Search Results (56)

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ², ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article

Background: The hepatitis A virus (HAV) is a major cause of acute viral hepatitis and a significant global health concern. This study provides a pre-vaccination baseline for Oman, enabling longitudinal comparison with post-hepatitis A vaccination cohorts. This study aimed to determine the pre-vaccination seroprevalence of HAV antibodies (anti-HAV) in Oman and explore the associated demographic factors. Methods: A cross-sectional study was conducted from April 2014 to August 2015 among patients attending the medical outpatient clinic of the Medical City Hospital for Military and Security Services. Demographic data were collected via a structured questionnaire, and serum samples were tested for anti-HAV immunoglobulin IgG and IgM using enzyme-linked immunosorbent assays. Multivariate analysis was performed to identify the predictors of anti-HAV seroprevalence. Results: Among 1975 participants, 88.1% were positive for anti-HAV IgG. The mean age was 37.4 ± 16.1 years; however, those negative for anti-HAV IgG were considerably younger (mean age: 24.8 ± 15.7 years). Anti-HAV IgG seroprevalence was 37% in individuals aged ≤18 years and 91% in those >18 years (p < 0.001). The factors associated with seropositivity included older age (p < 0.001), consuming food prepared outside the home (p < 0.001), occupation (p < 0.001), and education level (p = 0.003). In the multivariable analysis, only age showed a strong independent association with serostatus: per 10-year increase, the aOR for anti-HAV IgG seropositivity was 2.87 (95% CI 2.25–3.63; p < 0.001). Conclusions: Our study estimates show high anti-HAV IgG seroprevalence and serve as a pre-vaccination baseline for evaluating the hepatitis A vaccination program in Oman over time. Given the lower natural exposure among younger cohorts, continued routine vaccination, scheduled serosurveys, and strengthened surveillance are required to identify emerging immunity gaps and prevent future HAV outbreaks. Full article

Background: Appropriate medication management before surgery is essential to minimise perioperative risk. Patient adherence to preoperative medication advice demonstrates considerable variability and is influenced by multiple interacting factors. This study assessed patient understanding and adherence to preoperative medication advice provided in the Pre-Admission Clinic (PAC) and identified factors contributing to non-adherence. Methods: A cross-sectional survey study was conducted over 12 weeks in 2022 at a tertiary hospital. Adult patients scheduled for elective surgery who received preoperative medication advice in PAC were surveyed on the day of surgery. Data collected included demographics, clinical characteristics, adherence, reasons for non-adherence, and communication preferences. Descriptive and inferential statistics were used for analysis. Results: Of 156 participants, 91 (58.3%) adhered to medication advice, while 65 (41.7%) did not. Common reasons for non-adherence included forgotten advice (35.4%), misunderstood advice (33.8%), and intentional deviation due to surgery (18.5%). Non-adherence rates were highest for NSAIDs (50.0%) and P2Y12 inhibitors (45.5%). Two surgeries were cancelled due to the delayed cessation of anticoagulants. Non-adherence was significantly associated with a greater number of medications requiring perioperative management (p = 0.004) and a longer duration between PAC and surgery (p = 0.010). Most non-adherent patients (64.7%) preferred a combination of verbal and written advice. Conclusions: A substantial proportion of patients were non-adherent to preoperative medication advice, often due to unclear communication or a lack of understanding of the clinical rationale for the advice. Multimodal strategies, including written or digital reinforcement of verbal advice, multidisciplinary collaboration, and patient-centred education, may improve adherence and reduce preventable cancellations. Future studies should evaluate the impact of these interventions. Full article

Background: Telepsychiatry expanded rapidly during the COVID-19 pandemic, yet patient experience data from mixed urban and rural areas in Saudi Arabia remain scarce. Objective: We aimed to quantify the perception of telepsychiatry among adults with major depressive disorder [MDD] in Madinah City, the KSA, and to identify associated demographic and clinical factors. Methods: A cross-sectional survey was conducted at Madinah Mental Health Hospital between December 2024 and March 2025. Eligible participants were Arabic-speaking adults [≥18 years] with a clinician-confirmed diagnosis of major depressive disorder [MDD] according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], following a scheduled video- or audio-based telepsychiatry consultation. Perception of telepsychiatry was assessed using the validated 10-item Arabic version of the Telehealth Satisfaction Scale [TeSS], which evaluates audiovisual quality, communication, and support. Variables associated with perception at p < 0.20 in the bivariable analyses were entered into a multiple linear regression model to identify independent predictors. Results: Of the 218 eligible patients, 207 participated [response rate = 95%], with similarly high participation rates being reported in comparable telepsychiatry surveys [e.g., 90–91%]. The majority were male [59%], with a mean [SD] age of 38.4 [11.2] years. The mean satisfaction score was 32.3 ± 6.3, and 36% of participants were classified as highly satisfied. In the multivariable analysis, higher satisfaction was independently associated with male gender [B = 3.0, 95% CI: 1.3–4.7], intermediate versus elementary education [B = 4.3, 95% CI: 1.1–7.6], and the presence of a chronic illness [B = 2.1, 95% CI: 0.3–3.8]. Conclusions: Telepsychiatry is generally well-accepted among adults with depression in Madinah. However, women and individuals with lower educational attainment report lower satisfaction. Targeted interventions such as improving privacy, offering digital literacy support, and tailoring communication may help improve the telepsychiatry experience for underserved groups. Full article

