, psychiatrists, and community organization staff during a course on vulnerable populations, using semi-structured discussions and analyzed through grounded theory with iterative coding. Seven main themes emerged: (1) barriers and needs of vulnerable populations, highlighting challenges like homelessness and stigma; (2) psychiatric interventions and flexible approaches, emphasizing tailored care; (3) collaboration with community organizations, focusing on partnerships to improve care access; (4) ethical approach and respect for rights, ensuring dignity in treatment; (5) specific populations and associated challenges, addressing the needs of groups like LGBTQ+ youth and migrants; (6) intervention and support models, such as proximity-based care and post-hospitalization follow-up; (7) innovation and evolution of practices, focusing on research and institutional adaptations. This study emphasizes the need for personalized, intersectoral care, recommending improved collaboration, flexible models, and greater clinical exposure, with future research exploring how psychiatric education can better prepare clinicians to work with marginalized groups. Full article

Background: Eosinophilic esophagitis (EoE) is a chronic disease defined by esophageal dysfunction and >15 eosinophils per high-power-field on biopsy. Despite its increased incidence across the United States, studies evaluating its incidence at any state level are lacking. Methods: Record review of pediatric patients (<18 years) newly diagnosed with EoE based on ICD coding seen at the main two pediatric gastroenterology centers in the state: Children’s Nebraska (1 January 2016–31 December 2022) and Boys Town National Research Hospital (1 January 2022–31 December 2022). Data included demographics, age, and zip codes. Descriptive analysis focused on Nebraska residents. Results: The average point incidence of EoE between 2016 and 2022 was 10.84/100,000 inhabitants based on data from Children’s Nebraska. Considering both centers, the point incidence in Nebraska for 2022 was 32.45/100,000 inhabitants. Caucasians were 3.7 times more likely to be affected and older at time of diagnosis (average 9.7 years) compared to African Americans (7.0), Hispanics (7.4), and Asians (4.4). Conclusions: This is the first study evaluating the incidence of EoE in a specific U.S.A state. Studies at the state level are important to direct policy and interventions aiming limit its burden in communities. Full article

Abstract: Background/Objectives: Falls in nursing homes significantly affect residents’ health and quality of life. Although considerable progress has been made in fall prevention strategies in acute care settings and community environments, research on fall risk assessment methods and prevention strategies in nursing homes remains scarce. Nursing homes provide long-term care for residents with high levels of dependency, presenting unique challenges in managing fall risks. Nevertheless, unlike hospitals, nursing homes face operational constraints, such as limited resources and staffing. These factors necessitate a tailored approach to fall risk management. This study aimed to summarize the current knowledge of fall risk assessment and prevention methods in nursing homes, clarify practical insights for implementation, and identify research gaps based on studies published over the past five years. Methods: This narrative review targeted studies published between 2019 and 2024 on fall risk assessment and prevention methods in nursing homes. A literature search was conducted using the PubMed and CINAHL databases, combining keywords such as “Accident Prevention”, “Fall Risk Assessment”, “Nursing Homes”, “Long-Term Care”, and “Aged”. The inclusion criteria allowed the inclusion of peer-reviewed academic articles on fall risk assessment or prevention interventions in long-term care facilities published in English within the past five years. Studies focusing on community-dwelling older adults, hospitalized older adults, and review articles were excluded. Results: This review analyzed 55 studies; among them, 27 studies focused on fall risk assessment and 28 focused on fall prevention. Regarding fall risk assessment, widely used tools, such as the Morse Fall Scale, which is also utilized in medical settings, have been extensively examined. In addition, new predictive methods utilizing electronic health records (EHR) and wearable devices have been introduced. However, the limited number of reports highlights the potential challenges in developing indicators that consider the unique characteristics and feasibility of LTC facilities. Regarding fall prevention, studies have examined indirect approaches, such as environmental modifications, and direct interventions, such as exercise programs. Furthermore, staff education and organizational initiatives are crucial in implementing preventive measures. However, most studies have been conducted in experimental settings, with limited empirical research available to assess the practical applications of these strategies in real-world nursing home environments. Conclusions: Fall risk assessments in nursing homes lack practical indicators tailored to the specific characteristics of long-term care facilities. Although various digital technologies have been explored for fall prevention, empirical studies that validate their real-world applicability are lacking. Full article