Background/Objectives: Missed nursing care—defined as any aspect of required patient care that is omitted or delayed—has emerged as a significant indicator of healthcare quality. Fatigue among nurses, particularly in high-demand environments, may contribute to care omissions. This study aimed to assess the prevalence and patterns of missed nursing care and its association with occupational fatigue among nurses working in Saudi hospitals. Methods: A cross-sectional correlational study was conducted among 183 registered nurses from multiple hospitals in the Hail and Madinah regions, Saudi Arabia. Data were collected using the Missed Nursing Care Scale (MISSCARE) and the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Statistical analysis was performed to assess the relationships between missed care, fatigue, and demographic/work-related variables. Results: Nurses reported moderate levels of missed care, especially in basic care tasks such as oral hygiene, assistance with meals, and timely ambulation. The most frequently cited causes of missed care included insufficient staffing, high patient load, and a lack of support personnel. Occupational fatigue scores were also moderate, with notably low inter-shift recovery. A significant negative correlation was found between inter-shift recovery and missed care (r = −0.120, 95% CI: −0.23 to −0.005, p = 0.040), indicating that poorer recovery between shifts was associated with more frequent omissions. Other fatigue dimensions showed weak, non-significant associations with missed care. Conclusions: Missed nursing care is a prevalent issue in Saudi hospitals and is significantly influenced by organizational factors and nurses’ recovery between shifts. Interventions to improve staffing adequacy and promote rest and recovery may reduce care omissions and enhance patient outcomes. Full article

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

Background/Objectives: Physical activity (PA) during pregnancy presents health benefits for mother and child. The World Health Organization (WHO) recommends at least 150 min of moderate-intensity physical activity per week for a healthy pregnancy. The objectives of this study were to describe physical and sedentary activity patterns, estimate the proportion of women meeting PA recommendations, and identify associated sociodemographic and obstetric characteristics in a sample of pregnant women from southern Spain. Methods: For this cross-sectional study, a random sample of 385 pregnant women attending their 20th-week scheduled ultrasound at their referral hospital was selected. Inclusion criteria were being between 18 and 22 gestational weeks pregnant and communicating in Spanish. A face-to-face structured interview was used to collect demographic, obstetric, and PA data, as well as sedentary patterns. Indexes of weekly PA in various domains were computed. Bivariate analyses were conducted to assess the variability of physical and sedentary activities according to sociodemographic and obstetric variables. Statistical significance was set at p < 0.05. Results: A total of 84.4% of participants engaged in some type of PA and 73.7% met WHO PA requirements. Higher leisure PA was associated with higher education (p < 0.05) and first-time pregnancy (p < 0.01). Higher work PA was linked to lower education (p < 0.01), being born outside Spain (p < 0.05), and later pregnancy awareness (p < 0.01). Higher sedentary daily time was associated with higher education (p < 0.01), speaking Spanish as a child (p < 0.05), and first-time pregnancy (p < 0.05). Conclusions: Most pregnant women in this study met PA recommendations. Correlates of leisure PA differ from those regarding work PA. Full article

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB. Full article

Borderline Personality Disorder (BPD) is a multifaceted mental illness characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affect and marked impulsivity, beginning by early adulthood and presenting in a variety of contexts. The treatment of personality disorders is labeled as difficult, with various challenges identified in the literature, especially described in those with BPD. One of the challenges associated with BPD is treatment dropout, in which patients abandon their treatment schedules and protocols. The authors aim to explore the underlying motives for therapeutic abandonment in this population as well as discuss potential intervention methods to reduce this outcome during follow-up, whilst promoting regular adherence and active treatment participation. A cross-sectional study of patients that joined and subsequently dropped out of a specialized treatment program for Borderline Personality Disorder in a Portuguese hospital from 2014 to 2023 was realized utilizing data collected from surveys conducted through telephone interviews. Of the patients, 39 were identified as having dropped out of the program during the stipulated timeframe. Of these, five (12.8%) refused to participate, fourteen (35.8%) did not respond to contact attempts and two (0.05%) patients subsequently reintegrated into the program. Therefore, 18 (46.2%) agreed to respond to the questionnaire and were considered in the current study. The majority were female (94.4%) of single marital status and with secondary-level education. The main motivators for treatment dropout described by these patients included the large intervals between consultations, the loss of motivation and/or interest, as well as dissatisfaction with the program. Other variables were explored in the work, such as the desire to return to the program, the maintenance of other types of treatment, feelings after dropout and the evaluation of the usefulness of the program. Treatment dropout is an important problem in the treatment of BPD, as it stifles progress and therapeutic benefits through maintenance of the previous state, conditioned by impulsivity and marked instability. Although the current study attempts to clarify the motivating factors underlying abandonment in this population, further research is necessary in attempting to further reduce the lacuna regarding this common phenomenon and to develop interventions to promote positive outcomes. Full article

Objectives: This study aimed to evaluate the experiences of patients using a patient portal at a tertiary hospital in Riyadh, Saudi Arabia, focusing on engagement, usability, and patient-generated data. Methods: A descriptive cross-sectional study was conducted using an online survey distributed to 244 patients using the patient portal between September and December 2023. Data collected included sociodemographic characteristics, health literacy, internet and smartphone usage, and patient engagement with the portal. Results: Among the 244 respondents, 99.6% were smartphone users, and 85% reported using the patient portal. The most frequently used functionalities included scheduling appointments (60.1%) and viewing laboratory results. Significant associations were found between general satisfaction and perceptions of ease of login, information comprehension, and increased engagement (p < 0.05). High satisfaction was reported among those updating personal information (88.6%) and allergy status (78.1%) through the portal. Barriers to use included internet access limitations and privacy concerns. Age significantly influenced the need for training to enhance portal usage (p < 0.05). Conclusions: Patient engagement with the portal was high, indicating its potential as a tool for enhancing healthcare delivery. Improving usability, addressing identified barriers, and providing tailored training could further optimize patient engagement and utilization of health services. Full article

Background: Infections pose a significant risk of morbidity and mortality to patients on biologics, with the vaccination of both patients and their close contacts serving as a key preventive measure. Despite its importance, there are limited data on the vaccination coverage for this group, and no studies have examined the vaccination status of patients’ close contacts. Objectives: To assess vaccination rates among patients on biologics and their household contacts, identifying reasons for inadequate vaccination and examining factors influencing vaccination status and attitudes is crucial. Methods: A cross-sectional study was conducted from September 2022 to February 2023 at the two hospitals in Heraklion, Crete, including adult and pediatric patients on biologics. Data were collected through medical records and interviews and analyzed using Microsoft Excel 2016 and MedCalc2006. Results: Among the 446 adults, vaccination rates were as follows: 83% for COVID-19, 73.8% for influenza, 64.5% for the pneumococcal conjugate vaccine, 29.6% for the pneumococcal polysaccharide vaccine, and 4% for Tdap. Among the 26 children included, those with basic immunization schedule coverage exceeded 96%, but rates for the vaccines usually administered at adolescence were lower (Tdap: 47.8%, HPV: 42.1%, MenACWY: 66.7%). COVID-19 vaccination was at 38.5%. Regarding the additional vaccines recommended due to treatment-induced immunosuppression, 69.2% of pediatric patients received the annual influenza vaccine, while only 19.2% received the pneumococcal polysaccharide vaccine. Household contacts demonstrated low vaccination rates (<59%), except for COVID-19 (81%). Female gender (p < 0.007) and older age (by 1 year, p < 0.001) were associated with favorable attitudes and higher coverage in adults, while in pediatric patients, no statistically significant associations were found. A lack of physician recommendation was the primary reported reason for not being vaccinated. Conclusions: Significant vaccination gaps exist among patients on biologics and their close contacts, largely due to inadequate physician recommendations. Raising awareness and strengthening healthcare provider roles are essential to improve coverage in this high-risk group. Full article

Background/Objectives: Shift work schedules and mental and physical workloads affect the sleep homeostasis of nurses, increasing the risk of occupational injuries. This study aimed to investigate the relationship between sleep disturbances caused by shift schedules and the occurrence of needlestick and sharps injuries (NSIs) among nurses, considering significant worker and occupational factors. Methods: A total of 348 nurses from five hospitals of Santiago de Guayaquil, Ecuador, participated in this cross-sectional survey. Data on sociodemographic and occupational characteristics, work schedules, and NSI incidents during the previous six months were collected. Emotional status, sleepiness, and insomnia symptoms were assessed using validated questionnaires. Additionally, nurses with night shifts (fixed or rotating) were specifically assessed to estimate the relationship between NSIs and insomnia or sleepiness symptoms related to these types of shift work using logistic regression analyses. Results: Nurses whose schedule included night shifts showed a higher prevalence of NSIs than those with other shifts (33.2% vs. 29.0%; p < 0.05). High levels of depression, anxiety, and stress were associated with having had an NSI in the previous six months. Logistic regression showed that female sex (adjusted odds ratio, aOR 4.62, 95% CI: 1.65–12.97), less experience in the current clinical setting (aOR 3.12, 95% CI: 1.46–6.57), the use of psychotropic drugs (aOR 4.46, 95% CI: 1.51–13.17), and insomnia and sleepiness symptoms due to shift work (aOR 2.61, 95% CI: 1.15–5.91) increased NSI risk among nurses with night shifts. Conclusions: There is an acute need to explore the complex relationship between sleep troubles linked to shift work schedules, occupational factors, and the risk of occupational injuries and propose preventive strategies for enhancing nurses’ sleep health and workplace safety. Full article