Background/Objectives: Many social and environmental factors contribute to the disproportionate burden of COVID-19 mortality. Access to healthcare services has not been thoroughly examined as a factor contributing to COVID-19 mortality. This study examines distance to ERs and ICUs, uninsurance rates, and county-level COVID-19 mortality rates. Methods: Using data from the American Hospital Association survey, we identified hospitals providing emergency and intensive care services. Hospital locations were geocoded, and straight-line distance was calculated from the population-weighted county centroid. The county proportion of uninsured residents came from the American Community Survey. Generalized linear regression models with a log-link were used to examine study factors and county COVID-19 mortality rates. Results: A total of 2640 (84.0%) U.S. counties or county-equivalents were included in this analysis. The median COVID-19 mortality rate was 240 deaths per 100,000. In adjusted models, increasing distance to ERs (IRR: 0.95; 95% CI: 0.92, 0.98) or ICUs (IRR: 0.61; 95% CI: 0.57, 0.65) was not significantly associated with increased COVID-19 mortality. The proportion of residents (IRR: 3.81; CI: 2.58, 5.62) uninsured was significantly associated with increased COVID-19 mortality rates. Conclusions: Being in close proximity to hospital-based healthcare services may not provide any significant benefit for COVID-19 mortality outcomes, considering that hospitals are largely located in more densely populated areas conducive to COVID-19 spread. Financial barriers may largely contribute to persons avoiding necessary COVID-19 care. To continue to combat COVID-19 and future pandemics, greater attention should be focused on eliminating financial barriers to receiving medically necessary care. Full article

Chiang Mai is an emerging tourism-oriented city in Thailand. The booming tourism industry during the past decades has triggered significant expansion in its urban land area, resulting in a large number of newly-built residential communities appearing on unplanned land. In this study, we used multiscale geographically weighted regression (MGWR)-based hedonic price analysis to investigate 4624 housing transactions from 524 residential communities in Chiang Mai. This showed that the recent land-use planning in Chiang Mai has had unusual effects on housing prices; specifically, the effects of accessibility to hospitals, primary and secondary schools, green parks, and shopping malls could be ignored, demonstrating that local residents were well satisfied with land-use planning for high-quality medical and education sources and good living environments throughout the whole of Chiang Mai, and that no more land-use planning and investment on these facilities was needed. However, limited bus routes were only used for tourism and could not provide convenient routes for local residents, leading to their negative effects on housing prices in downtown areas, so the local government should lower the bus stop density in downtown areas and strengthen the transportation links between downtown areas and suburbs. Our study will not only support the urban land planning department of Chiang Mai to optimize residential communities and nearby facilities, but can also provide insights into housing price formation mechanisms in similar tourism-oriented cities in Thailand and beyond. Full article

Mainstream empirical studies on the spatial justice of medical facilities focus on equal accessibility or resource availability based on population scale, overlooking critiques that emphasize the importance of assessing inequality and the multidimensionality of human needs. However, access to medical care, particularly for vulnerable groups in social housing, often demands a higher level of consideration. Evaluating whether people can access the facilities they demand and expect is crucial for improving living standards. This study categorizes medical facilities into primary healthcare and hospital facilities based on their service grade, and integrates survey-based satisfaction into a spatial analysis of cost–distance-based accessibility and gravity-2SFCA-based availability. Analysis reveals that satisfaction primarily correlates with two factors: the distance to primary healthcare and the ease of reaching hospital facilities. While low accessibility to primary healthcare contributes to the evident distribution injustice of medical resources, satisfaction with service quality and scope is more strongly associated with the ease of reaching hospitals. To reduce injustice in social housing, specific remedies are needed to improve the difficult conditions for accessing primary healthcare faced by communities such as Guangdan, Likang, and Jinshazhou. Moreover, improving the easiness of reaching hospital facilities may significantly enhance the resident satisfaction with the level of medical service provided. Findings obtained in this research may not only enlighten Guangzhou’s urban planning, but may also be noteworthy for developing livable cities, which people anticipated. Full article