The prevalence of prenatal tobacco exposure remains high in many countries, particularly in southern Europe. The aims of this study were to estimate the prevalence of smoking among pregnant women in a southern Spanish city (Seville) and to identify the associated sociodemographic and obstetric characteristics. In a descriptive, cross-sectional study, a random sample of pregnant women who were scheduled to undergo a morphology scan at their public referral hospital in their 20th week of gestation were interviewed in person. At the start of pregnancy, 38.2% of the pregnant women were smokers. In the twentieth week, 19.1% continued to smoke, and the same percentage had quit. The prevalence of smoking in pregnant women was higher among those with a low level of education (60% among pregnant women with no studies and 30.4% in those with primary education) and among those who had had abortions (38.5%). Pregnant smokers with obesity were the least likely to have given up smoking during pregnancy. Women with a lower educational level should be a prime target for cross-sectoral interventions aimed at preventing prenatal tobacco exposure. Implementation of support measures for providing effective clinical advice in preconception and prenatal care regarding healthy lifestyles is particularly needed. Full article

Objectives: This study examines the recommendation behaviors and influencing factors for the 13-valent Pneumococcal Conjugate Vaccine (PCV13) among 3579 Chinese healthcare workers (HCWs), including 1775 pediatric care providers (Peds-PCPs) and 1804 primary care providers (PCPs). Data were collected from May to July 2023 through a national cross-sectional survey using a structured questionnaire, distributed across hospitals providing pediatric services in five provincial-level administrative divisions. Methods: The sociodemographic data, vaccine knowledge, and recommendation practices were analyzed using Pearson’s chi-square test, Wilcoxson rank-sum test, and multivariate logistic regression. Results show that while PCPs are more likely to recommend PCV13, vaccine hesitancy persists among Peds-PCPs. Logistic regression revealed that higher influenza vaccination intention, salary, vaccine consultation frequency, familiarity with immunization, work ethic, and flexible schedules positively impacted HCWs’ recommendation behavior. Results: Factors influencing Peds-PCPs’ recommendations include vaccine training (OR: 1.470, CI: 1.049–2.509), safety recognition (OR: 1.986, CI: 1.163–3.391), concern over rejection (OR = 1.274, CI: 1.076–1.508) and vaccine cost (OR = 1.203, CI: 1.023–1.414). For PCPs, influencing factors were the perceived susceptibility of children to pneumonia (OR = 2.185, CI: 1.074–4.445), acceptance of herd immunity (OR: 1.717, CI: 1.101–2.677), and belief that parents with better family conditions are more likely to accept vaccine recommendations (OR = 1.229, CI: 1.024–1.477).  Conclusion: This survey underscores the need for tailored interventions to address differing perceptions and enhance confidence in the safety and efficacy of vaccines among HCWs, particularly Peds-PCPs. Full article

Physicians are exposed to occupational stress and burnout, which have been identified as contributing to a decrease in the quality of work life (QWL). Thailand’s medical education program, consisting of a six-year curriculum with government tuition support followed by three years of internships, provides the context for this investigation. This study aimed to assess the QWL among intern physicians (IPs) in public hospitals and investigated the association between burnout and QWL. A cross-sectional study was conducted among 241 IPs in public hospitals in Thailand utilizing an online self-administered questionnaire. The questionnaire included a Thai version of a 25-item QWL scale and the Maslach Burnout Inventory—Human Services Survey for Medical Personnel. Data analysis was performed using multivariable logistic regression. A significant proportion of IPs experienced low to moderate QWL (72.6%), with low levels of home–work interface (39.4%) and employee engagement (38.6%). In the exploratory model, after adjusting for sex and age, IPs with high depersonalization and low personal accomplishment demonstrated an association with low QWL (adjusted OR, aOR 2.08, 95% CI 1.01 to 4.31; aOR 2.74, 95% CI 1.40 to 5.39). Healthcare organizations should regularly assess intern physicians’ QWL and burnout, prioritizing interventions; ensure reasonable work hours, schedule adjustments, and open communication; and develop support systems for cost-effective interventions. Further research on the dynamic relationship between burnout and QWL is crucial for targeted and culturally sensitive interventions. Full article